Been on CPAP about a month or so. I have a ResMed S8 Elite and a Mirage Swift II nasal pillow mask. Had a few minor problems at first, such as leakage, mask shifting, nose soreness, breathing through mouth, etc. Made some adjustments to get rid of the leakage (for the most part) and the nose soreness. Got a chin strap to get rid of the mouth breathing. So far so good.

However, I've been checking the efficacy and usage data every morning, and have noticed that there have been good nights and bad nights, but for the most part, they're not really that far apart, and they don't seem to necessarily correlate with how I feel the next day. A typical "good" night is a leak rate of about 0.34 L/s and an AHI of 3.5, with AI=0.1 and HI=3.4. A typical "bad" night is a leak rate of 0.68 L/s and an AHI of 6.0, with AI=0.1 and HI=5.9. The numbers vary slightly. I came to think that the "bad" nights were a result of the increased leak rate, since the pressure is always fairly constant, at either 8.0 or 8.2.

Last night was a different story. Pressure was again at 8.2. Leak rate was 0.04 L/s. That's the lowest leak rate I've seen so far. I thought "Wow! I've finally got this leakage problem licked!" Nope. AHI was 14.1. What the hell??!?! I finally have an almost perfect night on the CPAP and my AHI goes UP???? Almost no leakage. No nose soreness. A full 7:42 hours of usage (as opposed to my usual 6 or so hours). As far as the mouth breathing goes, I can't be 100% sure that I'm not still breathing through my mouth, but ever since I got the chin strap, I have not once had the tell-tale mouth dryness.

Physically speaking, nothing was different from any other night. I didn't drink any alcohol or take any kind of medications (prescription or otherwise). I didn't feel any more or less tired than I usually do, and I went to bed around the same time. The only difference is I'm on business travel right now (the first time since being on CPAP). So maybe it's the hotel bed??? But last night was my second night at the hotel, and the previous night I had normal numbers.


Also, one other question about the pressure. My doctor prescribed me a pressure of 9.0. As far as I know, the CPAP is programmed for 9.0, but I've never seen it go above 8.2 when looking at the efficacy data the next morning (and never below 8.0). Is it normal for the actual pressure to be that much less than the prescribed pressure? I guess I could go into the clinician's menu and make sure it's at 9.0, but I could have sworn I watched the DME guy set it to 9.0.

Note: so far I don't feel any worse than normal, regardless of the 14.1 AHI last night. It's only 11:45 AM here though. We'll have to see how I feel at 4 or 5 PM, which was usually my worst time of the day pre-CPAP.

Well, a chin strap can't do diddley-squat to prevent the "lip flutters". That's when air tends to build up in your mouth and escape gently thru your lips. It just kind of sneaks out. But gives you a high leak rate.

Do you use the Ramp feature? Do you know what pressure Ramp starts out at? Ramp starts at a set pressure and builds up in .5 cm increments to your set pressure over the specified period of time. Both the starting Ramp pressure and the length of time it is set for can be altered. Generally it is set for the length of time it usually takes you to get to sleep. Ramp use obviously then affects your reported pressure for thie night.

Are you using the EPR feature? At what setting? An EPR of 1 provides expiration pressure relief 1 cm below your set pressure, 2 provides 2 cms of expiration pressure relief and 3 provides 3 cms of relief. Since we inhale about half of the night and exhale half of the night I'm sure you can see where using the EPR feature also reduces the reported pressure for the night.

BUT, we're not done yet. The newer CPAPs can compensate quite nicely for leaks whether mask, mouth or lip leaks. That raises the pressure being provided. In addition, the reported pressure is the pressure at or below which you spent 95% of the night on the Resmeds. AND the reported Leak rate is also the leak at or below which you spent 95% of the night.

It sounds like last night you had a Leak rate beyond which the Elite could compensate for. What part of your 14.1 AHI was AIs and what part was HIs?


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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 & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

If the problem last night was a high leak rate, why did my CPAP report 0.04 L/s? Is it possible it was leaking so much that it couldn't accurately measure the rate? If that's the case, then how accurate was the AHI measurement?

Speaking of AHI, you asked what the AI and HI components were. As I recall, the AI was very low, as it typically is. Probably around the usual 0.1. The rest, obviously, was HI.

By the way, I've always wondered if the fact that the AI is so much lower than the HI is an indication that the CPAP is working (ie, it eliminates almost all apneas but it can't quite eliminate all hypopneas), or if that (AI being much much lower than HI) is just the natural state of affairs with sleep apnea. Sorry for the run-on sentence, but you get the idea.

As for ramp and EPR, I have the ramp set to 10 minutes and EPR set to 3. I used to have the ramp set to 20 minutes, but I found that was too long, because I would often fall asleep and have an apnea before the machine was up to the prescribed pressure. That initial apnea would wake me up and I'd have to start all over again trying to fall asleep. Setting the ramp to 10 minutes seems to have improved things, but frankly, I'm considering just turning off the ramp feature altogether. I'm so used to the full pressure that I no longer find it uncomfortable, and the initial pressure (which I currently have set to 4) is so low that when I put the mask on, sometimes I have to take the mask off to make sure it's still blowing, because I can't tell. Having the EPR at 3 feels quite comfortable. I think I'm going to leave that setting alone.

