Alternative ways to decrease the AHI

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
christo
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Alternative ways to decrease the AHI

Post by christo » Sun Dec 21, 2008 8:34 am

Hi,

It's been a month with the ResMed Elite S8 and it looks like the ideal pressure for me is 10.2. My AHI at this setting is at it's lowest. However, the AHI still remains in the mild range 5-10. In my case , it hovers around 6, one night even hitting 5.

Interestingly enough, increasing the pressure above 10.2 increases the AHI!!! I am wondering if there are any ways (outside of increasing the pressure setting) that may decrease the AHI?

I thought of using more pillows, trying new sleep positions, playing with the EPR setting, maybe (although I am not overweight) losing weight, using nose strips, shaving inside of nose, try to adopt a more relaxed attitude during the day?

Thank you for your help,
Christo

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rested gal
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Re: Alternative ways to decrease the AHI

Post by rested gal » Sun Dec 21, 2008 8:49 am

Christo, if the HI (hypopnea index) is what's mainly responsible for your AHI total, and if your AI (apnea index) is very low, I wouldn't worry at all about getting an AHI of 5 or 6 (or even higher) with a ResMed S8 machine.

ResMed S8 machines seem to have a higher threshold for when limited air flow will be called a "hypopnea" than do other manufacturers' machines. Doesn't mean one manufacturer is right and another is wrong. It's simply a difference in the definitions they all use in designing their algorithms for when a flow limitation is to be deemed a "hypopnea."

When using a ResMed S8 machine, I mentally cut the "HI" in half if I want to compare my results to what I get from my Respironics or Puritan Bennett machines.

When using a ResMed machine with EPR turned on, I also like to raise my regular pressure setting a cm or two.

I'm not a doctor or anything in the health care field. All that is just my opinion, and "what I do."

My edit: Added "S8" to all my references to ResMed machines in this old post, since the definition of hypopnea was changed by ResMed in the later S9 series machines.
Last edited by rested gal on Thu May 05, 2011 7:04 am, edited 1 time in total.
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christo
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Re: Alternative ways to decrease the AHI

Post by christo » Sun Dec 21, 2008 9:11 am

Thank you so much for the reply,

And in fact, you are correct. What is contributing to a my AHI is my HI. My AI is 0.0. So I will stop worrying, worrying makes me tired anyway.

Thanks,
Christo

christo
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Re: Alternative ways to decrease the AHI

Post by christo » Mon Dec 22, 2008 8:49 pm

Also wanted to mention,

That using to two to three pillows on top of each other, so that my head is elevated 4 to 6 inches and sleeping on the right side of my belly seems to make a difference. My AHI, according to my Resmed S8 Elite, dipped under 5 for the first time.

Thanks,
Christo

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LoQ
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Re: Alternative ways to decrease the AHI

Post by LoQ » Mon Dec 22, 2008 9:46 pm

christo wrote:Thank you so much for the reply,

And in fact, you are correct. What is contributing to a my AHI is my HI. My AI is 0.0. So I will stop worrying, worrying makes me tired anyway.

Thanks,
Christo
Hypopneas can matter; it's the big picture that counts.

Do you feel rested? If so, that's probably a good sign that your therapy is effective enough. If not, I would certainly start to look in more detail at the HI.

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rested gal
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Re: Alternative ways to decrease the AHI

Post by rested gal » Tue Dec 23, 2008 1:51 am

LoQ wrote:Hypopneas can matter; it's the big picture that counts.

Do you feel rested? If so, that's probably a good sign that your therapy is effective enough. If not, I would certainly start to look in more detail at the HI.
You're absolutely right, LoQ, that hypopneas can matter.

My point is that each manufacturer seems to use an arbitrary definition in how each manufacturer defines "hypopnea" (as opposed to what they would still call a 'flow limitation.") Each manufacturer's definition of what has to occur in the air flow -- and when -- in order to call it an "hypopnea" seems to be unique to that manufacturer.

None of the manufacturers use the definition of "hypopnea" that is used when scoring a PSG sleep study...where there has to be a certain percentage of drop in O2 before it's scored "hypopnea."

So, what may still be called "flow limitation" by a Respironics autopap, may be called an "hypopnea" in a ResMed machine. That sure seems to be the case when I've used both manufacturers' machines. With same pressure (or pressure range), same mask, no C-flex or EPR turned on, same separate humidifier, I consistently register two or three times as many "hypopneas" with a ResMed machine than with a Respironics machine. And feel equally well rested either way.

I believe with the machines we use at home, it sometimes comes down to a matter of "definition", not of actual "event." At least not by sleep lab standards. When it comes right down to it, at home a hypopnea IS just a "flow limitation" with a fancier name. So without being able to use O2 info, the machine manufacturers have to draw an arbitary line in the sand -- a line for when a flow limitation gets called "hypopnea."

I think it could be really discouraging to a ResMed user to keep seeing people (who happen to be using Respironics machines) reporting AHI's of 1 or 2 or 3, while he's getting AHIs of 6 or 7 (comprised mostly of hypopneas) AND also be reading about how the AHI should be under 5 (another rather arbitrary figure with its roots in Medicare's line in the sand... LOL! ) for "effective" treatment.

If that same ResMed user was using a Respironics machine, he probably would be seeing an AHI about half the amount he's been seeing. The lower AHI wouldn't mean he's getting "better" treatment because fewer hypopneas are being reported. Nor are the people with lower AHI's using machines that are "missing" something. As far as I can tell, it's just a difference in the way the manufacturers define "hypopnea."

