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+--- Thread: [Equipment] Stumped. Please help. (/Thread-Equipment-Stumped-Please-help)
RE: Stumped. Please help. - Sleepster - 06-23-2014
(06-23-2014, 01:13 PM)AllenM Wrote: I saw no software was listed, and I changed it to reflect that I am using ResMed's. I'm not familiar enough yet with their software or reports to know what to look at. That said, I tightened up the mask last night, and had 0 leaks. Zero! AHI was 8.0.
Any other thoughts other than trying a chin strap?
If you have zero leaks then a chin strap won't help.
What are the values of the three indices that add up to the AHI of 8.0?
If most of the AHI is due to obstructive apneas and hypopneas then that's a sign that the machine is at too low of a pressure. Maybe try raising the lower end of the pressure range.
Are you sleeping without your machine?
RE: Stumped. Please help. - retired_guy - 06-23-2014
That said, I tightened up the mask last night, and had 0 leaks. Zero! AHI was 8.0.
Any other thoughts other than trying a chin strap?
[/quote]
I know you just did this last night so it doesn't really explain what's been going on, but an over tight mask can actually contribute to a higher ahi. A bit of a leak is actually a better sign than none at all.
RE: Stumped. Please help. - readyforsleep - 06-23-2014
What about back sleeping? I swore I never slept on my back- but guess what
I started to...and my ahi went up.
RE: Stumped. Please help. - AllenM - 06-24-2014
[attachment=884]
(06-23-2014, 11:35 AM)retired_guy Wrote: So if I understand: You are accustomed to an ahi in the area of 1-6, but recently it has been climbing to 8-15?
What has been going on envirionmentaly? New cat? Gained weight? Sleeping on a different mattress?
I'm more inclined to think the increase is being caused by something other than your machine/setup.
Is the pressure still hovering around the 11.2 area even though the ahi is climbing? That would seem odd.
Took me a while to do, but here is my recent history.
[attachment=884]
RE: Stumped. Please help. - retired_guy - 06-24-2014
Thanks for the history Allen. Yes, you are having a problem with Centrals. It's not a huge problem though, and very likely can be managed without having to go to a different machine and all that. In the end, if you do have to go to a different machine that's fine too.
I'm concerned about your mask fit. A too tight mask can cause discomfort, which can contribute to centrals.
Making changes from one day to the next can aggrevate centrals.
Too high pressure can cause centrals.
In your case the pressure does not seem too high to me. You are controlling your obstructives just fine at the 9-12 range. You could try dropping the high end a 1/2 point, but I don't think that would make any difference. The low at 9 seems right to me.
So work on your mask. You don't want it to flop around, but you don't want it sucking the life out of your face either.
....and mostly once you're comfy, just give this thing a few days without doing anything and see what the centrals do. If they don't shape up, then talk with your sleep doc about it.
RE: Stumped. Please help. - AllenM - 06-24-2014
(06-24-2014, 11:32 AM)retired_guy Wrote: I'm concerned about your mask fit. A too tight mask can cause discomfort, which can contribute to centrals.
Making changes from one day to the next can aggrevate centrals.
Too high pressure can cause centrals.
In your case the pressure does not seem too high to me. You are controlling your obstructives just fine at the 9-12 range. You could try dropping the high end a 1/2 point, but I don't think that would make any difference. The low at 9 seems right to me.
So work on your mask. You don't want it to flop around, but you don't want it sucking the life out of your face either.
....and mostly once you're comfy, just give this thing a few days without doing anything and see what the centrals do. If they don't shape up, then talk with your sleep doc about it.
I understand about mask fit. I actually did somewhat loosen it last night, and still got 0 leaks. But, last night I also got AHI=7.7, AI=5.1, centrals were 4.3, and max leak rate was 8.4 but 95% leak rate was 0.0. Tonight I will further loosen the mask without it flopping around.
To be sure I understand what you are suggesting on pressure setting, I had it set last night at 9 and 14. Are you suggesting 9 and 13.5?
Thank you!
RE: Stumped. Please help. - AllenM - 06-24-2014
Quote:What are the values of the three indices that add up to the AHI of 8.0?
If most of the AHI is due to obstructive apneas and hypopneas then that's a sign that the machine is at too low of a pressure. Maybe try raising the lower end of the pressure range.
Are you sleeping without your machine?
Here is my recent history showing the indices and how centrals are a problem -- averages for the (bad) last month, averages for the (good) month before the bad one, and numbers for a recent really bad night.
[attachment=885]
RE: Stumped. Please help. - retired_guy - 06-24-2014
(06-24-2014, 02:32 PM)AllenM Wrote: I understand about mask fit. I actually did somewhat loosen it last night, and still got 0 leaks. But, last night I also got AHI=7.7, AI=5.1, centrals were 4.3, and max leak rate was 8.4 but 95% leak rate was 0.0. Tonight I will further loosen the mask without it flopping around.
To be sure I understand what you are suggesting on pressure setting, I had it set last night at 9 and 14. Are you suggesting 9 and 13.5?
Thank you!
Ok... I thought your max was at 12 so I felt lowering it a 1/2 point wouldn't do much to resolve the centrals. I did not know you were at 14. A higher pressure can contribute to centrals. But your apnea seems to be controlled nicely at a range of 9-12, so that's what I would suggest you do.
Then, don't make any changes for a few days until you see what happens.
Good job last night getting the centrals down below 5! You're doing very well!
RE: Stumped. Please help. - AllenM - 06-24-2014
Understood. Will go to 9-12 for a few days and report back. Not sure if this is related to the centrals or if I should tweak at some point, but EPR=2 (we both use the S9 Autoset).
RE: Stumped. Please help. - retired_guy - 06-24-2014
EPR can effect centrals in some cases. I found every time I changed my EPR, I'd pick up a few centrals and they would go away in a day or two. But I would not change the EPR right now. Just limit things to one change at a time.