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New to the forum - lower numbers possible or BiPAP a better choice?
#1
Hello,
I'm new to the forum but no stranger to sleep apnea. My first sleep study was six years ago. My most recent sleep study was December 2012. I received my resmed s9 auto the first week in January 2013.
My first cpap machine was set for a constant 8.
The current settings are 7-15 on the s9 resmed auto. World of difference in my sleep with the s9. However, I'm still tired, but not nearly as bad.
After reading some posts on the apnea-board, I downloaded the sleepyhead software and from what I've read, it appears my readings are still high.
I use the full face mask ResMed Mirage Quattro with the s9.
My question here is, Is it possible to get lower numbers or would bpap be a better choice?
Here's the data

Study Indications:
Diagnostic Impressions:
================
Adult obstructive sleep apnea
================
Interpretation:
================
Very server obstructive sleep apnea> AHI 65, minimal desaturation 66%, 54% of study showed oxygen saturation below 90%. No cardiac arryhmias. Successful CPAP titration.
================
Respiratory Analysis (Diagnostic Only)
================
AHI 65(110)
RDI 65(110)
Apnea Index 5(9)
Obs Apnea Index 5(9)
Central Apnea Index 0(0)
Mixed Apnea Index 0(0)
Hypopnea Index 59(101)
RERA Index 0(0(
================
Here are my latest readings from sleepyhead
================
Details Most Recent
AHI 20.29
Hours per Night 07:50
Average Pressure 12.74
95% Pressure 14.98
Average Leaks 0.90
95% Leaks 3.60
================

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#2
Hi Always_yawning,

Welcome

I take it that the latest data from your AutoSet is just one night's data. One night is not enough on which to base any reliable analysis; but, if this night is typical (i.e. the data average of a couple weeks worth of nights looks similar) then I think there is cause for concern. An AHI of 20.29 is high, ideally the aim is to get it below 5. Your pressure is set to 7 - 15. The average pressure the machine uses to try to clear apneas is 12.74. 95% pressure is 14.98 and the machine is set to only be able to go to 15 - the machine is probably being prohibited from raising pressure enough to clear obstructions.

If it were me, I would look at the averages shown for the past two weeks or so to see if this is typical (i.e. high AHI and machine bumping up against max pressure). I would also check to make sure the AHI is made up predominantly of Obstructive events (OA) and Hypopneas (H) with Clear Airway events (CA) being very few (I noticed you didn't have CAs in your sleep study, but CAs can sometimes be induced by PAP pressure, so it's important to look at those). If this is the case, I would consider raising the maximum pressure - probably raising it to 20 to let the machine do its job of finding the right pressure. After a couple weeks of letting the machine do its job, I would use the data to tighten up the pressure range (i.e. something like raising minimum pressure from 7 to just a couple cmH2O below 95% pressure and lower max pressure to just a couple cmH2O above 95% pressure). Keep in mind that changes need to be made gradually over time while keeping an eye on the data.




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#3
Hi Always_yawning,
WELCOME! to the forum.!
Full-face-masks (FFMs,) can be very proned to leaks, maybe you could try a different type of mask.
Hang in there for more responses to your post and best of luck to you.
trish6hundred
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#4
Welcome to the Forum!!! We are glad you joined us!!! Welcome

One night's data does not a trend make. You need to see if your data trends upward, downward, or remains the same.

Seeing that the 95% Pressure is virtually the same as your max APAP pressure leads me to believe your upper limit may need to be tweaked.

You need more data to see if your pressure is "flat-lining" against your max setting.

Sleep-well
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
Whats the breakdown of AHI (AI, HI, CAI)

The report say "Successful CPAP titration"
Whats was prescribed titration pressure and have you used that pressure at all?

Edit: Congrats ... leak well controlled
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#6
Hi yawning.

Welcome

I'm glad you checked in here!
Looks like your numbers could use some work.
Hang in there. Help is on the way.

