Replies to This Discussion

Permalink Reply by Robert Jones on November 25, 2009 at 12:34pm

Yes----both AI and HI vary day by day. The more important is AI which if treatment is working will remain within a consistently low range. Oxygen desaturation increases when AI increases and low O2 levels will over time causes damage.

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Permalink Reply by Henning on November 25, 2009 at 2:09pm

For almost a year ago we had an interesting debate about AHI.

This debate concluded, in my opinion, that the AHI is an outdated measure that really hasn't changed significantly in decades.

Here is a link to this debate.

http://www.sleepguide.com/forum/topics/is-ahi-a-good-measurement-unit

Henning

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Permalink Reply by FRANK R DIMICHELE on November 25, 2009 at 3:37pm

The doctors and DME don't give out this information, nor will the companies selling the equipment sell you a monitor. For the few people that can read their stats, are they helping you sleep better??? Have you made any changes based on the stats?? Is their some secret vendor out there that will actually sell you the hospital equipment to monitor??


While experimenting with my treatment...

I have discovered that those fleece covers for hoses do REALLY WORK. Pressures seem to matter very little as long as you are within +-2 of the right one. The most important part of treatment is finding a mask that you actually stays on at night and you like.

Even with humidifier, you still can benefit from a prescription like fluticasone that prevents your nose from producing mucous reacting to the air flow.

Equipment:

Currently using Fisher and Paykel 3000+ hour machine that hospital gave me a few years ago. I tried upgrading, but insurance keeps on taking the machine back when I lose my job a year later. I end up buying my own equipment and just say f&(* the DME all together. I don't like the masks they provide anyway.

Tried buying a BI-PAP off the internet to see if it was better. DIDN'T HELP ME SLEEP ANY BETTER.
I had a bi-pap sullivan vpap II that had the lcd screen die on me. Surprised, the lcd screen was so cheap. Now, all the cool configurations are useless. The lesson to be learned is don't buy old equipment off the Internet. Stay within a few years, even if machine has low hours.

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Permalink Reply by Mary Castrovilla on November 25, 2009 at 5:03pm

Hi Andy - and all!!

I feel like I'm in the Twilight Zone - MY RemSTAR - series M has all different numbers on it (which I report to DME once a month for Medicare compliance.

Total time 608.2
? 806.3
sesions grater than 4 hoiurs 68
? 60414

I was told i'm Medicare compliant, but have NO idea how many apnea, etc. a night i have
Is it the model of my machine? How can i know the number of apneas?

ANy help wokuld be VERY appreciated.

Thanks

MAry

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Permalink Reply by Carolyn on November 25, 2009 at 5:04pm

Andy said:

Hi Carolyn,

Here's what I do on my ResMed S8 AutoSet II in order to read my results:

There are four buttons just under the LCD screen. These are called Left, Right, Up, and Down.

To enter the patient data menu, press and hold both the Left and Right buttons for at least three seconds, until the display reads REVIEW.

Press the Left button to enter the REVIEW menu
Press the Down button until RESULTS is displayed
Press the Left button to enter the RESULTS menu
Press the Left button to enter the EFFICACY menu
Press Down to display LEAK results
Press Down to display AHI results
Press Down to display AI results
Press Down to display HI results
Press Right to exit the EFFICACY DATA menu
Press Right to exit the RESULTS menu
Press Right to exit the REVIEW menu

This procedure enables you to read all of your results, but it does not allow you to make any changes. so, you should be able to read the results without worrying about messing anything up.

Hope this helps!

Andy,
How did you learn to do this? I also had some type of small download card in my packet but I think that is for the Dr. I don't go to see him until Feb. I just don't want to mess up anything. Thanks.

Carolyn

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Permalink Reply by Jan on November 25, 2009 at 5:10pm

The doctors and DME didn't give me this information either-- I found most of it on here and a few other places on the web. For me, it is imperative to have the numbers and to see the data. There is no one more concerned about my health than I am. As much as I think my doctor does care about a healthy outcome for me, realistically I am only one of many patients.

Having the data helps to inform me of my progress, and also to better understand what is happening to me. It makes it easier for me to converse with my doctor so that we can get to a deeper level of understanding of the factors affecting my health. I'd find it very unsatisfying to have a doctor tell me to "put the mask on, sleep, breathe and come back in six months and we'll see where we are."

