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Ultra high AHI with new machine
#1
Rainbow 
Hi, I'm new here, and using a RESMED S9 elite with h5i. My sleep study said my titration need was 8cm with an EPR 2. Since using the machine for 30 days my average AHI reads 35.8. Something is wrong. Just last night I tried setting it at 15cm rather than 8cm, and my AHI reading was 4.6. Do I need an autoset, or a bipap machine? Or what? Any help is appreciated.
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#2
First, check leaks using software. Leak control is often the bane of those new to CPAP.
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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#3
Hi fede and....Welcome

By all means get the software and check your leak reading. The Mirage Quattro mask you are using is one of the best full face masks so you should be able to handle any leakage problems by adjusting the mask tension straps but be careful not to over tighten them since you'll often get the opposite results.

You have jumped your pressure too much for a normal titration increment so I would suggest you return to somewhere around 10 cm wc to start anew. Then use the software to help you decide where to go from there. Ask for help on analyzing it if you need to since there are some well schooled folks here that can help you.

As to whether you need an auto set machine, that remains to be seen and can likely be determined by analyzing the data you get from the software. The auto machines are nice but if you don't need the feature you won't be missing anything. If you have a fairly constant level of pressure requirement during the night, the S9 Elite will work very well for you. If most of the time your pressure requirements are fairly constant and low~medium but you have several incidents during the night that require a much higher pressure, then you could benefit from an auto set machine.
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#4
An auto machine for you would be a nice idea. But you don't have one right now, so you gotta dance with who brought you. Surfie's suggestion of going to pressure of 10 is correct. Then you need to watch things for a few days before you'll have enough data to justify further increases.

The leak issues are of course very important, so visit that.

The other issue I'm concerned about is what kind of events are you having? Are they OA, CA, or Hypop? Anytime you mess with the machine the CA's can sometimes go whacky, so that's one reason to sit still when you make a change for a few days before you decide to do anything else.

Last nights 4.6 sounds good, but depending on your leak experience it could be misleading.

So: Pressure to 10, install Sleepyhead and review the results... OA, CA, Hypop? 95% mask leak below 24? Let us know and we'll try to help you through this.
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#5
Hi fede,
WELCOME! to the forum.!
You've gotten great advice so far.
Hang in there for more suggestions and best of luck to you as you continue with and fine tune your CPAP therapy.
trish6hundred
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#6
(10-23-2014, 10:11 AM)fede Wrote: Hi, I'm new here, and using a RESMED S9 elite with h5i. My sleep study said my titration need was 8cm with an EPR 2. Since using the machine for 30 days my average AHI reads 35.8. Something is wrong. Just last night I tried setting it at 15cm rather than 8cm, and my AHI reading was 4.6. Do I need an autoset, or a bipap machine? Or what? Any help is appreciated.

Thank you all so far for your replies. My 90% leak rate for 30 days average is 2.40. My AHI 30 day average is 22.23; Obstructive is 16.97; hypopnea is 3.27 and CA is 1.95.
I'l try resetting the machine to 10cm for a couple of days and see where that leads also, and let everyone know the results. Thanks again.
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#7
Do start tracking with software. You may need a little more pressure; but concentrate on leaks first.
When it's time to up pressure, make small changes and let them run for a few days. Like 0.6 cm-H2O delta.

These things are like when cars had carburetors. If you adjust too many things at once, you'll lose the rabbit.
(Oh.. is R_G gonna have fun with that one)
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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#8
Well, if cars don't have carburetors anymore that explains the sudden shortage of rabbits, doesn't it?


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#9
There is also a self-help book on motivation recently (2005 I think, time flies! ) published that coins a similar phrase. "The Jackrabbit Factor." It's mostly about how to get rich but it applies to all of life's challenging goals, CPAP included.
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#10
(10-23-2014, 04:13 PM)fede Wrote: My 90% leak rate for 30 days average is 2.40. My AHI 30 day average is 22.23; Obstructive is 16.97; hypopnea is 3.27 and CA is 1.95.
I'l try resetting the machine to 10cm for a couple of days and see where that leads also, and let everyone know the results. Thanks again.

Your leak number is quite good, especially with a full face mask. Also, your CA's are low, and that's good. So it will be interesting to hear what your numbers tonight show. One thing I think we do know, and that is you're going to be able to manage your apnea stuff very well!
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