=^.^=
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#7
Thanks for the many replies.
Here's my readings for recent, last 7 days , last 30 days

Details Most Recent Last 7 Days Last 30 Days
================================
AHI 8.16 10.94 14.12
Hours per Night 04:02 06:36 06:40
Average Pressure 13.32 12.60 12.54
95% Pressure 14.98 15.00 15.00
Average Leaks 0.96 3.02 4.45
95% Leaks 3.60 16.80 16.80
Last night I fell asleep watching TV only 4 hours on the apap.
I'll change the max pressure to 16 in .2 increments over this week.
During the sleep test I started with the nose pillows, nose pillows with chin strap and finally full face mask. As the pressure went higher the air escaped and at the higher pressure I need the face mask. As you can see the leakage is going down.
I'll repost my current and last 7 day report next week.
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#8
(03-29-2013, 02:53 PM)jgjones1972 Wrote: Hi Always_yawning,

Welcome

I take it that the latest data from your AutoSet is just one night's data. One night is not enough on which to base any reliable analysis; but, if this night is typical (i.e. the data average of a couple weeks worth of nights looks similar) then I think there is cause for concern. An AHI of 20.29 is high, ideally the aim is to get it below 5. Your pressure is set to 7 - 15. The average pressure the machine uses to try to clear apneas is 12.74. 95% pressure is 14.98 and the machine is set to only be able to go to 15 - the machine is probably being prohibited from raising pressure enough to clear obstructions.

If it were me, I would look at the averages shown for the past two weeks or so to see if this is typical (i.e. high AHI and machine bumping up against max pressure). I would also check to make sure the AHI is made up predominantly of Obstructive events (OA) and Hypopneas (H) with Clear Airway events (CA) being very few (I noticed you didn't have CAs in your sleep study, but CAs can sometimes be induced by PAP pressure, so it's important to look at those). If this is the case, I would consider raising the maximum pressure - probably raising it to 20 to let the machine do its job of finding the right pressure. After a couple weeks of letting the machine do its job, I would use the data to tighten up the pressure range (i.e. something like raising minimum pressure from 7 to just a couple cmH2O below 95% pressure and lower max pressure to just a couple cmH2O above 95% pressure). Keep in mind that changes need to be made gradually over time while keeping an eye on the data.

Thanks for the analysis
================
I am having CAs. The CAs don't show in the report but over the past week I've averaged about 15 CAs a night.
That's why I've been thinking about getting a BPAP.
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#9
(03-29-2013, 05:14 PM)zonk Wrote: Whats the breakdown of AHI (AI, HI, CAI)

The report say "Successful CPAP titration"
Whats was prescribed titration pressure and have you used that pressure at all?

Edit: Congrats ... leak well controlled

Thanks for the reply.
Prescribe titration pressure is 7 15. I haven't changed the settings.
Date (Clear Airway Apneas) (Hypo Apneas) (Obstructive Apneas)
================================
3/28 21 1 11
3/27 27 21 39
3/26 25 37 41
3/25 14 35 33
3/24 12 6 22
3/23 19 2 25
3/22 7 17 71
3/21 1 33 51
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#10
Take a look at when your central events happened and note what the pressure is.

Your leak rate is good. No problem there.

You seem to be regularly hitting the top threshold of your pressure. It's not the bottom number you need to consider changing, but the top one. But then you are also having central events so that may not be a good idea. Instead, try dropping the maximum a notch and see what happens. Try 14 for ten days. It may increase the OA but decrease the CA which may be a happy medium. There's a phenomenon called "pressure induced central events" or something like that where the higher the pressure goes, the more CA events that happen. Usually they decrease with time or starting out at a lower pressure then increasing as the patient acclimatizes.

You say you've used the auto since January. Have the CA events remained about the same range since then or have they changed any in count?

A bilevel CPAP may not help with those central events. A bilevel lowers the exhale pressure more than a regular CPAP does. It does help some people with their central events but not many.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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