Frankly, I am also just plain curious. It might be a novelty now to check and see if there is a relationship with last nights numbers to how I perceive I slept and how I felt on awakening.

And, yes, I have changed the numbers on my bipap from the original prescribed settings. My AHI was not going down into a normal range and I was too impatient to wait till my next doctors visit (3 weeks from then). I made the changes, and my AHI numbers improved dramatically.

I did tell my doctor what changes I had made and he was not thrilled that I had made the changes on my own-- however, when I asked him if he would recommend changing the settings back to where they were originally set, he said no, that I actually had done fine.

We talk a lot about the AHI numbers, but I am also interested in the leakage numbers so I can make sure that the mask is doing what it needs to be doing.


FRANK R DIMICHELE said:

The doctors and DME don't give out this information, nor will the companies selling the equipment sell you a monitor. For the few people that can read their stats, are they helping you sleep better??? Have you made any changes based on the stats?? Is their some secret vendor out there that will actually sell you the hospital equipment to monitor??


While experimenting with my treatment...

I have discovered that those fleece covers for hoses do REALLY WORK. Pressures seem to matter very little as long as you are within +-2 of the right one. The most important part of treatment is finding a mask that you actually stays on at night and you like.

Even with humidifier, you still can benefit from a prescription like fluticasone that prevents your nose from producing mucous reacting to the air flow.

Equipment:

Currently using Fisher and Paykel 3000+ hour machine that hospital gave me a few years ago. I tried upgrading, but insurance keeps on taking the machine back when I lose my job a year later. I end up buying my own equipment and just say f&(* the DME all together. I don't like the masks they provide anyway.

Tried buying a BI-PAP off the internet to see if it was better. DIDN'T HELP ME SLEEP ANY BETTER.
I had a bi-pap sullivan vpap II that had the lcd screen die on me. Surprised, the lcd screen was so cheap. Now, all the cool configurations are useless. The lesson to be learned is don't buy old equipment off the Internet. Stay within a few years, even if machine has low hours.

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Permalink Reply by Jan on November 25, 2009 at 5:16pm

I have now been on the auto titrating bipap (respironics) equipment for just under a month. In watching the numbers over that period, both my inhalation and expiration numbers have increased. So while my average at first might have been something like 9/12 it looks more like 11/15 now. I even drifted into the 17 number a couple of times. Are those kinds of changes because the machine is working off a long term titration algorithm and just now getting into the "right place" or is just the natural variations one finds for any of the many reasons other posters have mentioned in this thread?

Thanks
Jan

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Permalink Reply by Daniel P. Bronson on November 25, 2009 at 7:23pm

So far, my AI has been bouncing between <1 and 6ish, although I don't have the data handy to refer to. I've only been at this for just under two weeks, however. I'm hoping I can get it to stabilize at some extremely low number.

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Permalink Reply by Maxine Driscoll on November 25, 2009 at 7:24pm

I have been on Respironics BiPAP auto SV therapy for about three months. For the prior six months I used BiPAP equipment that did not help at all. My first polysomnography report indicated that I have the less common "central sleep apnea " and perhaps complex sleep apnea.The second polysomnography report showed fewer central apneas. I have a low index for central apneas but a very high index for RDI (respiratory-effort related arousals) I also have severe PLMS (Periodic leg movement syndrome) My doctor said "mild" sleep apnea as indicated by the AHI, needs to be treated - especially if the episodes are Central apneas and not Obstructive apneas. In other words, the number on the AHI is not always an indication of the seriousness of your condition.

Maxine in California

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Permalink Reply by Jan on November 25, 2009 at 8:07pm

Maxine, you bring up a good point re. the Centrals and I am hoping someone with technical expertise can help here. During my sleep study I racked up a large number of centrals. I don't have the numbers in front of me but it might have been something like 73 events an hour (AHI 73) with maybe 5-10 of them being central. When I expressed concern about the more serious (I think) Centrals to my doctor, he said that they would most likely resolve when the obstructives were taken care of . My current AHI is averaging between 1.8 and 2.5 with my OI generally under 1 and my H a bit over 1. My auto titrating Bi-Pap does not track Centrals.

My doctor has been pleased with my results to date and has not mentioned any need to look into the Centrals any further...and I neglected to ask him about them.

In this context, are the centrals from my initial sleep lab test something to be concerned about?

