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ReScan Report Interpretation Help
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bensonlee Offline

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Posts: 6
Joined: Dec 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro Full Face Mask
Humidifier: H5i
CPAP Pressure: 4-14 cmH20
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #1
ReScan Report Interpretation Help
Hi Folks,

I am looking at the report generated by ReScan and it seems something does not look right (at least for me).

My Leak is reported as:
Max: 164 L / Min
95th Percentile: 156 L / Min
Median: 84

However, looking at the graph (attached), it seems that it shows only a max of 40 L / min, which I interpret as max of 40 L / min instead of 164 L / min.

   

Does anyone know why is it presented as such? Does that mean that anything above 40 L / min is as good as 40 L / min? Or am I missing an adjustment to make it appear correctly?

Thank you!
(This post was last modified: 12-28-2012 08:00 PM by bensonlee.)
12-28-2012 08:00 PM
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trish6hundred Offline

Advisory Members

Posts: 6,424
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #2
RE: ReScan Report Interpretation Help
Hi bensonlee,
WELCOME! to the forum.!
I don't use "ReScan"software but hang in there and someone will be able to help you soon.
Best of lukc to you with your CPAP therapy.

trish6hundred
12-28-2012 09:13 PM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,057
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #3
RE: ReScan Report Interpretation Help
It is because the leak is higher than the graph. It only goes up to 40 unless you change it in the settings. The red line indicates the "intentional leak" line. You want it to stay below that which is usually 24.

You've got a really bad leak problem. Either the mask comes off or you're opening your mouth and air leaks that way. Look at the detailed graph and it should show how long and how often the leaks happened.

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.
12-28-2012 09:46 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #4
RE: ReScan Report Interpretation Help
S9 is the only machine shows excess leak (unintentional leak = mask and mouth leak)
S9 subtract mask vents leak (intentional leak). just make sure you select the correct mask type so the S9 knows what are you using

anything above the threshold red line is bad
above 30 ... the S9 get dizzy and cannot analyzed data correctly and therapy is compromised

maybe try unplug the machine from wall power outlet ... wait few mins and plug back and check the data in the morning

few suggestions
don,t overtighten the straps
wash mask cushion in the morning so its squeaky clean
try different masks
nasal pillows and nasal masks less facial contacts and can works better than full face masks
chinstrap can help keeping mouth closed

use the mask fit feature
turn ramp off or reduce the time and even increase the minimum pressure

starting at 4 would not do much good if 10 your titrated pressure and would cause more leaks as pressure increases

it take some time get used to sleeping with things strapped around
it can be done ... just have to be persistence
12-28-2012 10:08 PM
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bensonlee Offline

Members

Posts: 6
Joined: Dec 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro Full Face Mask
Humidifier: H5i
CPAP Pressure: 4-14 cmH20
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #5
RE: ReScan Report Interpretation Help
Quote:It is because the leak is higher than the graph. It only goes up to 40 unless you change it in the settings.

I found the settings now. It is in Tools > Options > Preferences > Summary Graph Ranges and Detailed Graph Ranges. Interestingly, the highest value allowed for the Leak Graph is only 120.0 L / min. Anything beyond that, the software will revert it back to the max value. So more or less, I think I am stuck with this one.

Now things are getting more unusual. To address the leak issue, I have tighten the face mask (I have not seen the reco from zonk before this post before I slept) and I think it did the trick.

Today's report shows:
Leak Median: 0
95th Percentile: 1.2 L / min
Maximum: 109.2 L / min.

Is seeing 1.2 L / min too good to be true?

From an AHI standpoint, things got simply worse:
28 Dec AHI: 71.1
27 Dec AHI: 12.2

Is it because the device is now finally able to measure things correctly? because when the AHI = 12.2 was detected, leak rate was really high.


Quote:turn ramp off or reduce the time and even increase the minimum pressure

The only differences I had today was actually to reduce the max pressure from 14 to 12 because I incorrectly set it the first time. Using SleepyHead, I noticed that on the first night, I had ERP x1, while last night I set it to none.

