What is your AHI?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
tan
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Re: What is your AHI?

Post by tan » Thu May 21, 2015 9:20 am

Mine is "0.0" most of the time, but there is a important metric not in the picture: RDI, which, as far as I understand, can only be scored manually by looking at the waveform chart in SleepyHead.

AHI can be below 1, but if RDI is 20, sleep will be a mess

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49er
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Re: What is your AHI?

Post by 49er » Thu May 21, 2015 10:34 am

tan wrote:Mine is "0.0" most of the time, but there is a important metric not in the picture: RDI, which, as far as I understand, can only be scored manually by looking at the waveform chart in SleepyHead.

AHI can be below 1, but if RDI is 20, sleep will be a mess
Care to explain how to do that? Sorry if I am missing something obvious.

49er

tan
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Re: What is your AHI?

Post by tan » Thu May 21, 2015 11:08 am

49er wrote:
tan wrote:Mine is "0.0" most of the time, but there is a important metric not in the picture: RDI, which, as far as I understand, can only be scored manually by looking at the waveform chart in SleepyHead.

AHI can be below 1, but if RDI is 20, sleep will be a mess
Care to explain how to do that? Sorry if I am missing something obvious.

49er
That is what I understood from Morbius's posts. Sometimes, sleep disruption is apparent like here (shallow breaths preceding a spike associated with an extra respiratory effort, which results in an arousal):
viewtopic.php?f=1&t=105619&p=1001495#p1001495

Sometimes - not obvious (see the adjacent posts). The problem with such arousals is that they are not reported and the machine shows either a smiley face or well looking AHI < 1.0, while feeling like crap.

joeljjk11
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Re: What is your AHI?

Post by joeljjk11 » Thu May 21, 2015 11:24 am


How long have you been using this therapy?
What are your settings? (ALL of them)
Are you using software to monitor your own therapy? (doesn't sound like it)

And, if you're Central Apnea was known by them when they prescribed your machine and settings, it sounds like you may have the wrong machine (if your Centrals are significant).

Den

.
I have been using CPAP for about 6 weeks. My settings were 4-20 for pressure but the doctor changed the pressure to 10-19. I also start out at 10 now. My AHI was 7.3 last night so I am not sure what is going on. She also turned off ramp and turned on EPR on the machine to make exhaling easier. I believe that is pretty much it for settings, I turned down the humidity a bit because I was getting water in the mask. I am going to download Sleepyhead and try it out.

She said during my sleep test I showed signs of central apnea and on a sheet that I gave to the receptionist she wrote 'complex apnea.' So it seems like my official diagnosis at this point is complex apnea. I hope that helps.
There seems to be some confusion here -- Are you saying that your pressure was 10 and your doctor increased it to 19? Or is 10-19 the new pressure range (10 Minimum, 19 Maximum)? If it's the new range, what were your pressure settings before the doc adjusted them?

Complex apnea (CompSA) can develop when positive airway pressure (PAP) starts causing central apnea events. If your doctor suspects this is what's happening for you, then I'm not sure why she would start you out at a higher pressure and raise the maximum pressure to 19. Higher pressure can worsen centrals.

I'm going to assume that your doctor meant that 5 is your Central apnea Index (hourly average), not the total number of centrals. That is not insignificant. Neither is the 13.3 AHI that your doctor mentioned. And the numbers you're seeing on your machine are not low numbers -- the machine is displaying your hourly index, not the total number of events for the night. An obstructive apnea index of 9 is not low. If the central apnea index of 1 was a typical night for you we would not be overly concerned, but your doc was looking at higher central index numbers and mentioned 5 to you, and she is wondering if yours is a case of CompSA.

The best thing to do at this time would be to get SleepyHead set up: https://sleep.tnet.com/resources/sleepyhead Post a screenshot like the example you'll see on the website I linked to. Also post the Statistics page which will show us your pressure settings and the changes to those settings, as well as leak and AHI information since you started using your machine, like below. It's worth doing especially since you may have a more complicated case -- you will appreciate feeling more on top of what's going on with your apnea and your therapy.
I answered most of your comments aboe. I will get set up with Sleephead soon and post a screenshot. I take a medication at night that is very sedating which basically knocks me out so I think it is making my apnea treatment difficult.

joeljjk11
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Re: What is your AHI?

Post by joeljjk11 » Thu May 21, 2015 12:21 pm

Also if I go into the clinical settings on my machine (which I found instructions on) is there anything I should adjust? Should I lower the max pressure? It seems like this makes the most sense. I will see how my AHI is over the next week or two but if it is still high I was wondering what I should change.

Joel

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Re: What is your AHI?

Post by LSAT » Thu May 21, 2015 12:25 pm

joeljjk11 wrote:Also if I go into the clinical settings on my machine (which I found instructions on) is there anything I should adjust? Should I lower the max pressure? It seems like this makes the most sense. I will see how my AHI is over the next week or two but if it is still high I was wondering what I should change.

Joel

Lowering the max pressure does very little. The unit will not go to the max pressure unless it is trying to stop an apnea. Also...if lots of your events are Clear Airway (CA), pressure changes will not help with them. The machine only deals with blocked airways. Do what has already been suggested. Post some detail from Sleepyhead.

