New User - High AHI

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Pugsy
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Re: New User - High AHI

Post by Pugsy » Thu Oct 02, 2014 10:00 am

This is the only one I am interested in...the ones with the resp ...snore...insp...exp...don't need.
If you will click on this one so it is in full expanded view with no others showing in thumbnail there is a box of addresses on the right side. Copy the last address in the box....the IMG address and paste it into your post here and you will see the code...then click preview and you should see the image like this below.
Your album and the thumbnails require lots of clicking on to sort out which one...and my internet is giving me fits trying to do that.
It works better if we can see it here without clicking...if you could do that please.
More thoughts on the report itself it a few minutes.

Image

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Thu Oct 02, 2014 10:13 am

AHI is about half and half obstructive vs centrals.
The main grouping of centrals appears to be right after that therapy break when I suspect you may have been awake. Can you confirm it you were awake for a little while after that therapy break around 4:30ish?
Any idea why you woke up at that time?
Did you have other wake ups where you didn't turn off the machine? If so, approx how many?

The snores and RERAs tell us the airway is still trying to collapse and likely cause you to at least partially wake up and you may or may not remember it.

Leaks are well controlled. What little movement you see on that top leak line is mostly from the increased pressure because increased pressure means increased vent rate with your mask and that top leak line includes vent rate.
Ignore the bottom leak line as it has not been perfected yet.
Turn off the RedLine if it is annoying...at 24 L/min that's for ResMed machines and not your machine.
Preferences/CPAP tab (I think) let's you either remove the check mark or set the red line higher (around 90 L/min for your mask and pressures).

What position do you primarily sleep in if you have one or are you like me and be all over the place?

I am thinking try 12 cm minimum tonight...or 11.0 or 11.5 if you want to go up more slowly but since you are used to prior cpap pressures that are higher going up slowly probably isn't needed in your situation.

If you primarily sleep on your back you might not see such higher pressures if you were able to be on your side....but that's easier said than done for some people and it also might not make all that big of a difference.

Again keep one eye on the centrals especially if you can't explain some of them away with being awake when they are flagged.
Your report is still a bit ugly but improved over the past report.

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Thu Oct 02, 2014 10:27 am

Will do with the images from now on. Yes I did wake up at around 4:30 for bathroom break. I turn the machine off but it took me awhile to get back to sleep at that time. Also woke up earlier for same reason but went right back to sleep. I usually sleep on my back and would like to sleep on my side but can't find a position without affecting mask leaks. I'll make the necessary changes tonight and will post the new data in a couple days because I have to leave town. Once again, thanks for the help! I really appreciate it.

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Thu Oct 02, 2014 10:40 am

Have a safe trip.

Side sleeping with a full face mask can be challenging but not impossible.
Maybe a different bed pillow or mask...we can talk about that later. I am not much help with the technical aspects of full face masks because I don't use one.

I could maybe help with a nasal mask if you wanted to try one....but if you simply can't breathe well enough through your nose I won't go bring that up...but if you are using a full face mask for sometimes mouth breathing...we maybe could work around it.
Side sleeping with the nasal cushion or nasal pillow mask is a lot easier to manage.

Have you ever looked at one of those cpap pillows with the cut outs on the sides so the mask doesn't have so much pressure on it from the pillow?

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Thu Oct 02, 2014 1:27 pm

I have nose pillows but started breathing through my mouth after a week. I got a chinstrap but haven't used the nose pillows since I got it. I didn't like the idea of having 2 sets of straps on my head.

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Thu Oct 02, 2014 2:16 pm

I don't blame you for not wanting 2 sets of straps on your head at night. I do good to tolerate one set.

Just how bad was the mouth breathing you were doing with the nasal pillow mask? Was it really bad half the night or just 30 minutes.
I use a nasal pillow mask...I mouth breathe on occasion but rarely get into large leak territory with it and when I do it's only about 15 minutes or so. A full face mask would cause me more problems than it would benefit me with maybe fixing 15 minutes of less than optimal therapy because of a little mouth breathing. I would lose more sleep with a full face mask for sure.

Now if your mouth breathing was horrible...and massive and prolonged then yeah...full face mask or chin strap or tape but maybe it wasn't that horrible and maybe with a bit of time the mouth breathing would decrease.
I opted to tape my mouth when I was first starting therapy...the mouth was dropping open more out habit than a physical need because the nose was stopped up. After a couple of months of taping I started forgetting until lights were out and would let it slide. Come to find out the mouth breathing had pretty much went away. Yeah, occasionally I wake up with the mouth open but it's rare and when looking at the software reports...doesn't last long and sometimes doesn't even make it past the large leak barrier.

Something to think about down the line... maybe revisit the nasal pillows down the road if you have a mind to and the mouth breathing wasn't horribly bad. Sometimes we make compromises just to get good sleep.

