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Initial Results - Some Questions
#1
Hello Again:

I have now completed 8 nights on the ResMed S9 Autoset with H5i and ResMed Swift FX nasal pillows mask. I use a chin strap to prevent mouth breathing and I don't use the Ramp feature or the EPR (haven't tried it yet). I had a sleep study over a year ago, split session and they used a pressure of 6 cm. My AHI was 23 in test session and 2.7 in therapy session although the former lasted only 135 minutes and the latter only 22 min. My sleep doctor wanted to do another sleep study for titration but I declined (he wasn't very happy) and just got the Autoset and decided to do my own at-home titration - won't see the doctor again for a few months. I had the machine set at 4-12 and then raised the upper end to 12.6 as I seemed to be bumping up against the upper end in a couple of my sessions. My results so far have been good, at least I think so based on what I read on this board.

Usage: 51.54 with 7 days >4 hours (not sleeping all this time but I can tolerate the mask - get up once or twice a night). Median is 6.5 hours with 6.29 the average. I had one bad night due to nasal congestion where I really had a hard time breathing and took the mask off after 3 hours.

AI/AHI: AI is 1.1 (OA .5, CA .5, Unk .1) and Hypo is .3 for AHI of 1.4.
Last night was my best night with AI of .9 (OA .5 CA .4), HI .2 and AHI 1.1.

Leak: Almost nothing with median of 0 and 95th percentile of 1.2. Max leak is 132.6 which I think has to do with taking the mask off without turning the machine off first - I used the auto-on and auto-off feature so I think this affects the leak?

Pressure: Median is 8.2, 95th is 11.6 and max is 12.5 (my upper setting is 12.6). On my detailed reports I saw some high pressures around 14 but mostly lower than that.

Not sure what other data is relevant.

Other Items:

On 5 of 8 nights, I had more CA's than OA's. On one night I had 2.6 CA's per hour with no OA's and HA of 1.3 for an AHI of 3.9 which has been my highest. Don't know what this means if anything?

I started out with medium size pillows and switched to the small pillows on night 7 and 8. Night 7 was the bad congestion night but night 8 I did much better as the pillows were more comfortable.

I seem to experience some difficulty breathing for several minutes when I start out each night while the machine moves up from 4 cm to something closer to my Median/Average which is around 6 cm. Would it make sense to increase the lower setting say to 5 cm to help relieve this initial breathing issue?

Guess that is it - still trying to figure out what all the data means. I would appreciate any thoughts or comments anyone has.

Thanks











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#2
I'm not a Medical professional of any kind but your numbers look good to me. I wish my numbers looked that good. What is more important is how do you feel? Can you get more sleep each night?
This post is a natural product. The slight variations in spelling and 
grammar enhance its individual character and beauty and in no way 
are to be considered flaws or defects.
 
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#3
Ditto Cutter, How you feel is the most important, yep those numbers looks nice keep up the good works.
Just one thought your max pressure 12.5 and the upper setting 12.6 very close may be increase the upper slightly and the S9 wouldn't go there if not needed.
I agree with you about increasing the minimum pressure from 4 as the median 8.4 and 95% 11.6
Usually i get congested quite often due to deviated septum and turbinate and find sinus rinse helps a lot.

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#4
Hi Den. Your numbers are similar to mine, and seem to be just normal fluctuations. You should feel good about those numbers, as they indicate the therapy is working for you. I always recommend sending the data to your doctor, though, as a professional may spot something that we miss.

The comfort and breathing issues you're experiencing are a normal part of the adjustment-to-CPAP process. Lanolin (sold as a product for nursing mothers to soothe sore nipples) will help make the nasal pillow more comfortable. Just put a dab in each nostril.
Sleepster
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#5
Wink 
DenD, you have some enviable numbers. Appears that you have found the right combo of things that are working for you. I wouldn't do any more tweaking.

Compliance is now your mainstay..

Congrats on the good numbers and,, Good Sleeping..
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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#6
As a sleep technologist and a CPAP user, I can say that you are right on the money with your treatment. I don't think you need to tweak it any further.

I have experienced a higher than average pressure when I have nasal congestion, this is because of the way the algorithm works in the autoset.

Remember that a 0-5 AHI is normal for most people. Central Apneas generally can be caused by over-titration or something more serious such as Congestive Heart Failure. In your case, however, it is quite normal for people to have sleep onset central apneas when put on CPAP for the first few months. This is due to the over abundance of air that they are suddenly receiving and the bodies adjustment to this. I don't think that there is anything to worry about as i have seen it during titrations and it usually works itself out.

Sleep Well.

Robb
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#7
(03-08-2012, 02:43 PM)DenD746 Wrote: Leak: Almost nothing with median of 0 and 95th percentile of 1.2. Max leak is 132.6 which I think has to do with taking the mask off without turning the machine off first - I used the auto-on and auto-off feature so I think this affects the leak?

I think you are right. I had the same results. Now I press the ON/OFF button before I take the mask off.

Quote:I seem to experience some difficulty breathing for several minutes when I start out each night while the machine moves up from 4 cm to something closer to my Median/Average which is around 6 cm. Would it make sense to increase the lower setting say to 5 cm to help relieve this initial breathing issue?

I would increase the minimum pressure to minimize my discomfort, as Zonk suggested. The purpose of the min pressure is to make you more comfortable, and 4.0 is the machine's minimum, so it is certainly reasonable to increase it to eliminate your initial discomfort, particularly when you have some nasal congestion.

My age is none of my mind's business. --- Netskier
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