High HI Low AI - Bad Sinuses

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
TedVPAP
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Re: High HI Low AI - Bad Sinuses

Post by TedVPAP » Sun Jan 07, 2018 10:32 am

NewtoThis wrote:
TedVPAP wrote:
If you have a deviated septum and your ENT recommends surgery, I would do it. I did when I was 17. Nasal breathing is preferred.
It just doesn't bother me all that much other than the CPAP mask. Im considering it though while I have the insurance.[/quote]

Surgery improved my sinus conditions.
When you say it doesn't bother you that much - do you mean that you don't mind mouth breathing all the time?

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Pugsy
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Re: High HI Low AI - Bad Sinuses

Post by Pugsy » Sun Jan 07, 2018 10:50 am

In terms of that elevated Hyponea Index...I wouldn't be happy with it if it were me.
I would want to try to reduce it by using more pressure if it were me as long as using more pressure didn't create more problems.
Knowing the S8 machines seemed to historically flag more hyponeas for whatever reason...I would still at least try to reduce them by trying more pressure (minimum when using auto mode) if it were me.
I may have to RISE but I refuse to SHINE.

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Sun Jan 07, 2018 6:38 pm

TedVPAP wrote:
NewtoThis wrote:
TedVPAP wrote:
If you have a deviated septum and your ENT recommends surgery, I would do it. I did when I was 17. Nasal breathing is preferred.
It just doesn't bother me all that much other than the CPAP mask. Im considering it though while I have the insurance.
Surgery improved my sinus conditions.
When you say it doesn't bother you that much - do you mean that you don't mind mouth breathing all the time?[/quote]

It doesn't bother me in the day. I never breathe through my mouth. It's just when the mask is on and my sinuses are having a bad day it makes things not fun.

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Sun Jan 07, 2018 6:40 pm

Pugsy wrote:In terms of that elevated Hyponea Index...I wouldn't be happy with it if it were me.
I would want to try to reduce it by using more pressure if it were me as long as using more pressure didn't create more problems.
Knowing the S8 machines seemed to historically flag more hyponeas for whatever reason...I would still at least try to reduce them by trying more pressure (minimum when using auto mode) if it were me.
Okay. I'll try bumping it up a little every night. Also going to try the full face mask.

Does EPR have any affect on HI? Also, would buying the ResMed chip scanner attachment give me any useful information? I found them online for like 50 bucks.

Thank you Pugsy.

TedVPAP
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Re: High HI Low AI - Bad Sinuses

Post by TedVPAP » Sun Jan 07, 2018 7:01 pm

NewtoThis wrote:
TedVPAP wrote:
NewtoThis wrote:
TedVPAP wrote:
If you have a deviated septum and your ENT recommends surgery, I would do it. I did when I was 17. Nasal breathing is preferred.
It just doesn't bother me all that much other than the CPAP mask. Im considering it though while I have the insurance.
Surgery improved my sinus conditions.
When you say it doesn't bother you that much - do you mean that you don't mind mouth breathing all the time?
It doesn't bother me in the day. I never breathe through my mouth. It's just when the mask is on and my sinuses are having a bad day it makes things not fun.[/quote]

So you are able to nasal breath adequately during the day, but problems at night.
I do better at night. The pillows force the air through the nose. Once the flow starts the passage stays open for me. My congestion comes back once I take the pillows off.

_________________
Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: AutoPAP 16-20, Ultimate Chin Strap http://sleepapneasolutionsinc.com/
Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Mon Jan 08, 2018 12:10 am

TedVPAP wrote:
NewtoThis wrote:
TedVPAP wrote:
NewtoThis wrote:
TedVPAP wrote:
If you have a deviated septum and your ENT recommends surgery, I would do it. I did when I was 17. Nasal breathing is preferred.
It just doesn't bother me all that much other than the CPAP mask. Im considering it though while I have the insurance.
Surgery improved my sinus conditions.
When you say it doesn't bother you that much - do you mean that you don't mind mouth breathing all the time?
It doesn't bother me in the day. I never breathe through my mouth. It's just when the mask is on and my sinuses are having a bad day it makes things not fun.
So you are able to nasal breath adequately during the day, but problems at night.
I do better at night. The pillows force the air through the nose. Once the flow starts the passage stays open for me. My congestion comes back once I take the pillows off.[/quote]

Yeah exactly. A spray of afrin is awesome though.

