I know I should check with my doctor - but I want to know what he should be suggesting before I go there.

About a month with this mask and 1.5 months with the machine - My AHi readings have been about as high as 25 and as low as 7 - with an average of about 11-12.  AI readings are averaging about 2-3 (which is odd since they were 0.5 in the initial study).  (Leak rates are 0.0 or close to 0 every night).  I will have 3 days in a row sometimes with an AHI of 7 and then it goes back up for 6 days to 14-15.  No real trend that I can see.

I have read that AHI for mild cases (my AHI was 13.7 in the initial study) may take months to come down and that it may take months to feel better.  And that machines (S8 elite) may over report events - like counting shallow breathing as an AHI event.  So, it may be that I am doing fine.  It may be that something is not right and should be corrected.

My doctor already upped the pressure from 8 which the titration study found to be optimal, to 10 cm.  That was about a month ago.

I am feeling like the "fog" may be lifting slowly, or it may be that I am just going to bed earlier so I am feeling a little better, or maybe there is no improvement.  I am not sure

So, what would make sense from this point on?  
-------------
Keep on with what I am doing?  
Have the doctor look at the graphs from machine data but try to talk him out of raising the pressure any more?  
Ask him to raise the pressure?  
Will the data point to an obvious course to take?

I think my doctor knows what he is doing, but I have found that it is important to know what I am doing before I see doctors.


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Resmed S8 Elite II with FitLife total face mask.
DISCLAIMER - I am sometimes corrected by those that actually do know what they are talking about.

First off is the AI. You like to see that AI 1.0 or below. That is much more important than the HI. The AHI is a combination of adding AI to HI to come up w/the AHI. So concentrate on the AI.

Keep track of what your AI is in relation to the Leak rate. We like to see the Leak rate at 24 L/M (0.4 L/s) for reliable data. For some of us a month and a half of use of our CPAPs hasn't quite paid off our "sleep debt" yet. And one night's data does NOT tell the entire story. Better to pay attention to the WEEKLY data.


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Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Thanks for the reply

I posted the AI - I can't really do more than what I have done with it - and it is still more than before the cpap machine.  At least on the one night of the sleep study.

Leak rate is averaging about 0.09 or so.  There have been only a couple times it was not 0 in the last few weeks - once it got as high as 0.2 L/S and the other it was 0.02 I think.

Weekly figures are 12.5 AHI and 2.3 AI and 0.00 Leaks / second

So, no need to pursue it much further with the doctor yet, you think?  Wait till three months of consistent use, would you say?


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Resmed S8 Elite II with FitLife total face mask.
DISCLAIMER - I am sometimes corrected by those that actually do know what they are talking about.

dkdc,

You should always consult with your doctor to optimize your treatment and health.  Going by what you read on an Internet forum is not a good idea.   Although we know a lot, we are not medical professionals.  We are all simply patients like you.  An AHI under 5 is considered theraputic.  Normal, non-OSA patients (without a PAP) usually are not 0.  That is why an AHI of less than 5 is targeted for OSA patients.  Obviously, the lower you can get it the better.

Since your HI is what is making your AHI high (at least in the set of numbers you posted) maybe you have some components of Upper Airway Resistance Syndrome (URAS).   Read sypark's long post on page 3 of this thread.  Read the following link to see if anything fits.  It might be something to discuss with your sleep doc.  

http://www.apneasupport.org/viewtopic.php?t=19067&postdays=0&postorder=asc&start=0

Vicki


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Being defeated is often a temporary condition. Giving up is what makes it permanent.
Marilyn Von Savant

That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

No, I would continue to pursue your situation w/your sleep doctor. I expected improvement each 30 days or I was knocking on my sleep doctor's door asking WHY? You are only one of many sleep patients. The doctor can afford to be "patient". You are the one undergoing the therapy, WHY should YOU be patient? Yes, CPAP therapy takes time to acclimate to and to see good results. But, once you've mastered the mask situation and have found a mask that is relatively comfortable and leak free it is time to keep bugging the sleep doctor every 30 days until the answers are found. There may be contributing factors and you want to know what these are. It may take a consultation and some team work between your family doctor and your sleep doctor. Who knows? Neither you nor your doctors will know until you pursue the issue(s).


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Thanks, Vicky

Dr. Park said "the general treatment options of OSA also apply with UARS."  So, I am not sure that dealing with UARS is that different, practically speaking, from hypopneas.  

I will call the doctor - I just want to know whether I am checking in with him, or I need a change of some sort.  I can't assume he will make the correct assessment here.  I used to see a doctor who headed a department at NIH and he actually strongly encouraged me to do my own research so that we could make the best decision together when I saw him.