Thanks
Jan

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Permalink Reply by Steven B. Ronsen on November 26, 2009 at 9:57am

The numbers are unimportant - it's all about how you feel.

I recently replaced my almost ten year old dumb CPAP machine with a fully data-compatible machine.During that long period, I had no objective feedback, but I felt rested after my third night on CPAP, when I got the right mask. (It's all about the mask!)

Well, the new machine simply confirms this. After a month of recording numbers, my average HI is 1.2, and more importantly, my average HI is less than 0.1, (that's an AHI of 1.3) and I still feel rested.

Back to the original question, my numbers are pretty consistent. AI varies for 0 to 0.1 with on 0.2 on one night. HI varies from 1.0 to 2.1. I suspect that the HI numbers are affected by mask removal resulting from my chronically runny nose or conscious shallow breathing when trying to fall asleep.

Nevertheless, I just ordered a card reader to look at my data in more detail. Why? When my primary care physician thinks it's time for another expensive sleep study, I want to show him that's it's not necessary. I doubt any additional analysis will improve my treatment - my numbers are pretty close to optimal.

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Permalink Reply by Jan on November 26, 2009 at 11:20am

While I agree with you that how you feel is most important, I do also feel that some will benefit from a more careful scrutiny of the numbers. You are lucky. You felt better after three days of treatment. I didn't have the overnight "trip to Lourdes" that some others have. Elsewhere on the board, I asked how long it took to feel better. I didn't "calculate" the responses, but my general sense was that about 25% ish of the responders felt better right away...for the rest the range was anywhere from a few weeks to a year.

I'm one of the many people who is starting to feel better very gradually sometimes taking minute baby steps. I have good days and not so great days (an improvement over bad days and worse days). As a result, I feel that it is important for me to review the numbers and make sure that my 100% compliance to the therapy is resulting in AHI's and leaks and whatever else it allows me to review that will put me in the best position of continuing my slow but positive trend in how I feel.

I'm not doing this in a vacuum though. Just yesterday I had a phone consultation with my sleep doctor (and an in person meeting with him last week where we reviewed status together) to discuss next steps. (No one's ever called me low maintenance ;-) Both of us think that in addition to the apnea situation which appears to be getting into control through the therapy, that I have other sleep issues. As a result, I will be setting up a meeting with a behavioral therapist to discuss sleep hygiene and whatever else comes along with that. By eliminating a high AHI, and all the other goodies you can see through the reports, and combining that with a discussion of sleep habits and problems, a picture was painted that leads us to explore behavioral issues that goes beyond CPAP therapy. Without the numbers, trying a dozen different masks probably would make no difference since there seems to be multiple issues here with my sleep-- and I am loving my mask, it's in the right range of leaks etc :-)

In the big picture of "how do I get to feeling good" I feel that I have a toolbox. The numbers are an important part of my arsenal of tools...but just one tool. My sleep doctor, this forum, friendships I have made with people who are knowledgeable about sleep disorders, my primary care physician...etc. are all part of that tool box that I need to manage this condition.

I really wish I was one of those people, as you have been, who felt like a changed person overnight. There are times when I would get angry and sad that it wasn't working for me in the miraculous way is has for some others. In the first week or two, I woke up every morning "willing" myself to feel great and becoming disappointed when I didn't. I'm now resolved that this is going to take much more work and management from me...and I am going to need all of the tools available...especially the numbers...to help me get through to the other side on this.

Steven B. Ronsen said:

The numbers are unimportant - it's all about how you feel.

I recently replaced my almost ten year old dumb CPAP machine with a fully data-compatible machine.During that long period, I had no objective feedback, but I felt rested after my third night on CPAP, when I got the right mask. (It's all about the mask!)

Well, the new machine simply confirms this. After a month of recording numbers, my average HI is 1.2, and more importantly, my average HI is less than 0.1, (that's an AHI of 1.3) and I still feel rested.

Back to the original question, my numbers are pretty consistent. AI varies for 0 to 0.1 with on 0.2 on one night. HI varies from 1.0 to 2.1. I suspect that the HI numbers are affected by mask removal resulting from my chronically runny nose or conscious shallow breathing when trying to fall asleep.

Nevertheless, I just ordered a card reader to look at my data in more detail. Why? When my primary care physician thinks it's time for another expensive sleep study, I want to show him that's it's not necessary. I doubt any additional analysis will improve my treatment - my numbers are pretty close to optimal.

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