Can't get AHI below 38

[clearyt]

I have been using cpap for almost a year. AHI went from 53 to 33 the first month, but has not improved since. In fact now going backward. Have tried at least 8 masks. Mouth breather, which complicates. Sinus issues. Not sure where to turn. Very discouraging.

[Julie]

Wow, you are persistent! Which is a good thing, but I can't believe no one's been able to help you in all this time! Terrible.

Well, please tell us the full name & model of your machine and what masks you've tried and what's been wrong with them. Also what pressure settings you use and whether or not you track with software. Do you use the ramp feature? What about the humidifier and settings? What do you think has gone wrong specifically (with masks, machine, etc) til now?

The most info you can give us, the most help we can try to give you... because someone needs to do that!

[zoocrewphoto]

Welcome to the group!

Like Julie said, please post the info about your machine, settings, masks, issues, etc. The more info we have, the more we can help. Hopefully, you have a machine with full data. If not, we can help guide you to getting one.

[clearyt]

I have Philips Respironics rem star auto A Flex. With Sleep Mapper. I can look at the display on the machine to get some info, but do not have software to read card and print out. They act as though it is a big secret! Yes, humidifier. The pressure was 5-15, but recently upped the max to 18. No difference or worse. I'm a mouth breather because of long term sinus issues and deviated septum. Also have A Fib so surgery is a bit of a risk. Might have to do it though. Masks...where shall I start? Currently using the newest one out, Amara View. Also have used a number of others, with the main objection being the pressure on the nose cartilage making it very sore and even raw. I can't even begin to tell you how much I appreciate your interest and help! Please let me know what else info would help you to help me. Thanks!

[Julie]

Hi, ok. Empty your humidifier or detach it, whichever is appropriate, then turn the machine over and look for a Ref. # like 460 or 560, etc... that's the model #. Second, raising the high # doesn't do diddly, but raising the low of 5 to e.g. 7-8 should definitely make a difference. You also need to try different (and newer) masks, esp. the hybrid types that cover your mouth from below, and have nasal pillows extending to your nose, but never higher... look on Cpap.com who have the largest variety (and best prices) to see features of the new equipment out now... plus they have a 30 day return fee on most masks so you can try them out. You said yes to humidifier, but not whether you use it a lot, some, or never, and are you aware (by now ) that too much can cause congestion (and maybe aggravate your sinus issues)? You don't have to use it at all of course. Some people find they do need a lot because of where they live, so prefer it, esp. with a heated hose. And depending on which machine you have, you can download free software (SleepyHead - works with Macs too - tho' not with every machine model) from the 1st Announcement - main pg - and then download your results on Imgur.com, linking that to this thread so we can see all the info and advise on possible tweaks needed, etc. Do you ever use an oximeter overnight?

[kaiasgram]

Wait! Hold on Julie! Before any pressure adjustments are suggested --

clearyt, what is the typical breakdown of apnea event types (obstructive apnea, hypopnea, central or "clear airway" apnea)? We don't usually start recommending pressure changes until we know more about what's going on because not all apnea events should be treated with more pressure. Let's take this one step at a time.

If your computer doesn't have a built-in card reader you can buy an external card reader -- very inexpensive, and the software is free. Most of us use SleepyHead. You can see a lot more than what's available on SleepMapper.

For troubleshooting therapy that is not yet effective, it's most helpful to start looking at some typical nights with the SleepyHead software because it allows us to look at all-night graphs of your pressure, apnea events, mask leaks, etc. and what is happening when.

You can also use the link in my signature box to the video tutorials for the various machines. They will show you how to directly access the clinical menu in your machine -- from there you should be able to see all the data that the machine records including your pressure(s) and AHI averages. No more "big secrets "

Welcome to the forum. I can't believe what your AHI is after a whole year of treatment -- somebody is not doing their job.

[palerider]

I have Philips Respironics rem star auto A Flex. but do not have software to read card and print out. They act as though it is a big secret!

if you have a system one model, then get sleepyhead (see below).

[clearyt]

Working on downloading Sleepyhead so you can see what the readings are. I'm lost with some of the info here. How will I read the card?

[clearyt]

Julie, the ref # is 560. My newest mask does cover mouth but not up on nose. I have had many more leaks with it though, because I am a side sleeper I guess. I use humidifier. Always set on 5. It goes 1-5. I have downloaded Sleepyhead, I think. Now can't find on my IMac.. Also where will it read my card?

[clearyt]

Kalasgram, I have downloaded the software on my iMac, but now can't find it. I don't think my iMac has a card reader. I will get one, so I can post the info that will help you to help me. Thank you so much!

[kaiasgram]

Julie, the ref # is 560. My newest mask does cover mouth but not up on nose. I have had many more leaks with it though, because I am a side sleeper I guess. I use humidifier. Always set on 5. It goes 1-5. I have downloaded Sleepyhead, I think. Now can't find on my IMac.. Also where will it read my card?

Is it a desktop iMac? Mine has a built-in card slot on the side -- never knew what it was for until I got diagnosed with sleep apnea! It's pretty inconspicuous -- if you can't find a slot on your computer, you can buy an external card reader -- I think they're under $20.

[Julie]

Specific name etc. of your mask please. Thx!

[kaiasgram]

clearyt, on my iMac the card slot is on the side (where red arrow is pointing), right underneath the CD/DVD slot. Any luck finding a card slot on yours?

[zoocrewphoto]

There is a lot of good news in your info. One, you have a full data machine, so that is awesome. Once you are able to post some nightly graphs, there will be lots of good advice.

Since you currently have a really wide range, there is lots of room for improvement. Most people do better with a more narrow range as it keeps the machine more proactive and also reduces the ups and downs which can bother some people. Assuming you don't have a lot of centrals, raising the minimum will be a good start. But it is best to know the breakdown of the events first since centrals are treated differently.

It's too bad that your doctor and DME haven't done much to help you. They should have worked on lowering your numbers a lot sooner, and clearly there is room to change settings.

[stcrim]

As ZooCrew said I'm betting it's your low number that's the problem. It's a long walk from 5 to 15 and the machine does it slowly, not in real time. If you are comfortable with adjusting it I would bump the lower number up to around 8 or 9 and bring the top number down to 12 and see what happens for a day or two. Then raise either as needed. To get into the clinician menu press and hold both the knob and the home button until you hear a beep. The rest will be intuitive.

The machine you have responds slowly to your needs so the numbers need to be closer to your starting needs. Bringing the upper number down a little was helpful to me because the machine tends to over-shut...

By the way how do you feel at an AHI or 38?