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Pugsy
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Re: High HI Low AI - Bad Sinuses

Post by Pugsy » Mon Jan 08, 2018 10:10 am

NewtoThis wrote: Does EPR have any affect on HI? Also, would buying the ResMed chip scanner attachment give me any useful information? I found them online for like 50 bucks.
Using EPR effectively lowers the pressure during exhale which lowers the overall average a bit and it can (for some people) bring that average down to a point where the airway isn't held open well enough and it collapses somewhat more easily...and you get OAs and/or Hyponeas as a result.
It depends on how much EPR you are using and the minimum pressure being used and are you already using such a low pressure that you are really close to the line where the airway needs more pressure to hold it open.
Example....if you need 7 cm pressure to keep the airway open for the most part but using exhale relief drops the pressure down to 5 ...the overall average might allow some events to happen where if you used a higher minimum so that the pressure during exhale didn't drop below 7 the airway wouldn't collapse.
When this does happen to people that have 2 choices..don't use EPR or just increase the minimum so that during exhale the pressure doesn't drop down to a level that doesn't hold the airway open optimally.

Getting the card reader so you can use ResScan software (SleepyHead is NOT compatible with the S8 machines) would let you see when those hyponeas are happening...and that's about all it will show you that might be remotely useful. Might show some clustering that might be related to sleeping position or REM stage sleep but that's all it will show so I don't know that I would invest in the card reader at this time.
ResScan is Windows only...so if you don't have a Windows computer you would need a different computer too.
I would rather see you put money towards a newer machine than back into the S8...IMHO.

Up to you if you really want to see when those hyponeas are happening or not. If it were me I would still want to kill them and not care when or why they were happening.

ResScan tutorial so you can see what ResScan will show you if you are interested.
http://montfordhouse.com/cpap/resscan_tutorial/
I may have to RISE but I refuse to SHINE.

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Mon Jan 08, 2018 10:51 pm

Pugsy wrote:
NewtoThis wrote: Does EPR have any affect on HI? Also, would buying the ResMed chip scanner attachment give me any useful information? I found them online for like 50 bucks.
Using EPR effectively lowers the pressure during exhale which lowers the overall average a bit and it can (for some people) bring that average down to a point where the airway isn't held open well enough and it collapses somewhat more easily...and you get OAs and/or Hyponeas as a result.
It depends on how much EPR you are using and the minimum pressure being used and are you already using such a low pressure that you are really close to the line where the airway needs more pressure to hold it open.
Example....if you need 7 cm pressure to keep the airway open for the most part but using exhale relief drops the pressure down to 5 ...the overall average might allow some events to happen where if you used a higher minimum so that the pressure during exhale didn't drop below 7 the airway wouldn't collapse.
When this does happen to people that have 2 choices..don't use EPR or just increase the minimum so that during exhale the pressure doesn't drop down to a level that doesn't hold the airway open optimally.

Getting the card reader so you can use ResScan software (SleepyHead is NOT compatible with the S8 machines) would let you see when those hyponeas are happening...and that's about all it will show you that might be remotely useful. Might show some clustering that might be related to sleeping position or REM stage sleep but that's all it will show so I don't know that I would invest in the card reader at this time.
ResScan is Windows only...so if you don't have a Windows computer you would need a different computer too.
I would rather see you put money towards a newer machine than back into the S8...IMHO.

Up to you if you really want to see when those hyponeas are happening or not. If it were me I would still want to kill them and not care when or why they were happening.

ResScan tutorial so you can see what ResScan will show you if you are interested.
http://montfordhouse.com/cpap/resscan_tutorial/
Trust me I want them dead : )

Turned the pressure up to 15, turned off EPR and used the Full Face Mask. I like the full face mask better but breathing through your mouth is weird. My cheeks were blowing up with air. When I woke up I was just breathing through my nose. Still, I like the mask much better. Only thing is Im swallowing a little bit of air at this high pressure.

AHI: 7.7
AI: 1.1
HI: 6.6
Pressure 15.00
EPR Off
Full Face

Compared to the night before----

AHI: 11.9
AI: 0.4
HI: 11.5
Pressure: 12.8
EPR: 2
Nasal Mask:

That's the lowest HI has ever been. You think I should try even higher than 15?? Just seems so high.

I feel like I just naturally breath very poorly because of anxiety and muscle tension.

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Pugsy
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Re: High HI Low AI - Bad Sinuses

Post by Pugsy » Mon Jan 08, 2018 11:14 pm

I don't know if I would want to be going higher than 15 without EPR just to kill a few hyponeas showing up on a machine that was known to report elevated hyponea counts. I have had aerophagia issues enough to know that I don't want them all the time and if I were to use 15 cm all night long there's a real good chance I would blow up like a puffer fish....and with higher pressures there's the greater chance of leaks being annoying.
There can sometimes come a point where killing something causes more problems than what you are trying to kill might be causing.

