Morning Numbers

[projman65]

Hi to all,
after 4 years of using a basic Respironics CPAP machine, I was able to upgrade to the RESMED S9 Autoset (and that took a 2-week fight with the DME).

Last night was my first night on the S9 (Pressure: 9-16) and here are my morning numbers:

Sleep: 6.8 hours
Mask fit: good
AHI: 5.5
Pressure: 15.8
Leak: 10.8 L/min

Any opinions on the numbers?

The one that stands out to me is the pressure. for the last 4 years, my CPAP was set to a fixed 11 cm. I guess I wasn't really getting full therapy.

Thanks for any feedback.

[zimlich]

projman65, well you can't really compare the results from your time on a Respironics CPAP to one night on an S9 Autoset. Were you able to check your numbers while on the CPAP? How did you feel? Our pressure requirements can change over time so perhaps after awhile the pressure of 11 was not enough for you. Still I wouldn't assume that for the whole four years you weren't receiving good therapy. I believe if you felt bad you would have seen the doctor for an assessment. In spite of the increased pressure your AHI is still a little high. It will take some time for your body to get used to the new machine and the way it functions.
Good Luck and keep us posted. Please don't worry about the last four years. You're on a new path now. It's funny- when I put my machine on AUTO mode the pressure kept going up and my AHI kept going up also. I think as the pressure went higher my apneas increased (perhaps centrals) and the machine increased the pressure causing more apneas. Glad to have you on the forum. Thanks for posting.

[projman65]

Thanks for replying Zimlich. I know it's only been one day...we'll see how the numbers look in a 2-3 weeks. but it's interesting what you said about the increased apneas with the increased pressure. I wonder if that's common with others.

[JudgeMental]

Hi Projman.. It appears a tad strange to me that the pressure last night was 15.8 compared to the 11 that you have been riding on for the last 4 years. Thats quite a difference. And, yes, the AHI is a bit high, but I'm sure will come down in time. As Zimlich suggested. Give plenty of time before you get too concerned. Was the higher pressure ez for you to accept? It could be that you have been needing the higher pressure all along and the new APAP has brought out the truth. I understand that you said that the mask had a "good fit", but could it have been leaking?? Is it a new mask or one that you have been using for awhile?
I think you would benefit a great deal if you will search on this site and find and download some software. It would be quite beneficial to see just what is going on during the night, and what might be causing the high pressure and the high AHI>

[SuperSleeper]

Thanks for replying Zimlich. I know it's only been one day...we'll see how the numbers look in a 2-3 weeks. but it's interesting what you said about the increased apneas with the increased pressure. I wonder if that's common with others.

The ResMed S9 AutoSet will not raise pressures in response to a central sleep apnea event.. it basically ignores them. It will only raise pressures in response to an obstructive event.

Since your pressure range is set from 9-16, and (I'm assuming) your 95% pressure level was at 15.8 last night, it could be possible that you need to increase the upper limit on your pressure from 16 eventually.

Again, don't change anything right away, I'm just pointing out one possibility. Your leaks are fine, AHI isn't really that bad either.... it could easily go down over the next few days without changing any settings. That would be the best case scenario.

If after a week or two of using the AutoSet with the current settings, you still aren't getting an AHI lower than 5.0, you might want to slightly increase the upper pressure limit. Also, turning down the EPR level (if it's on) or turning it completely off may help as well. On EPR, high is 3, low is 1, lowest is "off". If you can sleep fine with the EPR off, that's really the best, but if you're completely uncomfortable breathing out against that level of pressure, leave it on - it's better that you keep using the APAP rather than quit because of discomfort.

But again, give the current settings time to work before you start messing around with them.

If I were you, I'd just keep using it as-is for at least 10 days, then come back and post your numbers to let us know what happens. As always, if you ask your doctor's advice at that point, it may help as well.

[SuperSleeper]

Ah, seems I was typing as the Judge was also.

Yes, as he said, get the software for your machine also. You'll need to be logged into your account, but go to our Private Files & Links area and look for ResScan (ResScan's free software) or for SleepyHead (open-source free software). Either one will help you to take a look at your data, but if you use ResScan, you can actually change your settings from within the software. A bit of a learning curve with it, but well worth your time if you want to take a more active role in your own therapy.

In either case, you'll need an SD card reader on your computer (either one that's built-in or attachable via a USB Cable - you can purchase them for around $15-20 at most computer supply stores).

