Ultra high AHI with new machine

[Sleeprider]

There are more leaks when you hit those pressures and OAs, but mask pressure is maintained. I think hold the course for now and consider that positional apnea may be an issue, or it could be REM. I still think that if this continues, the real answer is a machine capable of dealing with that stubborn OA, while offering exhale pressure relief, and that would be BiPAP. It's too soon to know if this will be a continuing pattern.

[readyforsleep]

Your graphs look alot like mine when I was using a full face mask. I discovered I was sleeping on my back
so I now wear a backpack filled with a empty Liquid Tide bottle and I am now using nasal pillows. The full face mask
Had a low back strap that was cutting off my airflow. Now I am a happy camper with ahi's under 3. I was convinced I neede a bipap machine to get enough pressure. Now I average 16.
Hope this helps

[fede]

[quote='Sleeprider' pid='99506' dateline='1423090828']
There are more leaks when you hit those pressures and OAs, but mask pressure is maintained. I think hold the course for now and consider that positional apnea may be an issue, or it could be REM. I still think that if this continues, the real answer is a machine capable of dealing with that stubborn OA, while offering exhale pressure relief, and that would be BiPAP. It's too soon to know if this will be a continuing pattern.

[Thanks for the advice. I will talk to my doctor in about 30 days with what you say, and try to keep off my back.]

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[quote='readyforsleep' pid='99508' dateline='1423091081']
Your graphs look alot like mine when I was using a full face mask. I discovered I was sleeping on my back
so I now wear a backpack filled with a empty Liquid Tide bottle and I am now using nasal pillows. The full face mask
Had a low back strap that was cutting off my airflow. Now I am a happy camper with ahi's under 3. I was convinced I neede a bipap machine to get enough pressure. Now I average 16.
Hope this helps

[Interesting solution. I'll consider doing something like that to keep off my back. I would like to try nasal pillows as my neck hurts so much from keeping the straps tight to prevent air leaks]

[fede]

[quote='Sleeprider' pid='99506' dateline='1423090828']
There are more leaks when you hit those pressures and OAs, but mask pressure is maintained. I think hold the course for now and consider that positional apnea may be an issue, or it could be REM. I still think that if this continues, the real answer is a machine capable of dealing with that stubborn OA, while offering exhale pressure relief, and that would be BiPAP. It's too soon to know if this will be a continuing pattern.

[Thanks for advice. If I needed a bipap unfortunately, my medicare would not pay for another machine, I assume, but will talk to the doctor about it and see what he says. Meanwhile, I'll stay the course to see what happens]

[readyforsleep]

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Your graphs look alot like mine when I was using a full face mask. I discovered I was sleeping on my back
so I now wear a backpack filled with a empty Liquid Tide bottle and I am now using nasal pillows. The full face mask
Had a low back strap that was cutting off my airflow. Now I am a happy camper with ahi's under 3. I was convinced I neede a bipap machine to get enough pressure. Now I average 16.
Hope this helps

[Interesting solution. I'll consider doing something like that to keep off my back. I would like to try nasal pillows as my neck hurts so much from keeping the straps tight to prevent air leaks]

Yes, definitely try the backpack. I bought a small one at walmarts for $3, I dont even realize it is on. Also try not to tighten the back strap too tight. The fact that your neck hurts, makes me think that the mask is part of the problem.
I also found I did much better on a narrow pressure range. Given an open range, I always end up maxing out. Now I keep the pressure between 14 -17.
Are you on the small side with a narrow neck?

[Sleeprider]

[Thanks for advice. If I needed a bipap unfortunately, my medicare would not pay for another machine, I assume, but will talk to the doctor about it and see what he says. Meanwhile, I'll stay the course to see what happens]

You were issued a CPAP under Medicare, and that is normal protocol. You have to FAIL CPAP in order to qualify for an upgraded machine. Your CPAP will be exchanged, and Medicare will pay for the more expensive machine only if you fail CPAP for efficacy or for medical necessity. You are a classic case of where the lower-end machine may not be adequate for your specific needs. You will need to show compliance (time in therapy) with a high AHI that can be better treated with an available alternative to qualify for BiPAP.

