Ultra high AHI with new machine

[toro33]

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.

I had a similar problem when I got my S9 Bipap. The AHI's were mostly "junk" variety while I was awake. The S9 does not like long breaths in default. I had to teach myself to do shorter breaths while waiting for sleep. Much later i discovered I could lengthen the breath cycle with the trigger and cycle controls.Trigger High, and Cycle set Very Low really helped.

[fede]

Since my last post, I bought a resmed s9 autoset. I have set it to 8-16cm and still have AHI readings about 22.0. Some days down to 6.5 which seems nice, but only 2-3 out of 15 days. My leak rates are minimal. EPR is set at 2 full time. I'm just about to give up and chuck the whole thing and sleep without it all as I used to. My sleep study set my AHI at 15-17 and with 8cm as handling it.

Without the CPAP I always awoke refreshed. With the CPAP, I wonder if I do?

[PaulaO2]

Is 8-16 where the data says you need to be?

What kind of events are you having? All OA?

[fede]

Is 8-16 where the data says you need to be?

What kind of events are you having? All OA?

The 8-16cm is my own settings. my sleep tests claimed 8 cm would control it. I originally set it at that and the average AHI came in about AHI=25-30.
However the higher I set my pressure, the AHI diminished to AHI= 12-24 average.
So I set the new autoset machine to 8-16 cm. A couple of nights it was down to AHI 4-6.0 at that setting.

Last night though, my AI =18.05; HI=2.78; CA= 0.83; UAI=0.56 -- all equal to AHI 22.22.
Also I try to not sleep on my back and do so most often now. But that doesn't seem to help.

QUESTION: Are these numbers the RESMED S9 spews out usually correct? They seem so far off from my sleep study.

[surferdude2]

It sounds like you may need even higher pressure than 16 cm but we can't be sure without having all the data. Increasing the pressure often increases the leakage rate so that you reach a point of diminishing returns with respect to lowering the AHI figure.

edit: And yes, the Resmed S9 figures are usually accurate enough for government work. Keep in mind that the sleep study is limited in that it was only one night's experience.

[PaulaO2]

What is your 95% pressure?

[fede]

What is your 95% pressure?

My opening intro said:
"The last time you used your ResMed AutoSet...
was last night (on November 14, 2014)
You had an AHI of 22.22, which is considered horrible, please consult your doctor
You machine was on for 7 hours, 12 minutes and 1 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 16cmH2O for 95% of the time."

[fede]

It sounds like you may need even higher pressure than 16 cm but we can't be sure without having all the data. Increasing the pressure often increases the leakage rate so that you reach a point of diminishing returns with respect to lowering the AHI figure.

edit: And yes, the Resmed S9 figures are usually accurate enough for government work. Keep in mind that the sleep study is limited in that it was only one night's experience.

Your are right about a 3 1/2 hour split study for one night. I've been using Cpap for 30 days and Apap for 15 days and my numbers are "horrible." My doctor just says, it seems OK, just continue to use it for another few months. REALLY?
Last nights' opening intro said: "The last time you used your ResMed AutoSet... was last night (on November 14, 2014)
You had an AHI of 22.22, which is considered horrible, please consult your doctor. You machine was on for 7 hours, 12 minutes and 1 seconds. You had a small but acceptable amount of major mask leakage.
Your pressure was under 16cmH2O for 95% of the time." Thanks for your help.

[PaytonA]

In looking at the break down you gave of your events, It looks like most of your apneas are centrals. The centrals might be the result of your increase of pressure. I would suggest that you leave that pressure alone for about a week and see if your AHI does not start to decrease. If it does, leave it alone. If not you might want to reduce your max pressure.

Best Regards,

PaytonA

[surferdude2]

Perhaps the small amount of major mask leakage was only during the short periods of time that the pressure came up to max while trying to prevent an apnea event. I rather doubt that but it's remotely possible but would depend on the interval between the events. Without analyzing your complete set of graphs, it's hard to guarantee that raising the top set pressure is the key but if I were you, I'd go ahead and allow the S9 AutoSet to have its head and set the top limit to the max of 20 cm and see what you see. That's just me so...but if the doctor knows how much trouble you are having and how many apnea events you are having and still won't see you for immediately, then you'll have to do whatever you think is best.

edit: I just noticed your added post and see that your pressure was under 16 cm 95% of the time. It seems that the S9 doesn't think you need any higher setting and wouldn't use it if you set it as I suggested. Considering that, and IF the majority of your events are clear airway type, then it's possible that lowering your minimum pressure will help. Maybe set the bottom at 7 cm and use the EPR at 3 for further exhaling relief to see if the events go down. It's normal to have a high score on central events when first starting treatment so the lower bottom pressure can help with that.

But still would be nice to see the graphs...