ResMed S9 - Are We There Yet?

[Ron AKA]

So, while I wait for the delivery of my AirSense 10, I continue to tweak the settings on my wife's S9 settings. My last change was to set the EPR function to Ramp Only. I have also increased minimum pressure and reduced maximum pressure from where we started. Is there room for more improvement? I was thinking of reducing minimum some more and possibly the maximum too. After I start to see some OA events I may back that off some, and then try putting the EPR back to full time, just to see what that does. The thought would be mainly to reduce average pressures. She has no real complaints and numbers are good, except for some leak issues, which come and go. Normally leakage is fine.

[Madcat207]

So, i know other nights may be better, but unfortunately, the leaks there are too much to say that the therapy is effective, at least for that night. I air on the side of accepting some leaks, but with a third of the night in leak, it is just too much. The night may have been ok, but we really cant tell.

[Ron AKA]

So, i know other nights may be better, but unfortunately, the leaks there are too much to say that the therapy is effective, at least for that night. I air on the side of accepting some leaks, but with a third of the night in leak, it is just too much.  The night may have been ok, but we really cant tell.

Here is where I started a week ago for settings. This is a more typical night for leakage. Last night I could hear it leaking and yes it was bad. Perhaps time for a new mask, but more realistically I think she didn't have it adjusted right. No chance that I'm brave enough to wake her up in the middle of the night to tell her that! She plans to test a nasal pillow mask soon, so we will see if that is better or worse. She currently has a full nose mask - Mirage FX.

[jaswilliams]

Based on the last graph you posted I would leave well alone 0.72 ahi is great if you wife is sleeping well and dies not feel shot of air (starting pressure/ramp may make her feel starved of air) the question you should be asking her is how are you feeling as her numbers show her as successfuly treated.

[DeepBreathing]

I agree with jaswilliams - the last graph you posted is near enough perfect. In fact it's probably a lot better than most people who don't have apnea.

However the leak on the previous graph was very excessive. If I had to guess I'd say she was breathing through her mouth. If that's an uncommon situation then don't worry about it, but if it recurs then you need to take steps such as a chin strap or cervical collar to help keep the mouth closed, or move on to a full face mask. I don't know your wife, or how violent she gets if awakened but you shouldn't let the leaking go on for so long. It's not doing her any good at all and is obviously disturbing your own sleep.

[PaulaO2]

Why use the EPR only on ramp? It isn't really needed then since it is ramping up and the pressure is lower. Unless she is asleep before the ramp ends. If so, then why bother with ramp at all?

And don't make too many changes at once. And let them sit for a while. Like ten days or so between changes. Even EPR changes need more than one night to evaluate. Unless the change is obviously wrong or causes sleep disruption. By making several changes at once and too often, you don't know if anything is right or wrong. No two nights are the same.

[OpalRose]

No chance that I'm brave enough to wake her up in the middle of the night to tell her that!

Yep, my hubby attempted to wake me up once to inform me he could hear air and to fix my mask.
Almost instinctively, my left arm flew out over to his side.....I don’t know where it landed.

[Ron AKA]

The leaking issue was out of the ordinary, and yes it was large. I could hear it leaking and made note of the times, so I'm sure it was a mask seal problem. It was making a funny noise which I believe was the silicone rubber seal on her mask vibrating from the leak flow. See the overview graphs from the last month below. Mar 25 was actually me using it instead of her. I have a nasal pillow mask and I see did well, but just one night. My pressures are lower. Her leakage issue seems to be very erratic.

[Sleeprider]

Ron, the chart with all the leaks also shows a high "snore" rate that coincides with the leaks. That snore is often recorded for "mask farts" where air is released around the edges causing noise vibrations. I think staying with EPR full time is a better more comfortable option, and I would let the results under 1 AHI stand as "mission accomplished". I'm sure your wife will be glad once you get your own Airsense 10 to play with so you can leave her alone.

[Ron AKA]

Why use the EPR only on ramp? It isn't really needed then since it is ramping up and the pressure is lower. Unless she is asleep before the ramp ends. If so, then why bother with ramp at all?

And don't make too many changes at once. And let them sit for a while. Like ten days or so between changes. Even EPR changes need more than one night to evaluate. Unless the change is obviously wrong or causes sleep disruption. By making several changes at once and too often, you don't know if anything is right or wrong. No two nights are the same.

My current view of using the EPR for her is comfort only while she is awake. She seems quite tolerant of mask pressure when sleeping. I put it to ramp only for a couple of reasons. One is just to see how it works, and the other is to simplify the relationship between mask pressure and events. The thought is to play around with pressure at bit first and when that is settled (and I suspect I'm close), then turn the EPR back on to see if it is detrimental to frequency of events. If it is not, then I will probably leave it on full time. I would think the lower exhale pressure must provide some comfort benefit, and I also believe EPR improves overall respiration efficiency and O2 levels.

My changes at this point are really only to try and find the limits of where pressure values have an impact on events. Yes, I agree you need a lot of nights to be sure any trend in results, especially the AHI are significant. I have been kind of ignoring the AHI value, and really focusing on when the OA and H events are occurring, and at what pressure. I'm ignoring the CA events as there are not many of them, and they are probably quite independent of pressure values anyway.