If you haven't seen them already, there's some S9 videos and ResScan videos on this page that are helpful:

http://www.apneaboard.com/resmed-s9-cpap-setup

[shutterbug sue]

Thanks for replying Zimlich. I know it's only been one day...we'll see how the numbers look in a 2-3 weeks. but it's interesting what you said about the increased apneas with the increased pressure. I wonder if that's common with others.

When I first got my S9 a few weeks ago it was set on auto from 10-20 (I had been on CPAP 10cm before that) and the pressure actually went up to 19 one night. I woke up feeling like my lungs were overinflated and I couldn't breathe very easily. It made me feel jittery. I couldn't go back to sleep after that and continued to feel jittery for several hours. I lowered the range to 10-14. I had been having a lot of CA's with the higher pressure. It's much lower now on the lower pressure and I feel better. I have the SleepyHead software and am still trying to figure out how to interpret all the different readings. There's a lot of good information and helpful friendly people on this board to help you. Good luck

PS: I had a respiratory therapist at a DME tell me central apneas are usually caused by your brain trying to keep your lungs from over inflating when the pressure is too high.

[greatunclebill]

Thanks for replying Zimlich. I know it's only been one day...we'll see how the numbers look in a 2-3 weeks. but it's interesting what you said about the increased apneas with the increased pressure. I wonder if that's common with others.

When I first got my S9 a few weeks ago it was set on auto from 10-20 (I had been on CPAP 10cm before that) and the pressure actually went up to 19 one night. I woke up feeling like my lungs were overinflated and I couldn't breathe very easily. It made me feel jittery. I couldn't go back to sleep after that and continued to feel jittery for several hours. I lowered the range to 10-14. I had been having a lot of CA's with the higher pressure. It's much lower now on the lower pressure and I feel better. I have the SleepyHead software and am still trying to figure out how to interpret all the different readings. There's a lot of good information and helpful friendly people on this board to help you. Good luck

PS: I had a respiratory therapist at a DME tell me central apneas are usually caused by your brain trying to keep your lungs from over inflating when the pressure is too high.

real central apneas are caused by your brain failing to tell your diaphragm to breathe. they are very real and dangerous and treated differently than obstructive apneas. so called clear airway apneas identified by the machine are the subject of controversy as to if they are real central apneas of caused by too much pressure. this is because the xpap is a one dimensional thing that makes all decisions based on resistance to it's air pressure. the only way to know what they really are is to have a sleep study that is multi-dimensional. if lowering pressure makes them go away they probably are clear airway and not central apnea.

[shutterbug sue]

Thanks for replying Zimlich. I know it's only been one day...we'll see how the numbers look in a 2-3 weeks. but it's interesting what you said about the increased apneas with the increased pressure. I wonder if that's common with others.

When I first got my S9 a few weeks ago it was set on auto from 10-20 (I had been on CPAP 10cm before that) and the pressure actually went up to 19 one night. I woke up feeling like my lungs were overinflated and I couldn't breathe very easily. It made me feel jittery. I couldn't go back to sleep after that and continued to feel jittery for several hours. I lowered the range to 10-14. I had been having a lot of CA's with the higher pressure. It's much lower now on the lower pressure and I feel better. I have the SleepyHead software and am still trying to figure out how to interpret all the different readings. There's a lot of good information and helpful friendly people on this board to help you. Good luck

PS: I had a respiratory therapist at a DME tell me central apneas are usually caused by your brain trying to keep your lungs from over inflating when the pressure is too high.

real central apneas are caused by your brain failing to tell your diaphram to breathe. they are very real and dangerous and treated differently than obstructive apneas. so called clear airway apneas identified by the machine are the subject of controversy as to if they are real central apneas of caused by too much pressure. this is because the xpap is a one dimensional thing that makes all decisions based on resistance to it's air pressure. the only way to know what they really are is to have a sleep study that is multi-dimensional. if lowering pressure makes them go away they probably are clear airway and not central apnea.

Good to know. I got the feeling she was just giving me a very short answer to get rid of me. What is a clear airway then if it's not a central apnea? How can you tell if you are having central apneas from the S9 readings in the SleepyHead software? How are central apneas treated?

[zonk]

How can you tell if you are having central apneas from the S9 readings in the SleepyHead software?

ResMed adamant that the S9 can detect CSA but the device can not tell whether if you,re awake or asleep as in the sleep lab you would have a technician watch over and those events recorded while awake wouldn't be noted.
I don,t use SH but in the ResScan you would zoom at particular event and see what is the shape of the flow graph look like and both CSA and OA looks quite different from each other.