AHI is up to 6.7 with CPAP? How to fix it?

[lakejumper]

I have a friend who has the same CPAP machine that I do in my signature. She has been using it for about 3 years and recently has been complaining about being tired during the day. She hasn't been checking her readout on the machine. I checked it for her a couple of months ago and her AHI was averaging over 6.0. She belongs to Kaiser and had an appt. at which time the therapist increased her upper pressure slightly. I checked her machine again and she is averaging AHI of 6.7. I went with her to her DME (Apria) today to get her card read at their drop-in clinic. Her pressure is currently set at 5-10. Her numbers are as follows:

AHI 6.7
Clear Airway 0.5
Obstructed Airway Apnea 3.9
Hypopnea 2.3
RERA 3.5
Ave. 90% pressure 10.6
Ave. CPAP pressure 8.5

The DME told her she had to go back to Kaiser because they aren't allowed to change the pressure without a prescription. What should she ask for or expect them to do? By the way, I just downloaded Sleepyhead for myself but am not informed enough yet to figure it all out.

[bayourest]

I dont know the machine in question here. I think the critical factor is the minimum pressure, not the upper pressure. I would think that if the minimum pressure was increased in a methodical manner your friend could get better results from her therapy. I believe it is possible to get a user's manual for most machines and someone on the forum might be able to instruct you about that. I would try each increase in pressure for about a week before evaluating because it sometimes takes a couple of days to adjust.
For myself, I was titrated in my sleep study at 10. Over time I have found that I do much better at a minimum of 13. My machine is set to 13-20. The upper limit is wide open but in fact the pressure never goes above 15.

[Kilgore Trout]

She'd likely expect one of the following, and it really depends on the doctor.

1. Increase the range to 5-20, since 10 may not be enough to support her during those hypopneas.

2. Move the range, as Bayou explained. Pushing from 5-10 to 8-13 might make a difference.

Since we can change the settings on our own--which is NOT recommended unless you're watching your data VERY carefully and know what the numbers all mean--your friend could make these changes for herself, or with your help.

If she can tough it out until she can see a doctor and have them go over everything, that's the best option by far.

[Pugsy]

If your friend's 90% pressure is 10.6 her maximum is not 10 cm. The maximum must be higher to have a reported 90% pressure above 10.

The minimum pressure is a bit too low. These machines raise the pressure in slow stages in response to apnea event precursors. If the minimum is too low the machine can't get to where it needs to be to do its job more effectively. A lot of people think that they can set the machine wide open and the machine will magically find the proper pressure. This idea works great if someone only needs 8 cm pressure and not so good if someone needs 10 cm or above pressure to do the job. We have to give it a head start with a little more minimum pressure.

So the 5 cm minimum isn't enough of a head start. Small increases in minimum pressure while watching the reports would be an option. Waiting for the doctor is an option but often they are one of the people who think that if the machine is an auto that the machine can magically get to where it needs to go in a blink of any eye. If it were me...I would try minimum of 6.5 or 7.0. Increasing the maximum from wherever it is..won't help the AHI. The minimum pressure is the most critical pressure to adjust in this instance.

[lakejumper]

Thanks for the replies. The pressure setting numbers must have been from Apria's files because they were printed on their pink form. The therapist didn't provide a pressure setting from the machine itself. I have to say that I was dissappointed with Apria's service. We waited almost an hour for the therapist to read the card, and she spent a long time running around finding everything and didn't have the correct tubing adaptor to pressure check the machine and we weren't even there to have that checked.

That's what motivated me to download Sleepyhead last night so that I could avoid the long waits. My friend is making an appointment with Kaiser and I will advise her to have them adjust the minimum pressure up. I look forward to learning more about the metrics and data from these machines.

[Pugsy]

The pressure setting numbers must have been from Apria's files because they were printed on their pink form. The therapist didn't provide a pressure setting from the machine itself.

Ahh, that probably explains the difference between the thought of max and the real max and the 90% number. Wouldn't surprise me to know they have the max wide open...seems that is done often..minimum of 5 and maximum of 20 and let the machine do its thing.

Doesn't matter what the maximum is in this case...the minimum is the critical number...bringing it up to where it gives the machine a better head start and the AHI should drop. Assuming that the bulk of the AHI is not Clear airway events. If it is most CAs...whole different story which I won't go into unless it is needed.

