Reading of First Three Days

[Nirvana]

Hello. New here. :grin:


I had a sleep study and was diagnosed with sleep apnea. They said I woke up 15 times a night and my oxygen drops to 88%. Haven't sleep well with the full face mask (Philips Amara), but lastnight was better.

Here's my results after 3 days. Do you think my oxygen level is staying up? That's what I'm more concerned about.

Day 1:

Total Usage:

6:52 (hrs:mins)

AHI & AI:

Apnea Index: 3.0
Obstructive: 0.0
Central: 2.7
Unknown: 0.2
Hypopnea Index: 0.4
AHI: 3.4

Leak:

Median: 32.4
95th Percentile: 85.2
Maximum: 154.8
Pressure: 7-12



Day 2:

Total Usage:

9:02 (hrs:mins)

AHI & AI:

Apnea Index: 1.6
Obstructive: 0.0
Central: 0.8
Unknown: 0.7
Hypopnea Index: 0.4
AHI: 2.4

Leak:

Median: 43.2
95th Percentile: 115.2
Maximum: 150.0
Pressure: 7-12



Day 3a:

Total Usage:

8:21 (hrs:mins)

AHI & AI:

Apnea Index: 1.5
Obstructive: 0.0
Central: 0.7
Unknown: 0.8
Hypopnea Index: 0.5
AHI: 2.4

Leak:

Median: 48.0
95th Percentile: 98.4
Maximum: 150.0
Pressure: 7-12



Day 3b:

Total Usage:

6:52 (hrs:mins)

AHI & AI:

Apnea Index: 1.2
Obstructive: 0.0
Central: 0.5
Unknown: 0.7
Hypopnea Index: 0.3
AHI: 1.5

Leak:

Median: 25.2
95th Percentile: 88.8
Maximum: 151.2
Pressure: 7-12

[eviltim]

Hey Nirvana,

Unfortunately, we can't know whether your oxygen stays up unless you actually have an oximeter on! But it's a good bet that if you fix the apneas, it should be normal while sleeping. Your AHI numbers are good, your leaks are a little high. But it's only been 3 days, so you may want to keep trying and see if it doesn't resolve as you get used to the CPAP.

[DeepBreathing]

G'day Nirvana, welcome to the hosehead club.

As eviltim said, we can't tell directly about your oxygen levels unless you have an oximeter. But we can infer what's happening from your AHI numbers, which are pretty good.

I don't know if you've had a chance to research the details of apnea, so I'll just mention a few things for you:

An apnea is defined as a cessation of breathing for 10 seconds or more. There are basically two types - obstructive (when your airways collapses and flow is blocked) and central (when your airway is OK, but your brain isn't telling your diaphragm to breath). You can have both central and obstructive, the combination is referred to as mixed or complex. An hypopnea is when your breathing is reduced by a set amount (usually 40 or 50%) for 10 seconds or more.

There are various indices, which measure the average number of events per hour. So you can have an obstructive index, central index and apnea index, which is the sum of central and obstructive. Then there is the hypopnea index. Add up the hypopnea and apnea index to get your apnea - hypopnea index, or AHI. This is just a measure of the number of events you have on average per hour. (Just add up all the events and divide by the number of hours you were asleep).

You mentioned you stopped breathing 15 times a night - it's more likely 15 times an hour, which corresponds to an AHI of 15.

Looking at your results, I think you need to work on the leaks. The Resmed S9 machines can manage a leak of up to 24 L/min, but yours are in excess of that. This will stop the machine getting an accurate indication of your events. In addition, a leaky mask will disturb your sleep - it might be blowing air onto your eyes or around your face. Alternatively it might be making trumpet or fart noises. All of this will disturb your sleep.

Make sure your mask is comfortable and that the straps are the right tension - tight enough for a good seal, but not so tight as to hurt or give you a headache. Sometimes it's better to relax the tension a bit, rather than tightening it more. The S9 has a setting where you can run it at full pressure for about three minutes to test the mask. Put the mask on, lie down and run the machine, adjusting the mask and headgear until you're comfortable and the leaks stop. (Important to lie down while you're doing this, as your face changes shape slightly when you're in a lying position).

It is most important that you have a comfortable mask that doesn't leak. Otherwise everything else is wasted. Everybody's face is different, which is why there are so many mask makes, models and sizes. Don't be afraid to try different masks until you get one which suits you - I was on my 4th or 5th until I got it right.