Could this explain the difference?

When I woke up today, I felt really sleepy (just like the days before I had the machine). Just as about to wake up, I tuned off the machine, and took off the mask, only to go back to sleep Sad Then few hours later, I woke up to turn on the CPAP and fit the mask. Few hours later, I finally woke up... still feeling very sleepy Sad
12-29-2012 08:37 AM
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PaulaO2 Offline
Wiki Editor
Moderators

Posts: 8,057
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #6
RE: ReScan Report Interpretation Help
The low AHI on the 27th is skewed due to the high leaks.

Take a look at the data. Are you hitting the max 14 too often? Are the events happening while you are way down at 4 then slowing when it finally reaches 14? What is your pressure 95th percentile?

And keep in mind, one night is not enough data to prove or disprove anything.

(side note: I've been on CPAP for so long, a pressure of 4 and I'd feel smothered!)

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.
12-29-2012 12:12 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #7
RE: ReScan Report Interpretation Help
it can take a while to see improvement after been sleep deprived for so long
everyone is different. for me, took more than a year to sleep right thru the night

straps need to be tight enough to hold the mask in place but not overtight to cause discomfort and pain
finding the right mask is essential. try different mask
nasal mask ... easier to live with and chinstrap can help keeping mouth closed

whats the median. 95P and max pressure also breakdown of AHI
how many mask events shown on usage (summary graph) and duration of each
12-29-2012 03:54 PM
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bensonlee Offline

Members

Posts: 6
Joined: Dec 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro Full Face Mask
Humidifier: H5i
CPAP Pressure: 4-14 cmH20
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location:

Post: #8
RE: ReScan Report Interpretation Help
Quote:Take a look at the data. Are you hitting the max 14 too often?

On my second and third night. It only reached as far as 12. 14 was hit only on the first night. It is probably explained by the large leak on the first day as well.

Quote:Are the events happening while you are way down at 4 then slowing when it finally reaches 14?

The events happened between 3 L / min to 12 L / min with most happening at 7.8 to 11 L / min. I was reviewing the graphs and looks like your statement is really true. Every time the pressure drops the count of events are increasing and will drop as soon as the pressure comes back to around 12 / min.

Looks like I will need to discuss this more on with the doc. Seems below 8 is really not helping.

Quote:What is your pressure 95th percentile?

12.0 L / min

Quote:how many mask events shown on usage (summary graph) and duration of each

27 Dec - 6 events
28 Dec - 3 events
29 Dec - 2 events

Events usually last from 30 minutes to 6 hours.
12-29-2012 06:22 PM
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zonk Offline

Advisory Members

Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #9
RE: ReScan Report Interpretation Help
(12-29-2012 06:22 PM)bensonlee Wrote:  Looks like I will need to discuss this more on with the doc.
I concur

machines cannot tell if we,re awake or asleep
apnea can be flagged while awake ... awake apnea events are meaningless, ought to be discarded for true AHI
increase pressure can help with obstructive apnea but doesn't help with central apnea and in some instances can make it worse

imo the first few weeks one should concentrate on improving sleep quality
there,re some folk who took PAP like ducks to water but for most the adjustment can take few weeks or even months

PAP therapy experience is evolving one ... we learn as we go
what I thought about while back ... now tend to think differently ... cest la vie
12-29-2012 07:06 PM
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vsheline Offline

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Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #10
RE: ReScan Report Interpretation Help
(12-29-2012 06:22 PM)bensonlee Wrote:  The events happened between 3 L / min to 12 L / min with most happening at 7.8 to 11 L / min. I was reviewing the graphs and looks like your statement is really true. Every time the pressure drops the count of events are increasing and will drop as soon as the pressure comes back to around 12 / min.

Looks like I will need to discuss this more on with the doc. Seems below 8 is really not helping.

Quote:What is your pressure 95th percentile?

12.0 L / min


Hi bensonlee, welcome to the forum!