[clrapstad]

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)

Mongo you are funny. You been at Malmstrom during your time in the Air Force?

[TorontoCPAPguy]

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!

First and foremost, welcome to the Apnea Board Forums.... here you will share much valuable information from many who have been there, done that and have the T shirt. In my own experience, my case of sleep apnea was extremely challenging as I did not have it before entering the hospital in 2009 with Influenza A/H1N1 and spending three weeks on total life support and three MONTHS in hospital under close care. I left with OSA, damaged lungs (from manually suctioning them), Atrial Fibrillation (another story - I am booked for a catheter ablation after 4 years on TIKKOSYN to keep my heart in Normal Sinus Rhythm), and a host of other issues. My sleep study showed that I wanted 9 cmH2O pressure. WRONG! Not only did I need an APAP machine (S9 Auto today) I wanted data. And I bought a Contec CMS50EW pulse oximeter to record my blood oxygen and pulse rate through the night. Results? (And I don't necessarily recommend self medication here, mind you).... I wound up at 12 - 20 cmH2O set in APAP mode with 3cmH2O exhale pressure reduction. BINGO! AHI dropped from 90's to teens, but I was still not getting a good night of sleep. Checking my SpO2 through the night and doing a little research pointed to the culprit. When I was about to enter REM sleep my SpO2 dropped, sometimes as low as the 70ish range. Respiratory distress is anything below 89%. My pulse rate was racing, likely my BP was spiking (stroke inducing), etc. I took all of my charts and white papers in a binder to the respirologist and sleep doc and he suggested I should have gone into medicine. I asked for supplementary OXYGEN during the night to be infused into the APAP air line, simply to raise the concentration of oxygen in the air from 21 to 30-35%ish. I got an Rx on the spot. Insurance in Ontario pays for the whole shebang almost... it would only cost me $125 a month as my end of renting a Resmed oxygen concentrator to inject about 4L/M into my air line. I got online and bought TWO of them, with all of the bells and whistles, for $625 each and I see they are still available (my first one burned out and needs to go in for service.... it has a 5 year warranty that expires in August). I also bought an oxygen analyzer on eBay for $500 which showed my airline was pushing about 30% oxygen into me at night instead of 21% room air. Presto! No more plummets in SpO2 and blessed REM sleep. It took me a year before my body retuned itself and I felt great. I could feel the difference right away though.

SO:
I heartily recommend an APAP data recording blower like the S9 Auto.
Ditto self titrating pressure slowly upwards (I did 1cmH2O per night) until my AHI came down to almost zero. I infused the oxygen and that also helped immensely. My lungs have returned to the point, I believe, where the oxygen infusion is no longer important but I am still watching). Masks? You cannot get much better than the Mirage Quattro but you MUST USE IT PROPERLY. That means getting a couple of containers of CPAP wipes and giving it a good wipedown EVERY morning to get rid of gunk and bacteria as best you can... and get rid of the facial oils built up on the surfaces! At night make sure your face is clean.. either wash it or use an unscented baby wipe to get the oils off your face. VERY important to get a steady leak rate. And talking about leak rate... every face mask is accompanied by a published leak rate. THEY ALL have a standard leak rate built in to prevent build up of carbon monoxide inside the mask. I use the Quattro FFM and it is, IMHO, one of the best mask out there. My wife is also using the Quattro but in size small. I was using LARGE or XL and went to medium when her first order of masks was too large for her face. It is important that the mask fit your face and that you learn to put it on correctly, making the final adjustments while laying in bed, to prevent undue leakage that can be mistaken for other things. Use the forehead brace to prevent waking up with a purple nose in the morning. And above all, give it time to get used to APAP/CPAP and the mask as it WILL take time. I do not travel anywhere, even for an overnight visit, without my gear excepting the oxygen generator. And up until just recently, I would toss the oxygen concentrator into the back of the Ford Flex UPRIGHT (NB) if I was doing more than a one night stay. If you travel mark your gear with MEDIC ALERT plastic cards with your name and cell number. This will assist in getting the gear on any flights you take without paying for extra luggage (FAA regulations). And always take a copy of all prescriptions with you. Sorry to babble on but I know how frustrated I was in the beginning. Please feel free to ask any questions you may have on this thread... you are amongst some of the most experienced folks in the apnea field. And for goodness sake, do NOT take everything your doctor or DME tells you as gospel. They had my wife running around in a state of depression until I finally convinced her that this was what they did for a living and 'fixed patients' was not good for business. We are still in the analyzing and titrating phase with my wife but her AHI has dropped to almost NIL. We are now watching her SpO2 nightly to see what we can see. But her quality of sleep has improved 1,000%. I don't believe that the sleep docs and DME would ever have got her to this point. She does have one issue and that is that she tends to cough some nights and that wakes here up. We are going to reattach the humidifier, leave the heat off but let the air flow over the water to humidify it. Good luck to you. Remember to get that mask comfy and sealed well to your face; it makes all the difference in the world.