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Re: What is your AHI?

Post by Pugsy » Thu May 21, 2015 12:30 pm

Don't go changing anything until you understand what the software reports are showing.

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Re: What is your AHI?

Post by kaiasgram » Thu May 21, 2015 12:49 pm

joeljjk11 wrote:I have been using CPAP for about 6 weeks. My settings were 4-20 for pressure but the doctor changed the pressure to 10-19. I also start out at 10 now. My AHI was 7.3 last night so I am not sure what is going on. She also turned off ramp and turned on EPR on the machine to make exhaling easier.

She said during my sleep test I showed signs of central apnea and on a sheet that I gave to the receptionist she wrote 'complex apnea.' So it seems like my official diagnosis at this point is complex apnea.

I answered most of your comments above. I will get set up with Sleephead soon and post a screenshot. I take a medication at night that is very sedating which basically knocks me out so I think it is making my apnea treatment difficult.
Thanks for the clarification Joel. With that AHI of 7.3 last night, what was the central component (CA index)?

I'll be interested to see your SleepyHead Statistics chart and a few nightly screenshots from before and after the pressure adjustments. Your doc saw signs of central apnea on your sleep study and diagnosed you with Comp SA so I'm at a loss about the reason for the pressure increases since pressure does not treat central apneas and can make them worse. It will be interesting to see if turning on EPR (expiratory pressure relief) helps a little with the centrals. The trick with CompSA is to have a high enough pressure to treat the obstructive events but low enough to prevent central apnea events.

I see Pugsy has posted since I started typing this -- she is right about getting more info from SleepyHead before making changes (other than to temp or humidification).

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Re: What is your AHI?

Post by La Zona » Thu May 21, 2015 3:35 pm

Prior to my CPAP my AHI was 60+

During my sleep study, my AHI was around 6

Now that I have had my CPAP for thge past 2 nights, my AHI is 2.83

pressure 8 to 18

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Re: What is your AHI?

Post by joeljjk11 » Thu May 21, 2015 5:29 pm

Here are my stats from sleepyhead, it seems to only show obstructive apnea?

Image

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Re: What is your AHI?

Post by palerider » Thu May 21, 2015 5:49 pm

joeljjk11 wrote:Here are my stats from sleepyhead, it seems to only show obstructive apnea?
well, that explains why your pressure was raised... maybe not enough though.

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Re: What is your AHI?

Post by joeljjk11 » Thu May 21, 2015 5:53 pm

Should I raise my minimum pressure? Not sure what to do.

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Re: What is your AHI?

Post by Pugsy » Thu May 21, 2015 6:22 pm

joeljjk11 wrote:Should I raise my minimum pressure? Not sure what to do.
I am with Palerider in that the bulk of your AHI seems to be obstructive and that's why the big increase in the minimum and I also agree that the minimum is likely not quite up there where it needs to be to do a better job preventing the OAs and hyponeas.
It is the minimum that is the most critical setting...and while I doubt that 11 cm minimum will quite get the job done that is what I would at least try and see what happens.
I would tell you to give the 10 cm more time but I doubt it will make that much of a difference if we give it more time.

I don't see the centrals being an issue at this time. Overall they have average less than 1 per hour which is way lower than where we would be worrying about complex sleep apnea or a problem with centrals.

So yes...a little more minimum and give it 3 or 4 nights before adjusting upwards again if you think that more minimum is needed.

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Re: What is your AHI?

Post by joeljjk11 » Thu May 21, 2015 6:28 pm

Thanks! I will try this. I am not sure what my doctor was seeing.

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Re: What is your AHI?

Post by Pugsy » Thu May 21, 2015 6:38 pm

Your doctor was seeing mostly obstructive apneas with a handful of centrals thrown in.
Having a handful of centrals is actually normal. Some might be the real deal but some are probably awake/semi awake breathing irregularities that the machine is flagging by "mistake". Remember the machine doesn't have any way to know if you are asleep or not and it just senses breathing and we often will pause our breathing while awake and not even realize it. Hold your breath for 10 seconds...that's more or less a "central" in that there is no air flow going on and the airway is open.
Obstructive apneas and hyponeas are when the airway tissues have collapsed to some degree and the airflow is blocked or greatly reduced by the floppy tissue.

There are also normal centrals during sleep stage transition...so seeing a few centrals isn't alarming even if they are the real deal. With your central (clear airway) hourly index being less than 1.0 even if all your centrals were real you aren't having enough of them to present a problem at this time.

Since with centrals the airway is already open then more pressure isn't going to help the air move...we only use more pressure when the reduction in air flow is from the airway tissues collapsing and blocking the airway.
There is a small % of cpap users who develop centrals or unstable breathing due to the addition of cpap therapy pressure and that's why until we could actually see the reports and see what the machine was reporting we couldn't advise what to do in terms of pressure. If you had been one of those people then increasing the pressure could have made things worse in terms of centrals.
But I see no evidence of that happening now and it appears that it's safe to proceed with trying to reduce the OAs with more minimum pressure.

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