I think you are saying that when the max pressure was set to 14 (cm H2O), the 95 percentile pressure was only 12, with most apnea events and hypopnea events happening while the pressure was between 7.8 to 11. If I had these numbers in my sleep report data, I would be tempted to set my minimum pressure to 10 and keep my max pressure at about 14. It is pretty common to set the max pressure about 2 higher than the 95% pressure.

The measurement unit for pressure is centimeters of water (cm H2O). One cm H2O is a really small amount of pressure. For example, it takes about 70 cm H2O to equal just one pound of pressure.

The measurement unit for leak and other air flows is liters per minute (L/min).

To answer an earlier question, your 95 percentile leak of 1.2 L/min is excellent, but even zero would not be too good to be true.

When adjusting the straps on an S9 Autoset, one should always use the Mask Fit feature. But keep in mind that it is easy to tighten the mask straps more than necessary. So, if the straps feel at all uncomfortable because of tightness, one can (while using the Mask Fit feature) see if the straps can be loosened just a little without increasing the Leak. Be sure to keep the strap lengths on the left side and on the right side symmetrical. (Top straps same length as each other, and bottom straps same length as each other).

bensonlee Wrote:The only differences I had today was actually to reduce the max pressure from 14 to 12 because I incorrectly set it the first time. Using SleepyHead, I noticed that on the first night, I had ERP x1, while last night I set it to none.

Could this explain the difference?

Do you mean the pressure was 14 on both 27 Dec and 28 Dec and tonight it will be 12? I would be tempted to leave the max pressure at 14 (especially if you use any EPR) and raise the minimum pressure.

Regarding EPR (exhalation pressure relief), lowering it from 1 to zero is unlikely to make the AHI worse, from 12.2 to 71.1. A more likely explanation would be your sleep position changed. For example, sleeping on one's back can often cause the AHI to be much worse compared to sleeping on one's side, unless one is using an Auto machine which can raise the pressure high enough. There are lots of reasons for AHI to vary from one day to the next, which is why it is recommended to change the pressure settings gradually, leaving things alone for a week or two or longer between each adjustment, paying attention to long term averages and not the night-to-night fluxuations.

When EPR is set to 1, 2 or 3 this is the amount the pressure is lowered during exhalation compared to the normal (higher) pressure used during inhalation. When a respiratory therapist does a "bi-level titration" to find the optimal bi-level pressure settings during an overnight titration study (and I think using EPR is in some ways very similar to using a bi-level machine), the procedure recommended by the american medical association is to (very gradually) raise the CPAP pressure until obstructive apneas are eliminated and then to raise only the IPAP (pressure during inhalation) higher, in order to eliminate sleep disturbances called RERAs (respiratory effort related arousals). The increased pressure during inhalation makes it easier to breath in.

My point is that if using EPR we may need to increase the min and max pressures by the same amount as the EPR. For example, increasing EPR from 0 to 3 would keep the IPAP pressure unchanged but would lower the EPAP pressure by 3. If we want to change EPR to 3 (from zero) without lowering the EPAP pressure we would need to raise the minimum and maximum pressure by 3 as well.


(12-29-2012 06:22 PM)bensonlee Wrote:  
Quote:how many mask events shown on usage (summary graph) and duration of each

27 Dec - 6 events
28 Dec - 3 events
29 Dec - 2 events

Events usually last from 30 minutes to 6 hours.

Not sure what you mean. In the Detailed results section of the ResScan report, ResScan shows apnea events as a red candlestick along with the number of seconds that the breathing was stopped. The candlestick has a red diamond on top if the apnea was an Obstructive Apnea event, or a white diamond on top if ResScan classified the event as a Central Apnea event.

On the Statistics page, what are your CAI (Central Apnea Index), OAI (Obstructive Apnea Index), UAI (Unknown type Apnea Index), HI (Hypopnea Index) and overall AHI for each date? If few of the apneas are classified by ResMed as Central events (in other words, if very little of the AHI is from CAI), then keeping the max pressure at 14 should be OK.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 12-29-2012 10:50 PM by vsheline.)
12-29-2012 09:29 PM
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