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Sun Oct 05, 2014 10:40 am

Here is the screenshot from last night sleeping on my side not my back with min pressure set to 12. Had to get up 2x for bathroom breaks. I drink alot of water during the day and should probably scale it back a bit.

Image

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Sun Oct 05, 2014 11:28 am

There was a slight improvement in your report last night with the new minimum of 12. Probably isn't going to be quite enough yet. Makes me wonder what that past fixed cpap pressure of 13 was letting slip past the defenses.
If you use the new minimum for a couple more nights and the AHI and reports remain unchanged then a little more minimum is in order. At this point you are close to getting optimal results so any changes I would make would be small...like 1 cm at a time increase in that minimum.

Do you normally have to urinate often during the day too? Nocturia is a symptom of OSA and usually goes away with optimal therapy and your therapy is not quite optimal yet.
Of course nocturia can be caused by other things too. The most common for males is the prostrate issue. I don't remember if you are male or not. Another reason might be diabetes especially if you have an issue with excessive thirst during the day causing a lot of fluid intake.

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Sun Oct 05, 2014 7:55 pm

I'm a male. The number of times I urinate during the day depends on how much water I drink. Like I said I drink alot but am going to scale back a bit to see if it helps. I get bloodwork done every 3 months and the doctor never mentioned anything about diabetes. Believe me I know all about it. My 11 year old daughter has Type 1. I'm sure you're referring to Type 2 but my bloodwork is pretty good in that area if I recall. I'll discuss with my doctor when I go back in a couple weeks. Once again thanks for all your help. What number would be considered optimal in the daily report?

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Sun Oct 05, 2014 8:01 pm

badgerwooz wrote:What number would be considered optimal in the daily report?
Are you referring to the AHI?
If so, under 5.0 is considered "acceptable" but I usually also take a look at the pressure graph and flow limitations and snores.
Flow limitations and snores aren't part of the AHI but they mean that the airway is still trying to collapse so I also try to reduce those type of events when possible and they are just a little too frequent to suit me.

If there's still a wide variation in pressure occurring often along with snores and FLs and the AHI is a little higher than I would like then I would try to clean up the reports a little more. I don't try for total eradication of all events...just lessen the frequency.

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Mon Oct 06, 2014 10:49 am

Thanks again for all your help. Changed the min pressure to 13 last night and here's the report. Almost made it the entire night without getting up to go to the bathroom.

Image

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Pugsy
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Re: New User - High AHI

Post by Pugsy » Mon Oct 06, 2014 11:05 am

Getting close.
While last night's AHI technically falls barely below the 5.0 "acceptable" number the amount of "clutter...FLs, snores" is still a little more than I would be content to let slide by.
I would most likely try to reduce the snores and Fls a little better and the OAs and Hyponeas should follow suit.

If it were me...1 cm more minimum pressure and this time leave it at that for a couple 3 nights and then if the clutter was still a little too much then I would start making 0.5 cm changes in that minimum. You are at this point very close to some optimal settings so need to make smaller changes and give each change a little more time before making another change.

I speak from experience....we can have good nights and bad nights in terms numbers without ever changing a thing. There comes a point where we have to stick with a change for a while so we can make sure we aren't changing things on a sometimes bad night. You are real close to that point....at 14cm minimum I would want to give it a few nights if it were me.

How's the sleep otherwise? Not counting the one pee break....better, worse, the same?
Feeling okay otherwise? No aerophagia issues with these increases?

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badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Mon Oct 06, 2014 11:33 am

Sleep seemed a little better last night. No problem with aerophagia with the high pressures. I'll make the increase to 14 then post the data later in the week. Thanks A lot!

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MyJanine
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Re: New User - High AHI

Post by MyJanine » Mon Oct 06, 2014 12:11 pm

Pugsy wrote:That 4 cm minimum pressure is no where near what you need to prevent the airway collapse. I suspect that you need at least 10 cm minimum pressure and that goes along with your past history of needing 13 on cpap.
Listen to the pressure advice on this forum. We slowly (2-3 nights per each .cm raise) moved my wife's up from the 5 cm RX when the device first arrived, eventually settling on 9 cm when the AHIs became less that 1.0. Then there might develop some minor issues with burping, f*rts, and gas. Now we are very carefully dropping the .cm at .05 settings change to see if the gas improves without adverse AHI response.

badgerwooz
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Re: New User - High AHI

Post by badgerwooz » Tue Oct 07, 2014 9:21 am

Upped the min to 14 without issues. Won't post report for a couple more days, but have 1 question until then. Last night I slept for 8 hrs before having to getup and when I did it was 30 minutes before my alarm went off. If I wake up for a pee break 60/45/30 minutes before I'm supposed to getup should I put the mask back on for that 60/45/30 minutes?