_________________
Resmed S8 Elite II with FitLife total face mask.
DISCLAIMER - I am sometimes corrected by those that actually do know what they are talking about.

Have you asked for and received not only the doctor's dictated results (1-2 pages each) AND the full scored data summary reports w/condensed graphs from BOTH your in-lab sleep evaulation studies AND your in-lab titration studies??  Your previous NIH doctor was a WISE man and a WISE doctor!! Some or part of your answers may well be in those results. Expecially when combined w/the data downloads from your CPAP therapy. While these doctors SHOULD actually LOOK at the data, they all to often don't look much past the compliance data. You will probably have to point out and question some of that data and try to engage the sleep doctor in a good explanation of it all. I say try because some sleep doctors are hopeless in that respect. Be diplomatic, but be firm, in wanting answers and explanations.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Have you asked for and received not only the doctor's dictated results (1-2 pages each) AND the full scored data summary reports w/condensed graphs from BOTH your in-lab sleep evaulation studies AND your in-lab titration studies?? Your previous NIH doctor was a WISE man and a WISE doctor!! Some or part of your answers may well be in those results. Expecially when combined w/the data downloads from your CPAP therapy. While these doctors SHOULD actually LOOK at the data, they all to often don't look much past the compliance data. You will probably have to point out and question some of that data and try to engage the sleep doctor in a good explanation of it all. I say try because some sleep doctors are hopeless in that respect. Be diplomatic, but be firm, in wanting answers and explanations.

YES I have the five page initial and titration studies

Hmm - guess I need to learn how to interpret all that data


_________________
Resmed S8 Elite II with FitLife total face mask.
DISCLAIMER - I am sometimes corrected by those that actually do know what they are talking about.

There are those here than can answer some of your question about the data. General replies, not specific, only your sleep professionals can be specific as they have access to your full medical history.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.

Last night was night #6, and mask fit and tolerance are going really well.  I slept 7.5 hours with the machine/mask, with next to no leaks.  A few things seem to be helping - putting on the mask slightly damp after washing, putting it on "chin first" so it doesn't slide down and hurt my nose, and using the ramp.  I'm finding I don't need the ramp for breathing comfort but it seems to help settle the mask on my face better.

But my AHI mean for the week hasn't come down below 10 yet, and last night it was ~25, with 3.3 of those apneas.  (I'm going to try to wear the fingertip oximeter tonight and see how my O2 sat is doing as well.)

AHI in my initial sleep study was much higher, at 48 (68 REM, 40 NREM, 2.3 AI overall), so I'm seeing a significant improvement.   But looking for input on what I should I expect as far as any kind of "curve" on AHI improvement.  

Also, my pressure is set to 13, with EPR of 3.  On my results the pressure is displaying at 11.0, is that due to the EPR brining the "average" down?

I'm doing this through my GP, not a sleep doc, so I'm probably going to have to point him in the right direction.

Thanks!!


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Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

mreewh wrote:

Also, my pressure is set to 13, with EPR of 3.  On my results the pressure is displaying at 11.0, is that due to the EPR brining the "average" down?

Could be. EPR of 3 isnt going to drop 3 cm h20, but it will drop for exhalation. It also could be that your leak rate is high enough that your machine isnt able to deliver the prescribed pressure.

If you can manually adjust the EPR, then you can always try and turn it off and see what the data displays.

Just a few thoughts.

Good luck!

RAM_Sleep wrote:

It also could be that your leak rate is high enough that your machine isnt able to deliver the prescribed pressure.

Leak rate last night was 0.02 L/s .  Of course I've jinxed myself now.


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Marie
Newbie with Severe OSA
ResMed S8 Elite II CPAP with EPR and H4i humidifier
ResMed Mirage Quattro full face mask
Contec CMS 50-E Pulse Oximeter

I turned the EPR off.  This improved the recorded scores on the machine.  I wouldn't adjust the pressure without advice from my Sleep Doctor.

My ahi was down to 6 last night - and if resmed "over-reports" as some think - I am doing fine.  AI was under one I think.


_________________
Resmed S8 Elite II with FitLife total face mask.
DISCLAIMER - I am sometimes corrected by those that actually do know what they are talking about.

Resmed doesn't "over report" the AI at all. It is the hypopneas they tend to score differently and thus tend to report a higher HI than Respironics, for instance.

An AI less than 1.0 is considered good.


_________________
Some people are like Slinkies... Not really good for anything, but they still bring a smile to your face when you push them down a flight of stairs.
Resmed VPAP Auto. Humidaire 3i, Simplicity mask, ResScan 3.7, S8 ResLink, Embla oximeter.