Good luck with your therapy, and again welcome to the wonderful world of the hoseheads!

[zonk]

Hi
The only relevant info at this stage is leak
We want leak to be somewhere below the red line on the leak graph 24 L/m
Unknown apnea scored when leaks higher than 30 L/m and high leaks rate affect the accuracy of the data and sleep quality
Not uncommon to try few masks until you find the right one, here is good mask fitting guide
http://www.apneaboard.com/forums/Thread-...GUARANTEED

[Nirvana]

The woman at the respiratory care told me people have had bad results with the Philips Amara (which I selected), but I liked it because it put a lot of air up my nose, whereas the one she said people have better results with didn't put much air up my nose. Should I try another one or just work with this one more first?

[DeepBreathing]

The woman at the respiratory care told me people have had bad results with the Philips Amara (which I selected), but I liked it because it put a lot of air up my nose, whereas the one she said people have better results with didn't put much air up my nose. Should I try another one or just work with this one more first?

If it's comfortable and you like the feel of it, then it's worth persevering. Follow my instructions above, or the thread that Zonk referred to, and try to eliminate leaks. If you can't stop it leaking then try a different type.

[me50]

the pressure (or air as you called it) is determined by the settings on your machine (if I understand you correctly). It may feel differently according to the mask you are trying but your pressure will be the same in each mask depending on what you need at the time you are sleeping and depending on what is happening with your leaks, events, what type of events, etc. I noticed that when it records a central, my pressure does not go up but it does when I have an obstructive or hypopnea and what pressure it goes to is what pressure it needs to take care of the event.

Don't give up. The mask is the hardest part to adjust to and find the right one.

[robysue]

Welcome to the forum Nirvana.

As others have said, the only relevant number right now is the Leak Rate.

You asked whether to try to make the Philips Respironics Amara work or switch masks. If the Amara is comfortable, it's worth trying to make it work at least for a few more nights.

Some questions that may help us help you in making it work:

1) Which cushion are you using for the Amara---the gel cushion or the silicone (air) cushion?

2) Have you reviewed the fitting instructions carefully? A lot of DMEs tell newbies to pull the straps on FFM way, way too tight. And as counterintuitive as it sounds, when the straps are too tight, that can cause additional leak problems---particularly with air-based cushions that need to fully inflate to make a proper seal.

3) What is your prescribed pressure? Are you using the ramp? If so, what is the starting ramp pressure? If there's a big difference between the prescribed pressure and the starting ramp pressure, you'll need to figure out a way to fit the mask at full pressure.

4) Any idea on where the leaks are developing? In other words, when you wake up, do you ever detect any leaks? Air blowing into or at your eyes? An extra dry mouth perhaps? Air blowing out down around (and perhaps chapping) your chin? Or your cheeks?

5) Any chance the mask cushion is too large or too small? An improperly sized mask cushion is more prone to leaks than a properly sized cushion. Did the tech who fitted the mask just eyeball your face and say, "You look like you're a medium" and only have you try on one size? Or did they actually measure your face or have you try on more than one cushion?

[trish6hundred]

Hi Nirvana,
WELCOME! to the forum.!
What everyone has said so far.
Don't give up, the mask is the hardest part of this therapy. If you keep having trouble with leaks with the mask you are using now, don't be shy about asking to try another one 'till you find the right one that works for you.
Best of luck to you with your CPAP therapy.

[zonk]

Should I try another one or just work with this one more first?

Everyone is different. It won,t hurt to try the other one as well. The more you try, the more likely to stumble on one that you really like

Its important to be fitted with right size cushion, not too small or too large. I recall when tried Quattro FX full face mask, the large cushion was too big and medium size cushion was small, there is no size in-between. I ended up with nasal mask which fit better and easier to control leaks which is a surprise as first thought I needed a full face mask

This might be of some help, Amara fitting instructions
http://amara.respironics.com/resources/

Washing your mask on daily basis together with washing your face before bed helps with the seal
Are you using mask fit feature? mask fit pressure is based on 95th percentile of previous night or 10 cmH2O whichever is greater

This would not affect leak rate greatly but nevertheless you need to select the type mask you,re using (default set on Pillows)