AHI, chasing numbers

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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LoBattery
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AHI, chasing numbers

Post by LoBattery » Thu Mar 16, 2017 10:57 am

Or will I be able to sleep at night after looking at the data.

I started cpap in August with a Resmed CPAP. Doctors recommendation was 7cm. Sleep test results
at 7 & 8 were about the same. I wasn't happy with the results and decided to go with 7.8cm, raised
the start pressure to 6.4 and reduced the ramp time to 5 min. This was comfortable and in November
finally saw the doctor. I averaged 4.6AHI for that last month. Numbers each night were somewhat
consistent.

Got a 10 Autoset Jan 1 with APAP 6-10cm for two weeks. Pressures were in high 8's so a week later
I increased low pressure to 7.6cm. Pressure was now averaging in the high 9's. My card reader did
not work so did not have Sleepyhead data wt work with, just AHI. I had numbers under 1 and higher
than 11. I had never seen these wide swings before on just CPAP. I was still averaging lower numbers
of 2.7 AHI for the month.

I had been experiencing dry mouth problems for a couple months, even on CPAP, after coming back
from camp in November. I never even turned the humidifier on at camp and not a single problem. I had
gone through every problem there was setting up the humidifier. A week ago I woke up and noticed
that little air channels were forming between my gums and inner mouth working their way to the lips.
Even a concerted effort couldn't prevent this from happening. It was a eureka moment. Just lowering
the max pressure to 9.4 eliminated this problem. If my dock was happy with 7.6, this had to be a
lot better and it eliminated the dry mouth. I would gladly trade a better sleep experience for an
extra couple AHI. The high numbers when they happened got worse, going up to 17 last night.

I was finally able to read the SD card today in Sleepyhead. I'd pop up some data, but it goes all
over the place. There is no discernible pattern. Pie chart and graphs go all over the place. It
is a lot to look at the first time. My career has involved looking at data and I have tried not to
chnge settings too often without giving them time to average out. It just seems that going to APAP
would have given better results.

So which chart should I try to understand first?
Seeing and believing are often both wrong. FOW

linuxman
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Location: Indiana

Re: AHI, chasing numbers

Post by linuxman » Thu Mar 16, 2017 1:04 pm

I think you're micro-managing the situation here too much. My guess...your pressure isn't high enough so you're on the edge of effective therapy. As such, sleeping position becomes more important, and that can certainly manifest as seemingly chaotic data. Why the consistency on the old machine? Hard to tell. Maybe the machines don't each produce exactly the same absolute pressures and the old one's actually a bit higher..that could do it. Maybe the range you have set straddles your true effective therapy pressure, and the auto is taking you back and forth across that threshold. Again, that means your base number is too low.

Here's what I'd do. Crank it up a coupe of points.... say to 10 or 11. Then, see how that goes. Keep doing that until get to consistency, and the lowest AHI you can get, but keep in mind it will change from night to night. I see .5 to 1 point differences at times..that's just how it rolls. At that point you'll know what pressure is truly the minimum required for every sleeping position. From there, you can try dropping down a little at a time to tweak it.

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Pugsy
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Re: AHI, chasing numbers

Post by Pugsy » Thu Mar 16, 2017 1:15 pm

I would understand the AHI bar graphs and which category those events are in before I would go changing pressures based on an elevated AHI but no mention of what kind of events.
Make sure that what you want to fix with more pressure is fixable with more pressure.
If the AHI that is elevated is primarily Central...more pressure isn't going to fix things and could potentially make things worse.

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linuxman
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Re: AHI, chasing numbers

Post by linuxman » Thu Mar 16, 2017 1:17 pm

Pugsy wrote:I would understand the AHI bar graphs and which category those events are in before I would go changing pressures based on an elevated AHI but no mention of what kind of events.
Make sure that what you want to fix with more pressure is fixable with more pressure.
If the AHI that is elevated is primarily Central...more pressure isn't going to fix things and could potentially make things worse.
Indeed..thansk Pugsy. I assumed they would take a look at the events to mask sure they're obstructive..but agreed, that's not a good assumption to make .

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Pugsy
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Re: AHI, chasing numbers

Post by Pugsy » Thu Mar 16, 2017 1:40 pm

linuxman wrote:I assumed they would take a look at the events to mask sure they're obstructive..but agreed, that's not a good assumption to make .
You would be surprised at people just looking at the AHI and not bothering (or understanding) to learn what each category means and what to do. The think OMG AHI is high and I need more pressure and often it is that simple but it isn't always that simple.

Some time ago someone contacted me because "they kept increasing the pressure because the AHI was to high and the AHI is getting worse...not better"
They were up to 17 cm pressure and the AHI was indeed getting worse and worse....primarily central.
Once we looked at the breakdown into each event we figured out he was one of those people who had a line in terms of pressure where centrals were triggered and below the line the centrals weren't a big deal.
His line for pressure triggered centrals was 12 cm...as long as he stayed below that line his centrals weren't a big deal.
He didn't understand that you can't fix centrals with more minimum pressure on an apap machine.
So that's why I always mention "know the categories" when someone doesn't offer the AHI breakdown.
The guy I was talking about...ended up using 8 cm minimum and 12 max and his AHI never went over 3.0...and it was about half and half central and OA. He didn't have to spring the big bucks for ASV which was a good thing because he didn't have insurance.

I think LoBattery probably already knows this but just thought I would mention it in case he didn't or more importantly if some newbie came along and was reading this thread and thinking the same "OMG the AHI is too high and I need more pressure"....they might and they might not.

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palerider
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Re: AHI, chasing numbers

Post by palerider » Thu Mar 16, 2017 1:52 pm

linuxman wrote:
Pugsy wrote:I would understand the AHI bar graphs and which category those events are in before I would go changing pressures based on an elevated AHI but no mention of what kind of events.
Make sure that what you want to fix with more pressure is fixable with more pressure.
If the AHI that is elevated is primarily Central...more pressure isn't going to fix things and could potentially make things worse.
Indeed..thansk Pugsy. I assumed they would take a look at the events to mask sure they're obstructive..but agreed, that's not a good assumption to make .
looking back on the posters history makes that a rather unfounded assumption.

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zonker
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Re: AHI, chasing numbers

Post by zonker » Thu Mar 16, 2017 8:53 pm

palerider wrote:
linuxman wrote:
Pugsy wrote:I would understand the AHI bar graphs and which category those events are in before I would go changing pressures based on an elevated AHI but no mention of what kind of events.
Make sure that what you want to fix with more pressure is fixable with more pressure.
If the AHI that is elevated is primarily Central...more pressure isn't going to fix things and could potentially make things worse.
Indeed..thansk Pugsy. I assumed they would take a look at the events to mask sure they're obstructive..but agreed, that's not a good assumption to make .
looking back on the posters history makes that a rather unfounded assumption.
wow! what a great,insightful and ON TOPIC answer!

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