When I first started CPAP therapy the S8 was the latest and greatest from ResMed and people were bitching about the high hyponea count all the time.
Some people got nice low numbers but it sure seemed like most people didn't.
I never used a S8 machine...I started with Respironics so I have no personal experience to draw upon. I have no idea what my hyponea count on a S8 machine might have been.

What you might do is give the 15 a week and see how things go and then decide if you want to try a little more.
I may have to RISE but I refuse to SHINE.

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Thu Jan 11, 2018 2:15 am

Pugsy wrote:I don't know if I would want to be going higher than 15 without EPR just to kill a few hyponeas showing up on a machine that was known to report elevated hyponea counts. I have had aerophagia issues enough to know that I don't want them all the time and if I were to use 15 cm all night long there's a real good chance I would blow up like a puffer fish....and with higher pressures there's the greater chance of leaks being annoying.
There can sometimes come a point where killing something causes more problems than what you are trying to kill might be causing.

When I first started CPAP therapy the S8 was the latest and greatest from ResMed and people were bitching about the high hyponea count all the time.
Some people got nice low numbers but it sure seemed like most people didn't.
I never used a S8 machine...I started with Respironics so I have no personal experience to draw upon. I have no idea what my hyponea count on a S8 machine might have been.

What you might do is give the 15 a week and see how things go and then decide if you want to try a little more.
Okay. I think I'm going to try to bump it up a little very few days. Last night at 15 pressure HI was 6.6 so I think Im okay with that considering it tends to over estimate the HI count. Plus I bought the card reader so I'll wait to see what it shows me : )

I LOVE the full face mask btw. I end up breathing through my nostrils throughout the night but it's much more comfortable.

Since starting the CPAP I am SO MUCH less tired in the day. So even with the HI hi I'm happy.

Thank you Pugsy

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Muse-Inc
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Re: High HI Low AI - Bad Sinuses

Post by Muse-Inc » Thu Jan 11, 2018 5:45 am

Suggestions

Melatonin 1 mgm 20-30 mins before bed (std dose is 3 mgms but it makes me feel like cr#p the next day). This helps me sleet through the night.

Congestion: try increasing humidity OR if already high try decreasing. I have chronic congestion problems and often get completely stopped up overnight, click on the name of the mask I wear (Hybrid) and check it out. I buy from our host cpap.com. Comes with 3 sizes of nasal pillows and 3 sizes of oral cushions (they cover the mouth) making this a Full Face Mask (FFM). You can breathe through nose or mouth without losing therapy air. If you are congested during the day, you might be dehydrated; if you are, try drinking more water in AM (so not getting up to pee at night).

If I were you, I'd set EPR to 3 and leave it there for at least a week to see if it helps with breathing/sleeping.

S8 APAP average AHI was 1.4 (increased hypop number), S9 APAP average AHI is 0.1

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NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Sat Jan 13, 2018 2:31 am

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NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Sat Jan 13, 2018 2:33 am

Muse-Inc wrote:Suggestions

Melatonin 1 mgm 20-30 mins before bed (std dose is 3 mgms but it makes me feel like cr#p the next day). This helps me sleet through the night.

Congestion: try increasing humidity OR if already high try decreasing. I have chronic congestion problems and often get completely stopped up overnight, click on the name of the mask I wear (Hybrid) and check it out. I buy from our host cpap.com. Comes with 3 sizes of nasal pillows and 3 sizes of oral cushions (they cover the mouth) making this a Full Face Mask (FFM). You can breathe through nose or mouth without losing therapy air. If you are congested during the day, you might be dehydrated; if you are, try drinking more water in AM (so not getting up to pee at night).

If I were you, I'd set EPR to 3 and leave it there for at least a week to see if it helps with breathing/sleeping.

S8 APAP average AHI was 1.4 (increased hypop number), S9 APAP average AHI is 0.1
The humidity has helped a lot. With the full face mask I've adjusted to the pressure. Comfortably sleeping but HI is still high

NewtoThis
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Re: High HI Low AI - Bad Sinuses

Post by NewtoThis » Sat Jan 13, 2018 2:37 am

Pugsy wrote:I don't know if I would want to be going higher than 15 without EPR just to kill a few hyponeas showing up on a machine that was known to report elevated hyponea counts. I have had aerophagia issues enough to know that I don't want them all the time and if I were to use 15 cm all night long there's a real good chance I would blow up like a puffer fish....and with higher pressures there's the greater chance of leaks being annoying.
There can sometimes come a point where killing something causes more problems than what you are trying to kill might be causing.

When I first started CPAP therapy the S8 was the latest and greatest from ResMed and people were bitching about the high hyponea count all the time.
Some people got nice low numbers but it sure seemed like most people didn't.
I never used a S8 machine...I started with Respironics so I have no personal experience to draw upon. I have no idea what my hyponea count on a S8 machine might have been.