When I use a ResMed machine, I mentally cut the Hypopnea Index in half. Makes me feel better than doubling the Respironics hypopnea index. LOL!! Doing it either way, though, would be the only way I could get an approximate comparison of my data from the different brands, as I feel just as rested in the morning with either brand's treatment.
LoQ wrote:Do you feel rested? If so, that's probably a good sign that your therapy is effective enough. If not, I would certainly start to look in more detail at the HI.
One thought, though, about going by "how we feel." It's possible to be getting optimum CPAP or AutoPAP treatment (regardless of the AHI, AI, HI, we see) and still not feel good, or refreshed, or energetic. There can be many, many other factors at play -- other health issues, sleep hygiene issues, other sleep disorders, med side effects, etc.

Quite a puzzle to sort out -- this sleep disordered breathing stuff, and the treatment(s) for it.
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FoxNewsFan
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Re: Alternative ways to decrease the AHI

Post by FoxNewsFan » Tue Dec 23, 2008 6:12 pm

Reinforcing what RG is saying-

In the 1st issue of ResMedica, http://www.resmed.com/en-au/assets/html ... edica.html Dr. Michael Berthon-Jones, the Chief Scientific Officer of ResMed talks about hypopneas.

He says you can have them when lying quietly awake, when you first go to sleep, when you are dreaming, right after you sigh, (which you do every few minutes), after you have just rolled over and are getting settled and these have nothing to do with the state of your airway.

I like to sleep on my side. A while back, I broke a rib and it still hurts after 10-20 minutes on my side so, when I'm sleeping, I constantly roll from my side to my back and later to the other side and then back to my back. I videoed myself to figure this out.

I too have gotten my apneas near zero but my hypopneas are usually somewhere between 5-10.

My point is that each person is an individual and their results are unique to them.

Keep reading and learning and most of all be proactive in your care.

Take care,

Ed
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turbosnore
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Re: Alternative ways to decrease the AHI

Post by turbosnore » Wed Dec 24, 2008 2:23 am

RG wrote:
One thought, though, about going by "how we feel." It's possible to be getting optimum CPAP or AutoPAP treatment (regardless of the AHI, AI, HI, we see) and still not feel good, or refreshed, or energetic. There can be many, many other factors at play -- other health issues, sleep hygiene issues, other sleep disorders, med side effects, etc.
And I guess i'm a good example: The numbers from my ResMed Autoset Spirit were
Pressure 13,00
leak (L/s) 0,00
AHI 3,90
AI 0,90
HI 3,10
I still didn't sleep well.

At the moment I'm off the treatment, because of a bad flu combined with bronchitis.
(What a Christmas present .)

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Re: Alternative ways to decrease the AHI

Post by wongnog » Thu Dec 25, 2008 1:52 pm

Interesting topic. I've been on CPAP for about 10 days now (equipment listed in sig) and have already noticed that I wake up significantly more refreshed and alert than before, even with only 6-7 hours sleep. I've been logging my efficiency data from the Elite II for a few days now, and am happy to report that I've got a leak rate of 0 L/s (or close to it) for the last 6 nights. However my AHI has been hovering between 5.0 - 10.0, with my HI being 4.6 - 8.8. I'm currently at a pressure setting of 7.0. I do notice however that I still feel the need for an afternoon "siesta" on most days, which was one of my big problems pre-CPAP -- namely I'd be practically falling asleep on my drive home from work. I've also been recording audio of myself sleeping and I can still hear myself snoring, but I'm told it is much less than before (i.e. I can't be heard from outside the room with the door closed). Do you guys think this is a sign that I need to increase my pressure? I do have a sleep test booked for 4 weeks from now, at which point they will monitor my CPAP usage to tweak my pressure settings. It's just that now that I know how to get into the Clinician's Menu on the Elite II, I feel compelled to change settings for myself!

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rested gal
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Re: Alternative ways to decrease the AHI

Post by rested gal » Thu Dec 25, 2008 3:02 pm

If it were me, yes, I'd raise the pressure. I'd go up one (or even two) full cm's at a time, giving each change at least 4 or 5 days to see how it goes. I'm not a doctor, but that's what I'd do.
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wongnog
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Re: Alternative ways to decrease the AHI

Post by wongnog » Thu Dec 25, 2008 3:30 pm

thanks restedgal. I'll give 8.0 cm a try and see what happens

thomastom682
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Re: Alternative ways to decrease the AHI

Post by thomastom682 » Fri Aug 05, 2011 12:10 am

Nice Post friends and thanks for sharing.

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robysue
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Re: Alternative ways to decrease the AHI

Post by robysue » Fri Aug 05, 2011 8:21 am

rested gal wrote: None of the manufacturers use the definition of "hypopnea" that is used when scoring a PSG sleep study...where there has to be a certain percentage of drop in O2 before it's scored "hypopnea."
Just want to point out that under the AASM Alternate scoring standard, in a PSG sleep study, a hypopnea is scored if there is a 50% reduction in airflow lasting at least 10 seconds AND EITHER of the following happens:

an associated arousal in the EEG happens at the end of the event OR there is an associated 3% drop in O2 saturation.

So if your sleep lab uses the Alternate standard for scoring hypopneas, there does not need to be a drop in O2 for a hypopnea with arousal.
I believe with the machines we use at home, it sometimes comes down to a matter of "definition", not of actual "event." At least not by sleep lab standards. When it comes right down to it, at home a hypopnea IS just a "flow limitation" with a fancier name. So without being able to use O2 info, the machine manufacturers have to draw an arbitary line in the sand -- a line for when a flow limitation gets called "hypopnea."
And add---since the EEG evidence is missing, our home machines also cannot tell when we are awake or asleep. And sleep disordered breathing events, by definition, have to occur when we're asleep. So any time we slightly hold our breath while awake may well be scored as an event by our machines. And this kind of thing can and does happen when we're dozing in and out of real sleep or when we arouse ourselves just enough to turn over in bed.

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