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Strange Question, Well maybe!
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2Tim215 Offline

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Posts: 283
Joined: Oct 2012

Machine: S9 ResMed AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
CPAP Pressure: 6cm-12cm
CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #11
RE: Strange Question, Well maybe!
(12-22-2012 09:01 PM)PaulaO2 Wrote:  Yeah, you have a leak issue. Not sure why it has such a low median but the max each night in the 70s indicates a major leak at least once.

Do you get up during the night? If so, do you leave the machine running or do you turn it off?

With a max leak that high, not sure how valid the AHI result is.

My opinion is to leave it alone. You've got too many issues going on at once.

The key question is: are you feeling like you are getting enough sleep and adequate sleep? If so, leave it alone until this other stuff settles.
Okay, I'll leave it alone until things settle a bit. I have been using the auto on/off feature that doesn't work all the time. I'll go back to manual. My family is setting me up in another room where I''ll have more comfort features. Project started but busy time of year for them. I'll be able to reach the machine easier to turn off for BR trips. The leaks are probably my fault, nasal pillows fit good so I don't think its the mask. Appreciate the replies. I'll turn off the auto now and see what things look like tomorrow.

Tim
Finger Lakes Region, NY
12-22-2012 09:13 PM
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TheWerkz Offline

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Posts: 261
Joined: Oct 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: H5i & ClimateLine Hose
CPAP Pressure: Auto-CPAP 11 - 20
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Dallas, TX - USA - Planet Earth

Post: #12
RE: Strange Question, Well maybe!
(12-22-2012 08:47 PM)2Tim215 Wrote:  Hi Zonk, are my leaks bad? Sometimes I turn off the machine when I use the BR, guess I'll need to break that habit for more accurate data.

Also I stand corrected from the above reply. My 02's are hitting into the 85 range several times during the day.

Tim,

You should turn it off before removing the mask and on after the mask is in place for the most accurate results, removing the mask really skews the leak results.

We already know you need O2 sometimes during the day but, was your SpO2 in the 80's during the 5 hour nap you referenced? If it was, you're probably going to need to bleed-in supplemental O2 while on CPAP too. If you're staying above 92% SpO2 while asleep on CPAP then you shouldn't need it.

In the mean time (get meaner!) Too-funny have you tried doing breathing exercises to get your SpO2 higher?

Can you breathe in (through your nose), hold for 4 seconds, exhale through your mouth, you can also interlock your fingers and put your hands on your head to help you breathe deeper. This might help your lungs to have more time to utilize the O2 and to off-gas the CO2 to and from your lungs since we know they're not working as efficiently as they used to.

Was the 3rd statistics chart with a 13.97 AHI mostly hypopnea or clear airway event's? It's really curious that it's so much higher than the previous 2 nights.Thinking-about

Ren
12-22-2012 09:20 PM
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2Tim215 Offline

Preferred Members-2

Posts: 283
Joined: Oct 2012

Machine: S9 ResMed AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
CPAP Pressure: 6cm-12cm
CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #13
RE: Strange Question, Well maybe!
(12-22-2012 09:20 PM)TheWerkz Wrote:  
(12-22-2012 08:47 PM)2Tim215 Wrote:  Hi Zonk, are my leaks bad? Sometimes I turn off the machine when I use the BR, guess I'll need to break that habit for more accurate data.

Also I stand corrected from the above reply. My 02's are hitting into the 85 range several times during the day.

Tim,

You should turn it off before removing the mask and on after the mask is in place for the most accurate results, removing the mask really skews the leak results.
Great idea! I'll do that from now on, appreciate the tip!

We already know you need O2 sometimes during the day but, was your SpO2 in the 80's during the 5 hour nap you referenced? If it was, you're probably going to need to bleed-in supplemental O2 while on CPAP too. If you're staying above 92% SpO2 while asleep on CPAP then you shouldn't need it.
Yes my 02 is bad at night also, I never knew it was bad during the day. After the diagnosis the other day I thought I should check. I was surprised and disappointed! That graph is from the nap, but I didn't sleep the whole 5 hours, it was a day test with a nap.