I'd hate to steer you wrong and give you the wrong answer to your initial questions. But I do know that very few people can breathe adequately at 4 cms of pressure w/a mask on. Most need at least 5 cms and more like 6 cms. I'd try turning the Ramp off or setting the starting cms higher.

"They" say that the Resmeds tend to "chase" hypopneas more than the other brands and most always report a higher HI. Since, other than a two week loaner Respironics autoPAP and a few nights on a Remstar autoPAP which I quickly resold to my son in law when a Resmed autoPAP became available, I don't have any experience w/other than the Resmeds. I prefer them.

There are some really experienced CPAPpers at cpaptalk dot com's apnea forum that are better able to answer your question about last night and last night's data and why than I am.


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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 & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

Well, turns out it was all academic anyway. I felt great today. Didn't doze off or even get drowsy. Not even a little bit. In fact, I'm participating in this challenge at my local health club to walk 10,000 steps a day for 7 days. Today was day 3. I got 13,393 steps. It's 11PM now and I still feel great. I'm learning not to necessarily expect a !@#! day when my AHI goes over 5 or 6.

Just woke up and checked the data. Last night I turned off the ramp feature. Had no problems dealing with the full pressure right off the bat, so I think I'll just keep it that way. Anyway, back to the data. This time the leak rate was 0.00 and the AHI was 14.3, with AI=1.1 and HI=13.2.

So it's looking like the AHI reading goes up when the leakage goes down. I can only assume that when the mask is leaking, the CPAP has a much harder time trying to measure apneas and hypopneas. Still, if I can have an AHI of 14 and still feel as good as I did yesterday, I'm happy with that. If those 14's keep up, I'm sure my doctor will want to do another titration, and that's fine with me, as long as I can still feel good in the meantime.

The only thing I wonder about is if an AHI of 14 (assuming the machine is finally making accurate AHI measurements now that the leakage is gone) is enough to significantly affect my O2 levels, etc. Don't want to have any of those nasty health effects that sleep apnea can cause.

Meanwhile, I've got my fingers crossed that my continued weight loss (lost 70 pounds in the last 6 months, got 70 more pounds to go) will eliminate the need for CPAP altogether. From what I've read, it's a small chance, so I shouldn't get my hopes up too much, but still...that's what I'm hoping for. Not that I'm not adjusting well to the CPAP, because I really only have very minor problems with it so far. But hey, I'm sure none of us would choose to wear the CPAP if we really didn't have to.

Great! Glad to hear you are doing so well and feeling so good already!!! Man, a 0.0 leak rate is almost unheard of!! One night doesn't tell the entire story. Get a week's data under your belt and then see what you data averages.

Wow! A 70 lb weight loss! GOOD GOING! You obviously are dedicated and determined. We are PROUD of you and your accomplishments. Honestly. I don't have a weight problem, but I have friends who do, and I know the struggle they sometimes go thru. I don't know if I could do it when and if the time comes that I have weight problems!!


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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 & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.

CrohnieToo wrote:

Wow! A 70 lb weight loss! GOOD GOING! You obviously are dedicated and determined. We are PROUD of you and your accomplishments. Honestly. I don't have a weight problem, but I have friends who do, and I know the struggle they sometimes go thru. I don't know if I could do it when and if the time comes that I have weight problems!!

It hasn't been easy. I've been heavy ever since I was about 9 or 10. I just turned 35 a couple months ago, and I've just had this feeling the last couple years that if I don't do something about my weight soon, it's going to be too late. The older I get, the harder it gets to lose weight, and the more likely it becomes that I'm going to encounter serious health problems (heart attack, diabetes, stroke, etc) due to my weight. I just kept thinking to myself "If I'm ever going to lose the weight, I'd better do it now, because that ship is going to sail." When I was younger I always procrastinated, because I always felt like there was plenty of time, and besides, I thought, I wasn't that heavy. Well, the truth is, I really was that heavy. At one point, a couple years ago, I tipped the scales at 385 lbs. Even for my height of 6'4", that is morbidly obese. Even that wasn't enough to shock me into action. As recently as 6 months ago, I still weighed 377 lbs. That's when I really started to see that there was no longer any "gray area." It was a clear choice between two (and only two) options: lose weight now, or never lose it. Live or die. There wasn't going to be any more "next year," because if I kept telling myself later, later, later, I was going to eventually break the 400 lb mark and probably have a heart attack before the age of 40.

Instead, I chose to do something about it, and I'm glad I did. But I'm not done yet. Even my current weight of 307 is way off the side of the BMI chart, well into the "severely obese" category. And as anyone who's ever tried to lose weight knows, the closer you get to your goal weight, the harder it becomes to keep losing those pounds. I still have a lot of hard work and frustration ahead of me. My goal weight is somewhere between 225 and 240, depending on how much muscle mass I put on by then.

Good luck, CheepNis. I admire your determination and perseverence. Would that we all had a healthy dose of it, whether our problem be weight, alcohol, smoking, exercise ... whatever.


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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 & Micro masks, ResScan 3.4, S8 ResLink, Embla oximeter.