Is AHI the thing I need to improve?

Hi Folks,

I've just been diagnosed and have had 3 nights with my DreamStationAutoCPAP. I was told by my Doctor my AHI was 43 during my test.

I'm looking at the results using SleepyHead and I can see the AHI was 13.21 on Wed, 7.32 on Thu and 5.78 last night (Fri). Friday was the best night sleep I've had so far.

Is this the key metric I'm trying to improve or is there something else I should be looking out for? I can see from the graphs when the pressure ramps up, I wake up and press the ramp button so I presume long periods of sleep are also a goal?

Here is the SleepyHead data from last night.


Any thoughts or comments very welcome - I know nothing about any of this.

Many Thanks!

For me it is 2 goals...and the number one goal for me is good sleep and feel decent during the day.
Without good sleep and feeling decent the AHI is really rather meaningless. An AHI of less than 1.0 and poor sleep and not enough hours of sleep will still mean I feel like crap.
Numbers alone mean nothing really....don't necessarily guarantee good sleep or feel good.

Your AHI is a bit too high...coming down of course which is to be expected when someone is new to therapy. When we first start this therapy we don't sleep so great just because there is an alien stuck on our face and blowing air up our nose and it just takes the body and brain some time to get into the new "normal" routine.
I suspect that some of your earlier nights with the high AHI probably had a lot of awake breathing irregularities getting flagged.
With time as your brain gets more used to things those awake breathing flags will be reduced as you sleep more soundly.

All that aside....your machine is set pretty much wide open and there seems to be a really wide range of where the pressures want to go.
The minimum pressure is the most critical pressure setting and in your situation it needs to be higher. How much higher I don't know. Too soon to really get much of an idea where the pressures will end up.
The snores and OAs and hyponeas are numerous and densely clustered (probably REM related or maybe you were on your back during those dense clusters).

The cluster of events is also enough to likely causing wake ups...so some of your wake ups during the night might be from the events themselves disturbing your sleep.

I would start increasing the minimum pressure slowly and watch the clusters. While the AHI isn't horrible last night...the clusters are.
Often when the minimum pressure is a bit higher and more optimal the maximum pressure will drop meaning the machine won't have the need to go so high to try to fix a problem if the problems is better prevented in the first place.
Prevention is better than trying to fix after the face.

I would think at starting minimum of 6 cm would be a good place to start...probably need a little more but not sure because sometimes small changes give us huge results. Besides going up is easier if you take small steps. Making a big change from say 4 to 8...not going to be all that comfortable and if we aren't comfortable it's hard to go to sleep and remember...gotta get the sleep first and foremost because without sleep all this stuff means nothing.

KC1977 wrote:Is AHI the key metric I'm trying to improve

Yes, AHI and leak line are the key metrics for CPAP therapy.

Of course, ultimately, you are trying to improve sleep quality and sleep time.

Midnight Strangler wrote:

KC1977 wrote:Is AHI the key metric I'm trying to improve

Yes, AHI and leak line are the key metrics for CPAP therapy.

Of course, ultimately, you are trying to improve sleep quality and sleep time.

And TRUE compliance, NOT INS compliance, everytime you fall asleep, use it. Jim

Goofproof wrote:

Midnight Strangler wrote:

KC1977 wrote:Is AHI the key metric I'm trying to improve

Yes, AHI and leak line are the key metrics for CPAP therapy.

Of course, ultimately, you are trying to improve sleep quality and sleep time.

And TRUE compliance, NOT INS compliance, everytime you fall asleep, use it. Jim

Excuse my ignorance, but what is INS compliance?

Usually people are told 4 hours is needed for compliance, this is INS compliance, whats needed to keep the XPAP Police from taking your XPAP Machine from you.

It has nothing to do with what your body needs, Treatment starts when you get yourmachine and mask set up correctly, and you use your equipment every time you could fall asleep. Jim

It's Insurance compliance. Your insurance company can refuse to pay for it if you don't use it for at least 4 hrs per day (for the first month, I believe). The the DME will try to get it back from you.That's my recollection.

RiverDave wrote:It's Insurance compliance. Your insurance company can refuse to pay for it if you don't use it for at least 4 hrs per day (for the first month, I believe). The the DME will try to get it back from you.That's my recollection.

Wow. I didn't know that. Thanks for the heads up.

Most insurance companies use the same compliance requirements that Medicare uses. You must use the machine for at least 4 hours a night for 75% of the time within a 30 day period. In other words, you must use it for 21 out of 30 nights. Medicare gives you 90 days to fulfill this requirement. I managed to fulfill my compliance requirement in the first 22 nights. The first night I only had it on for a little over two hours.

Okie bipap wrote: You must use the machine for at least 4 hours a night for 75% of the time within a 30 day period. In other words, you must use it for 21 out of 30 nights.

That's 70%.

If you're not already, try doing some nasal cleansing before bedtime to see if you can reduce those snores. Increasing minimum pressure (as previously mentioned) may help some, but the increasing pressure isn't squashing the snores. APAPs chase Snores and Flow Limitations with the (programmed) assumption that they precede apneas. Sometimes the do and sometimes they don't.

Your report is a prime example of why fixed pressure can help identify problems and solutions. It's also an example of how ranges of pressures (especially when they're too wide open) can cause/create more problems.

Welcome to the forum and keep posting reports as you tweak your settings.


Den

.

Wulfman... wrote:If you're not already, try doing some nasal cleansing before bedtime to see if you can reduce those snores. Increasing minimum pressure (as previously mentioned) may help some, but the increasing pressure isn't squashing the snores. APAPs chase Snores and Flow Limitations with the (programmed) assumption that they precede apneas. Sometimes the do and sometimes they don't.

