how to reduce ahi?

Hi everybody!

do you have any idea how to improve those numbers, please?
first
second

(sorry, imgur didn't want to make any thumbnails )

Do you take any medications of any kind? If so, what?

Did you sleep soundly with minimal wake ups during those nights or did you spend a lot of time awake with mask and machine on?

Have you tried turning the Flex exhale relief feature off?

Pugsy wrote:Do you take any medications of any kind? If so, what?

no medications at all

Did you sleep soundly with minimal wake ups during those nights or did you spend a lot of time awake with mask and machine on?

it was mostly in one go, both nights, just - as you noticed - on the 15.01 AHI screenshot I woke up at 9 and tried to fall back asleep as I was so tired, but stayed awake and eventually got up.

Have you tried turning the Flex exhale relief feature off?

Yes, and after a few hours I wake up in pain from all the air in my stomach
thank you for the answer

Did the number of Clear Airway/Central events happen to reduce when you had Flex turned off?

Turning Flex off is about all you can do to maybe (stress the maybe) affect the number of central apneas. For a very small percentage of people the use of exhale relief can create a bilevel situation that sometimes for some people will trigger centrals.
If turning off Flex didn't help...then you are one of that very small percentage of people.
Nothing else we can do with your machine will do anything for the centrals and the bulk of your AHI is central in nature.

If you look at the time frame around the known wake up time you had a large cluster of CAs immediately preceding the turning off of the machine at around 9:00.
Makes me wonder just how long prior to turning the machine off that you might have been awake and thus increasing the chance that those centrals are SWJ centrals (Sleep/Wake/Junk).

It's odd that you have periods of time where centrals are pretty much normal in number and then periods where there are very dense clusters of centrals. Makes me wonder how much of those dense clusters might be SWJ and not real.
I also can't help but wonder if some of those hyponeas might lean towards being centrals in nature.

Do you have a follow up appointment with your sleep doctor scheduled anytime soon?

Since you are having aerophagia issues with just the little bit of increase in pressure that turning off Flex will give you...I don't know if trying to reduce the OAs and hyponeas with more pressure would be a good idea or not.
With the idea being that maybe those OAs and hyponeas (assuming obstructive in nature) are causing some sort of arousal and the centrals are post arousal centrals which would make them SWJ.
It's going out on a long skinny limb for sure but I have seen it happen. Better reduce the obstructive stuff and the central flagged stuff gets reduced too when they are post arousal SWJ.

Your Central pattern doesn't look like what we would expect to see if this was complex sleep apnea going on brought on by cpap pressure. Doesn't mean it isn't but it sure doesn't look like what we would expect to see.
And there's no obvious pattern or relationship between periods of pressure increases and the CA clustering...you get them with no pressure increase anyway.

How long did you try having Flex turned off? Did you change the settings one way or another when you turned Flex off and did the CAs reduce at all with Flex off?

Thank you for your answers!

Yes I am trying to find a new doctor, GP appointment tomorrow for a referral.

And it was all not so bad before the last doctor reset all the settings, have had AHIs 15-20 ever since, they were around 4-5 before. But I can't seem to replicate how it was

So... To sum it up:
Without any flex: no sleep
With CFlex: lots of air, GERD, less CAs
With AFlex: no GERD, less air, more CAs

I'll try a few nights with aflex and higher pressure as you kinda sorta suggested? And if that doesn't help, will try to get used to less exhalation relief.

The Flex exhale relief drops the pressure a little upon exhale. It's flow base meaning it can vary depending on how forcefully you breathe but the most it can do is 2 cm even at a setting of 3.

If you remove Flex from...try reducing the pressure just a little to see if it helps with the aerophagia issues.

I am thinking maybe a tight range 7 min and 10 max.... It might let too many obstructive stuff through though. Gotta start somewhere though and that's as good a place to start as any.

At any rate..yes, you need a real sleep doctor helping you out here.

Until you get one I would back up and first try to figure out what pressures seem to trigger the aerophagia and then see what is going on in terms of the apnea stuff.

I don't know that the Flex is a culprit in the centrals...it might not have any impact at all.
Just a thought to try to see if it helps or not. If it doesn't help with the centrals then by all means use it to help with the aerophagia issues.

More aerophagia issues could very well be causing arousals which in turn some of those centrals might be post arousal centrals and not real. If we aren't comfortable we don't sleep so soundly.

Can you find one of those prior reports with the AHI of 4 or 5 and post it? Maybe I can spot something.

Thanks.
And I had aerophagia issues even with low pressures (5-7), it doesn't seem to be pressure related much.

Will find an "old" report and post it tomorrow

Bummer.
Some people get the puffer fish syndrome with the least little bit of pressure.
You may need a different machine...a bilevel but as to which bilevel at this time...dunno.

Can you also maybe zoom on the central cluster so we can see up close what the flow rate looks like?

Do this on the report dated Aug 26

Go to the Events tab and click on the Clear Airway category.
You will see a long list of each CA flagged event and when they happened.
Scroll down to near the bottom until you find the time frame around 8:50. Pick one of those flagged events that has 2 or 3 on either side of the time you choose. Then click on one of the flagged events.
Your graphs will change so that we can see the flow rate up close. Don't worry about not getting a whole bunch of CAs flagged events on the screen shot...you will be lucky to get 3 or 4 zoomed in this close but I need this level of zooming in to see what I am looking for.

Will do!

For the record, this night, with min pressure of 10, and AFlex down to 1 (from 3), got an AHI value of 9.1 (24 CAs, from 71 events total, that's all that the dreammapper app will show)

Here are the close-ups:

http://i.imgur.com/rsi9m2n.png
http://i.imgur.com/gFauRaf.png

(Just for the record, maybe this can be of some help to somebody later on, if you are on Ubuntu, with an SD-Card with a P-SERIES folder, make a copy of it and rename it to P-Series, as that is what SleepyHead is looking for.)

Shnorky wrote:For the record, this night, with min pressure of 10, and AFlex down to 1 (from 3), got an AHI value of 9.1 (24 CAs, from 71 events total, that's all that the dreammapper app will show)

Roughly 1/3 the AHI is central/CA. So roughly 3 centrals per hour. That would be acceptable but the 6 per hour other stuff isn't.
Wonder how much was spread out and how much was clustered.

How's the belly?

Pugsy wrote:

Shnorky wrote:For the record, this night, with min pressure of 10, and AFlex down to 1 (from 3), got an AHI value of 9.1 (24 CAs, from 71 events total, that's all that the dreammapper app will show)

Roughly 1/3 the AHI is central/CA. So roughly 3 centrals per hour. That would be acceptable but the 6 per hour other stuff isn't.
Wonder how much was spread out and how much was clustered.

How's the belly?

The belly was full but with no pain, thank you for asking
And will go to see a new doctor on Thursday! Yaay!

Is it possible that humidifier settings change AHI values?
Also, are there any important questions to ask the doctor?