What you might do is give the 15 a week and see how things go and then decide if you want to try a little more.
Hi Pugsy,

Uploaded screenshots of the ResScan software. Sorry the images are so big.

So all those little blue dots are hypopneas throughout the night? And the red bars are the apneas and the number on top is the length of the apnea?

If you could let me know if this shows me anything useful Id appreciate it.

Thank you.

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Pugsy
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Re: High HI Low AI - Bad Sinuses

Post by Pugsy » Sat Jan 13, 2018 9:18 am

NewtoThis wrote:So all those little blue dots are hypopneas throughout the night? And the red bars are the apneas and the number on top is the length of the apnea?
Yes to all 3 questions.
Hyponeas didn't get a duration in seconds ...only the OAs.
S8 machines didn't give a flow rate (breathing) graph. S8 machines didn't give us anything to really monitor or look at in terms of what was really happening in terms breathing that be causing flags. All the good useful stuff was added with the S9 models and of course the subsequent AirSense models.

Your reports look pretty typical for what we used to see from S8 users bitching about the hyponea count.

If you notice the hyponeas also seem to increase when you have the OA cluster late in the night...probably you are either in REM sleep stage or are on your back when you see the OA cluster.
They do seem to reduce with the higher pressure so that makes me think they are "real" since they seem to respond and increase when OAs increase.

Personally I was never one to pooh pooh off a high hyponea count totally by the "cut it in half" theory because we had nothing to prove that it was okay to dismiss half those hyponeas just because we wanted more acceptable numbers. And we had zero way to evaluate how important they were with the S8 machines.
Hyponeas are flow reductions that aren't "bad" enough to earn an OA flag but they are important enough to be included in the AHI numbers AND for auto adjusting algorithms to try to increase the pressure in an effort to kill them. Somebody thought they were very important or they wouldn't be on the hit list or naming list. So I am not about to pooh pooh them off by cutting the "number" to just get a better number. I know some people did..but I wouldn't have done it if I had ever been using a S8 machine and I had only high hyponeas to worry about.

Now was this "high hyponea" count thing something because of the people with the flow reductions or was it from the sensitivity of the sensors and the machine's firmware algorithm for naming stuff? I don't know but I did see plenty of S8 reports where the hyponea count as nice and low....so not everyone had high hyponea counts. It's not something at was universally a problem with the Hyponea numbers. It was seen often though and often enough that people came up with the "cut them in half" thing in an effort to get some number they would wrap their brains around to prove to themselves the therapy was effective/acceptable enough.

Same people later reported nice much more reasonable Hyponea counts when they went to the S9 model machines and still using the same pressure.
Makes a person wonder what it was that caused the difference if the pressure was unchanged between the 2 machines. Was it a sensitivity issue?
Or a change in the way that ResMed defined hyponeas? We were never told what or why or even if there was a difference in that regard.
We know that a lot of things changed (for the better) with the change to the S9 machines. Different auto adjusting algorithm for one thing but we were never told if the definitions or sensitivity were changed.

The S8 machine was discontinued in 2010. It was one of the top dogs in its day but its day has long passed in terms of technology. It has its limitations and when compared to the newer models...the limitations were significant. It is what it is.

Now for you....about all you have available to you with this machine is "increase the pressure" and see if the hyponea count continues to reduce with more pressure. It seems to work with you but I know people who it didn't work with. Unfortunately it means you are using pressures near the maximum available with the S8 machine.

If you were reporting that you were feeling great and sleeping great then I don't know that I would worry so much about those hyponeas. They would probably still be in the back of my mind because I am not one of those people to so quickly dismiss the number without proof that it was okay to dismiss half of them and there was never any proof. Now maybe it was okay and didn't mean much but for me there was never any proof and I try to deal with provable facts whenever possible. It's not always clear cut even now but was even less clear cut with the S8 models.

Again I wish you had bought at least the S9 Elite and preferably the S9 AutoSet because I am betting that you only need the higher pressures some of the night and not all of the night.
My OSA is worse in REM...sometimes I need 8 cm more in REM and let me tell you it is much nicer to use 8 cm for 80% of the night and let the machine go to 16 if it wants to for the 20% of the night I am in REM...than to use 16 all night long.
I don't know if your clusters are REM related or supine related but for me I would prefer auto adjusting no matter what the reason and sleep however I wanted and let the machine sort it out. It's not always so easy to stay on one's side (if supine sleeping is the culprit) and we can't control REM so why not just cover both bases with a machine that will sort it out for you.
I may have to RISE but I refuse to SHINE.