In the mean time (get meaner!) Too-funny have you tried doing breathing exercises to get your SpO2 higher?
YES! Every time I take a breath!Too-funny
Can you breathe in (through your nose), hold for 4 seconds, exhale through your mouth, you can also interlock your fingers and put your hands on your head to help you breathe deeper. This might help your lungs to have more time to utilize the O2 and to off-gas the CO2 to and from your lungs since we know they're not working as efficiently as they used to.
I'll have to work on it, I believe I can do that okay.

Was the 3rd statistics chart with a 13.97 AHI mostly hypopnea or clear airway event's? It's really curious that it's so much higher than the previous 2 nights.Thinking-about

Ren
[Image: AHI_1397.png]

Tim
Finger Lakes Region, NY
12-22-2012 09:57 PM
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vsheline Online

Advisory Members

Posts: 1,908
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: #14
RE: Strange Question, Well maybe!
(12-22-2012 11:49 AM)JJJ Wrote:  It has been noted here in the past (in threads discussing the silliness of requiring prescriptions) that even 20 cm. H2O cannot harm you. However, I don't know if that also applies to someone with your condition.

Hi 2Tim215,

As you know, no one on Apnea Board is qualified to dispense medical advice, and we are taking our health into our own hands if we deviate from our physician's prescribed pressure. That said, of course we are free to follow or reject any suggestions which forum members may offer, with the implicit understanding that we do so fully accepting all risk on ourselves.

(I know you already fully understand the above, but I hope to make this clear, yet again, for the sake of visitors who may read these posts.)

You seem to have some amount of excessive leak. Do you TURN OFF the machine when getting up (rather than just taking off the mask and creating a big leak and relying on the smart start/stop feature to turn the machine off for you)? Do you use the Mask Fit feature to verify the mask is on tight enough to not leak at the max pressure setting (but not too tight)? Are the strap lengths on your headgear adjusted to be same length on left and right sides, symetrically, so that the mask is not being pulled off center? When using the high pressure Mask Fit feature, are the top straps and bottom straps well adjusted to be no tighter than neccessary to eliminate all leaks?

I suggest keeping an eye on your weekly and monthly average AHI, weekly and monthly average Obstructive Apnea Index, weekly and monthly average Clear airway Apnea Index, and weekly and monthly average unclassified Apnea Index. (Look at weekly and monthly averages, not daily results, and don't change the pressure more often than weekly.) IMPORTANT EXPERIMENT: Do any of these averages get worse when your max pressure is LOWERED? If not, why raise the max pressure?

I think the Enhanced S9 AutoSet algorithm may increase pressure in response to Flow Limitations and Snore (not just obstructive hypopneas and obstructive apneas). The data you have posted shows the machine is interpreting some of its sensor readings as indicating Flow Limitations and Snore and Obstructive apneas. QUESTIONS OF QUESTIONABLE VALUE: Could the machine be getting fooled and some of the obstructions be occuring in the bronchial tubes rather than your throat? (I would guess "Maybe".) If some of what the machine interprests as Flow Limitations and Snore and Obstructive apneas actually ARE occuring in the bronchial tubes rather than in your throat, is increasing the pressure still the best thing for the machine to do? (Again, I would guess "Maybe".) If you asked ResMed Customer Service whether it is safe for you to use the AutoSet in your condition, would they decide the safest thing (for them, not neccessarily for you) would be to say "No, we cannot assure you the use of the AutoSet will be perfectly safe for someone in your condition, so we advise you to change to another manufacturer's product", to save ResMed from incurring any liability and likelihood of getting successfully sued by your heirs? (Again, I would guess "Maybe".)