Your report is a prime example of why fixed pressure can help identify problems and solutions. It's also an example of how ranges of pressures (especially when they're too wide open) can cause/create more problems.

Welcome to the forum and keep posting reports as you tweak your settings.


Den

.

Thanks - I'll try increasing the minimum pressure.

Are the snores actually a problem? I use a nasal spray before bed and I've always snored

Why do you think fixed would be better than a range?

Thanks!

Pugsy wrote:For me it is 2 goals...and the number one goal for me is good sleep and feel decent during the day.
Without good sleep and feeling decent the AHI is really rather meaningless. An AHI of less than 1.0 and poor sleep and not enough hours of sleep will still mean I feel like crap.
Numbers alone mean nothing really....don't necessarily guarantee good sleep or feel good.

Your AHI is a bit too high...coming down of course which is to be expected when someone is new to therapy. When we first start this therapy we don't sleep so great just because there is an alien stuck on our face and blowing air up our nose and it just takes the body and brain some time to get into the new "normal" routine.
I suspect that some of your earlier nights with the high AHI probably had a lot of awake breathing irregularities getting flagged.
With time as your brain gets more used to things those awake breathing flags will be reduced as you sleep more soundly.

All that aside....your machine is set pretty much wide open and there seems to be a really wide range of where the pressures want to go.
The minimum pressure is the most critical pressure setting and in your situation it needs to be higher. How much higher I don't know. Too soon to really get much of an idea where the pressures will end up.
The snores and OAs and hyponeas are numerous and densely clustered (probably REM related or maybe you were on your back during those dense clusters).

The cluster of events is also enough to likely causing wake ups...so some of your wake ups during the night might be from the events themselves disturbing your sleep.

I would start increasing the minimum pressure slowly and watch the clusters. While the AHI isn't horrible last night...the clusters are.
Often when the minimum pressure is a bit higher and more optimal the maximum pressure will drop meaning the machine won't have the need to go so high to try to fix a problem if the problems is better prevented in the first place.
Prevention is better than trying to fix after the face.

I would think at starting minimum of 6 cm would be a good place to start...probably need a little more but not sure because sometimes small changes give us huge results. Besides going up is easier if you take small steps. Making a big change from say 4 to 8...not going to be all that comfortable and if we aren't comfortable it's hard to go to sleep and remember...gotta get the sleep first and foremost because without sleep all this stuff means nothing.

Thanks

I'll increase the minimum to 5 and work from there. I tried starting at 6 last night but it felt too high so I went back to 4.

When you say the clusters are horrible what exactly do you mean?

I don't know if it's just optimism but I've felt better this last few days than I have in a while. I often wake feeling tired and as if I could just all day.

KC1977 wrote:

Wulfman... wrote:If you're not already, try doing some nasal cleansing before bedtime to see if you can reduce those snores. Increasing minimum pressure (as previously mentioned) may help some, but the increasing pressure isn't squashing the snores. APAPs chase Snores and Flow Limitations with the (programmed) assumption that they precede apneas. Sometimes the do and sometimes they don't.

Your report is a prime example of why fixed pressure can help identify problems and solutions. It's also an example of how ranges of pressures (especially when they're too wide open) can cause/create more problems.

Welcome to the forum and keep posting reports as you tweak your settings.


Den

.

Thanks - I'll try increasing the minimum pressure.

Are the snores actually a problem? I use a nasal spray before bed and I've always snored

Why do you think fixed would be better than a range?

Thanks!

Well, too many snores could be a sign of nasal congestion and not getting enough airflow coming in.
On a side note, my snore numbers when I started were off the charts (in the hundreds) so that's where my personal experience comes from on this subject. But, I had very few AHI events so it was more of a "sound effects" issue. I subsequently learned to do some nasal cleansing and got my snores down to some very low numbers (less than 2.0 overall).

Since Snores and Flow Limitations are what drive APAPs to increase pressures, I would think either straight pressure or a very narrow range might be the best option. Your snores don't subside until your pressures really get "up there", so some nasal cleansing may allow you to use a minimal range or fixed pressure.

I hope you're not using Afrin for a nasal spray. It has been known to have a rebound effect and subsequent dependence on it. Other saline-type sprays should be fine or Neti-pot or other water-type irrigation routines work, too.

So, snores are mainly a "problem" when using ranges of pressure if they actually don't precede apnea or hypopnea events.


Den

.

Wulfman... wrote:
Well, too many snores could be a sign of nasal congestion and not getting enough airflow coming in.
On a side note, my snore numbers when I started were off the charts (in the hundreds) so that's where my personal experience comes from on this subject. But, I had very few AHI events so it was more of a "sound effects" issue. I subsequently learned to do some nasal cleansing and got my snores down to some very low numbers (less than 2.0 overall).

Since Snores and Flow Limitations are what drive APAPs to increase pressures, I would think either straight pressure or a very narrow range might be the best option. Your snores don't subside until your pressures really get "up there", so some nasal cleansing may allow you to use a minimal range or fixed pressure.

I hope you're not using Afrin for a nasal spray. It has been known to have a rebound effect and subsequent dependence on it. Other saline-type sprays should be fine or Neti-pot or other water-type irrigation routines work, too.

So, snores are mainly a "problem" when using ranges of pressure if they actually don't precede apnea or hypopnea events.


Den

.

Thanks Den. I see what you mean. If I look at the night before I see the snores subsided at the top of the ramps. By nasal cleaning do you mean more than a spray? I'd try anything if it would help. My sinuses have never been great and I got a full face mask since I know I breathe a lot through my mouth.

I will try a raised minimum tonight. I know when I wake and the pressure is 16 I need to hit the ramp button but maybe I'll get used to it. I really appreciate your help!