[Goofproof]

While they may have the same machine, do they have a ff mask or a nasal mask, a nasal mask can leak off your treatment even if you do get it set correctly, by set correctly I mean iusing a 3 CM range from low to high so the machine can keep up with you needs. Nothing will work if your leak rates arent under control or your airway isn't sealed. JIm

These are the first things that need to be addressed.

[lakejumper]

Goofproof,

She has a FF mask and the leak rates are all low as follows:

Large leak rate: 0.1%

[Kairosgrammy]

I would go to the apnea board, download the manual on how to reset the pressure settings. That is if she doesn't have insurance or her insurance won't pay for the study. DMEs are highly regulated I would imagine and being 3 years out and the probability of her apnea being worse, are probably required to do that and of course, are worried they could be sued. Reasonable fear given the current rate of medical folks being sued.

I have a friend who has the same CPAP machine that I do in my signature. She has been using it for about 3 years and recently has been complaining about being tired during the day. She hasn't been checking her readout on the machine. I checked it for her a couple of months ago and her AHI was averaging over 6.0. She belongs to Kaiser and had an appt. at which time the therapist increased her upper pressure slightly. I checked her machine again and she is averaging AHI of 6.7. I went with her to her DME (Apria) today to get her card read at their drop-in clinic. Her pressure is currently set at 5-10. Her numbers are as follows:

AHI 6.7
Clear Airway 0.5
Obstructed Airway Apnea 3.9
Hypopnea 2.3
RERA 3.5
Ave. 90% pressure 10.6
Ave. CPAP pressure 8.5

The DME told her she had to go back to Kaiser because they aren't allowed to change the pressure without a prescription. What should she ask for or expect them to do? By the way, I just downloaded Sleepyhead for myself but am not informed enough yet to figure it all out.

[Goofproof]

Goofproof,

She has a FF mask and the leak rates are all low as follows:

Large leak rate: 0.1%

The large leak rate number only stand for untreated, but you also need to monitor normal leaks ( the mask vent rate at your pressure + 10% or so) Too much venting or leak will make the data useless and your treatment poor. Jim

[DoriC]

While they may have the same machine, do they have a ff mask or a nasal mask, a nasal mask can leak off your treatment even if you do get it set correctly, by set correctly I mean iusing a 3 CM range from low to high so the machine can keep up with you needs. Nothing will work if your leak rates arent under control or your airway isn't sealed. JIm

These are the first things that need to be addressed.

Goof, or anyone, I know I'm being "dumb" but is a 3cm range 10-13 or 10-14?

[lakejumper]

Wit the help of the Resp. Therapist, she increased the lower pressure to see if it will help.

Kairosgrammy,How do I get to the Apnea board where you can download manuals?


Thanks again for all of your help.

[Pugsy]

Check your private message box in a few minutes. I will send you a link for the PR S1 Auto CPap clinical manual pdf download.

[Cotay]

The minimum pressure is a bit too low. These machines raise the pressure in slow stages in response to apnea event precursors. If the minimum is too low the machine can't get to where it needs to be to do its job more effectively. A lot of people think that they can set the machine wide open and the machine will magically find the proper pressure. This idea works great if someone only needs 8 cm pressure and not so good if someone needs 10 cm or above pressure to do the job. We have to give it a head start with a little more minimum pressure.

Thanks Pugsy...I'd wondered about this. My PR S1 has been set wide open from 4-20cm. My AHI has been creeping up steadily now to 3.9. My average pressure is at 10.8cm right now.
I wondered if closing the cm gap would help lower the AHI...I think I'll set it to about 6-7 tonight and see if I notice any changes before I have to ship it back on Monday.

[lakejumper]

Thanks Pugsy and everyone! I'm learning a lot about how to manage my own treatment as well. Since this is most likely a lifetime adventure it's worthwhile! I've been using my CPAP for about 9 months and feeling much better but I'm still a newbie with the technology. I've become a believer and have encouraged several friends to get tested and provided support to two family members (severe apnea) to use their machines as they have struggled with the therapy.

Goofproof, I would like to know how you meaure "normal leaks" and vent pressure? I did see a graph on minimal leaks on my friend's report but it was on reports for each individual day and there wasn't any data showing averages or indices.