Nonetheless, I suppose it may be worth asking questions like these from ResMed Customer Service, and asking your doctor whether there are any guidelines on the safety of high pressure CPAP therapy for someone in your condition. Who knows, maybe there are clear and appropriate guidelines from the medical establishment concerning the safety and advisability of higher CPAP pressures for someone in your condition, and maybe the guidelines would be found by your doctor if he searches for it.

In the meantime, I suggest you be very cautious in raising (or lowering) your pressure, and be looking out for any symptoms that higher pressure (or lower pressure) is making your condition worse.

Take care,
--- Vaughn (maybe I should change my name to Worryhead, huh?)

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: 12-22-2012 10:55 PM by vsheline.)
12-22-2012 10:14 PM
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TheWerkz Offline

Preferred Members-2

Posts: 261
Joined: Oct 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: H5i & ClimateLine Hose
CPAP Pressure: Auto-CPAP 11 - 20
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Dallas, TX - USA - Planet Earth

Post: #15
RE: Strange Question, Well maybe!
(12-22-2012 09:57 PM)2Tim215 Wrote:  Was the 3rd statistics chart with a 13.97 AHI mostly hypopnea or clear airway event's? It's really curious that it's so much higher than the previous 2 nights.Thinking-about

I'm stumped, your pressure was much lower during that session for some reason, with that many events it should have stayed up toward 13 cm like the previous 2 nights...

I got nothing! Dont-know
12-22-2012 10:15 PM
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PaulaO2 Offline
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Posts: 8,065
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: #16
RE: Strange Question, Well maybe!
Not necessarily. About the pressure I mean.

The reason we have 95th Percentile is because sometimes it takes less to open the airway and sometimes it takes more. It depends on body position, depth of sleep, and which planet is in retrograde in your individual constellation. A person can max out their pressure of, say, 17 and still have a high AHI yet the next night not get over 14cm and have a lower AHI.

This is why we say look at the overall data and not a single night.

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.
12-23-2012 01:06 AM
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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: #17
RE: Strange Question, Well maybe!
whenever you get high level of unintentional leak ... the machine cannot analyzed AHI correctly

also the machine flag events while you,re awake so those type of awake events are not real, ought to be discarded for a true AHI

are you using EPR
12-23-2012 03:10 AM
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2Tim215 Offline

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Posts: 283
Joined: Oct 2012

Machine: S9 ResMed AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
CPAP Pressure: 6cm-12cm
CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #18
RE: Strange Question, Well maybe!
(12-23-2012 03:10 AM)zonk Wrote:  whenever you get high level of unintentional leak ... the machine cannot analyzed AHI correctly

also the machine flag events while you,re awake so those type of awake events are not real, ought to be discarded for a true AHI

are you using EPR
Yes, I am using EPR at 2.

Tim
Finger Lakes Region, NY
12-23-2012 09:51 AM
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2Tim215 Offline

Preferred Members-2

Posts: 283
Joined: Oct 2012

Machine: S9 ResMed AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
CPAP Pressure: 6cm-12cm
CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #19
RE: Strange Question, Well maybe!
(12-22-2012 10:15 PM)TheWerkz Wrote:  
(12-22-2012 09:57 PM)2Tim215 Wrote:  Was the 3rd statistics chart with a 13.97 AHI mostly hypopnea or clear airway event's? It's really curious that it's so much higher than the previous 2 nights.Thinking-about

I'm stumped, your pressure was much lower during that session for some reason, with that many events it should have stayed up toward 13 cm like the previous 2 nights...

I got nothing! Dont-know

It's okay, I'm stumped twice as much as you! Dont-knowDont-know

Tim
Finger Lakes Region, NY
12-23-2012 09:53 AM
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2Tim215 Offline

Preferred Members-2

Posts: 283
Joined: Oct 2012

Machine: S9 ResMed AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX Nasal Pillow - Medium
Humidifier: ResMed H5i w/Climate Hose
CPAP Pressure: 6cm-12cm
CPAP Software: ResScan SleepyHead

Other Comments: OSA, Fibromyalgia, Rheumatoid Arthritis, Osteoarthritis, Gout, PTSD, & Meralgia paresthetica.