[TorontoCPAPguy]

[quote='retired_guy' pid='99352' dateline='1423012943']
Sure looks like we rolled over on our back around 11:30, didn't we?
[I guess that is what causes the apneas. Will have to try and stay off the back. Thanks for the review and comments]

With all due respect, there are plenty of reasons that your pressure can climb; I don't think I have seen a pressure chart quite as interesting as this one in a while.

I would suggest that it is a result of OSA events and/or leakage. Moving around in bed can play havoc with the seal between your mask and your face. In my prior post I suggest that you (A) ensure that both your mask and your face are squeaky clean of surface oils before putting the mask on at night; and (b) that you adjust the mask properly and then make final adjustments while in bed and in the position that you normally sleep in.

Adjusting for sleeping on your side and then rolling onto your back without putting pressure on the mask can surely do this but so can simply "smoooshing" your face into a pillow. There are special CPAP pillows on the market; I have not bought into this, but, rather, I simply have made a habit of sleeping on my side with a this but firmish pillow on top of my soft pillow and my face/mask over the edge of the pillow. I find that if properly adjusted I can roll onto my back without issue - at other times I spring leaks and get what are known as "face farts" with the Quattro due to the design and the seals flapping under the pressure.

If you are going to be rolling around in bed you may be forced to 'reef down' the lower straps a bit more although it will leave lines on your face when you awaken in the morning.

[TorontoCPAPguy]

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Your graphs look alot like mine when I was using a full face mask. I discovered I was sleeping on my back
so I now wear a backpack filled with a empty Liquid Tide bottle and I am now using nasal pillows. The full face mask
Had a low back strap that was cutting off my airflow. Now I am a happy camper with ahi's under 3. I was convinced I neede a bipap machine to get enough pressure. Now I average 16.
Hope this helps

[Interesting solution. I'll consider doing something like that to keep off my back. I would like to try nasal pillows as my neck hurts so much from keeping the straps tight to prevent air leaks]

Yes, definitely try the backpack. I bought a small one at walmarts for $3, I dont even realize it is on. Also try not to tighten the back strap too tight. The fact that your neck hurts, makes me think that the mask is part of the problem.
I also found I did much better on a narrow pressure range. Given an open range, I always end up maxing out. Now I keep the pressure between 14 -17.
Are you on the small side with a narrow neck?

Overtightening the straps, especially the lower straps, on a Quattro, can actually be detrimental to a good seal due to its design. The edges of the silicon mask are intended to "inflate" to make a proper seal with one's face. Easy enough to demo to yourself. Simply turn on the blower and hold your hand over the mask where it would normally sit on your face... gently. The mask will "inflate" and you will get a good seal (if your hand is large enough). Now push down with your hand so that the edges of the mask are NOT permitted to inflate as they are designed to. Chances are that you will find that your seal is poor and much more sensitive to small movements. Interesting? Read up on the Quattro mask. If you are a mouth breather during the night a full face mask is the way to go (I tried everything and even have one of those CPAP hats that are intended to hold your mouth closed). I suffer from environmental allergies and due to that and some surgery I had often breath through my mouth. For me, a full face mask is mandatory. I have a good friend who uses nasal pillows and loves them. I tried ten different kinds.... my friend has them all now.