Sex: Male
Location: Finger Lakes Region, NY

Post: #20
RE: Strange Question, Well maybe!
(12-22-2012 10:14 PM)vsheline Wrote:  
(12-22-2012 11:49 AM)JJJ Wrote:  It has been noted here in the past (in threads discussing the silliness of requiring prescriptions) that even 20 cm. H2O cannot harm you. However, I don't know if that also applies to someone with your condition.

Hi 2Tim215,

As you know, no one on Apnea Board is qualified to dispense medical advice, and we are taking our health into our own hands if we deviate from our physician's prescribed pressure. That said, of course we are free to follow or reject any suggestions which forum members may offer, with the implicit understanding that we do so fully accepting all risk on ourselves.

(I know you already fully understand the above, but I hope to make this clear, yet again, for the sake of visitors who may read these posts.)

You seem to have some amount of excessive leak. Do you TURN OFF the machine when getting up (rather than just taking off the mask and creating a big leak and relying on the smart start/stop feature to turn the machine off for you)? Do you use the Mask Fit feature to verify the mask is on tight enough to not leak at the max pressure setting (but not too tight)? Are the strap lengths on your headgear adjusted to be same length on left and right sides, symetrically, so that the mask is not being pulled off center? When using the high pressure Mask Fit feature, are the top straps and bottom straps well adjusted to be no tighter than neccessary to eliminate all leaks?

I suggest keeping an eye on your weekly and monthly average AHI, weekly and monthly average Obstructive Apnea Index, weekly and monthly average Clear airway Apnea Index, and weekly and monthly average unclassified Apnea Index. (Look at weekly and monthly averages, not daily results, and don't change the pressure more often than weekly.) IMPORTANT EXPERIMENT: Do any of these averages get worse when your max pressure is LOWERED? If not, why raise the max pressure?

I think the Enhanced S9 AutoSet algorithm may increase pressure in response to Flow Limitations and Snore (not just obstructive hypopneas and obstructive apneas). The data you have posted shows the machine is interpreting some of its sensor readings as indicating Flow Limitations and Snore and Obstructive apneas. QUESTIONS OF QUESTIONABLE VALUE: Could the machine be getting fooled and some of the obstructions be occuring in the bronchial tubes rather than your throat? (I would guess "Maybe".) If some of what the machine interprests as Flow Limitations and Snore and Obstructive apneas actually ARE occuring in the bronchial tubes rather than in your throat, is increasing the pressure still the best thing for the machine to do? (Again, I would guess "Maybe".) If you asked ResMed Customer Service whether it is safe for you to use the AutoSet in your condition, would they decide the safest thing (for them, not neccessarily for you) would be to say "No, we cannot assure you the use of the AutoSet will be perfectly safe for someone in your condition, so we advise you to change to another manufacturer's product", to save ResMed from incurring any liability and likelihood of getting successfully sued by your heirs? (Again, I would guess "Maybe".)

Nonetheless, I suppose it may be worth asking questions like these from ResMed Customer Service, and asking your doctor whether there are any guidelines on the safety of high pressure CPAP therapy for someone in your condition. Who knows, maybe there are clear and appropriate guidelines from the medical establishment concerning the safety and advisability of higher CPAP pressures for someone in your condition, and maybe the guidelines would be found by your doctor if he searches for it.

In the meantime, I suggest you be very cautious in raising (or lowering) your pressure, and be looking out for any symptoms that higher pressure (or lower pressure) is making your condition worse.

Take care,
--- Vaughn (maybe I should change my name to Worryhead, huh?)
Guess I'll have to wait to see the Pulomologist, this is a bit to much for me to take in right now. Not sure how to spell Pulomologist, just a guess, hope they get me in before March!!!

Tim
Finger Lakes Region, NY
12-23-2012 09:58 AM
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