Tips for lowering AHI?

Finally more or less content with the fit of my Mirage Liberty with the nasal pillows. The pillows still have to be adjusted multiple times in the night, and there's a little leakage around the mouth, but not bad. Got the CPAP pillow as well, which helps.

Last night AHI 3.5, 0% leakage, 90% pressure 10.5. Machine set to 9.5 low, 11.5 high. Heater/humidity set at 3 (out of 10).

My question is this: how have many of you gotten the AHI under 1.0? Just continuously fiddling with the settings? What settings?

It varies by machine, mask,settings etc. So what works for my setup, may not work for you. I've done a lot of adjusting--different mask sizes,headgear adjustments, machine settings,etc. I can't seem to get leaks under control, but my AHI still remains low. I'm on a mini-streak of AHI under 1.0, but I'm not sure it's ever been higher than 3--and I think that was a fluke reading.

Last night my leak rate was 75L/m but my AHI was 0.7, at a pressure of 10, EPR off (new change), and humidity at 3. I wear a FF mask.

Wanted to ask: How do you feel?

I think it is a great goal to give yourself the optimal treatment you can give yourself, and there are many knowledgable and experienced users here that I am sure will offer you great ideas on how you can reduce events with your equipment. But, I do want to point something out in case it is playing a role in your desire to lower your AHI (and maybe this isn't playing a role at all, but it is good for people to know).

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

So, if you see ResMed S9 users getting AHI's like 0.3, and you are getting AHI's of 3.5 with a different machine, and you are wondering how you can get your AHI under 1 like the S9 users are getting, just remember that the S9 is likely not counting AHI's the same as your machine.

But, as for you getting the lowest number of events you can get on your machine, what some people do is raise their min pressure to their 90%ile value.

I recall reading that for some significant proportion of individuals (~50%?), apnea is partly positional, and that side-sleeping rather than supine sleeping reduces the number of events. Some people sleep with something on their back to try to keep themselves on their sides.

Hueffenhardt wrote:I think it is a great goal to give yourself the optimal treatment you can give yourself, and there are many knowledgable and experienced users here that I am sure will offer you great ideas on how you can reduce events with your equipment. But, I do want to point something out in case it is playing a role in your desire to lower your AHI (and maybe this isn't playing a role at all, but it is good for people to know).

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

So, if you see ResMed S9 users getting AHI's like 0.3, and you are getting AHI's of 3.5 with a different machine, and you are wondering how you can get your AHI under 1 like the S9 users are getting, just remember that the S9 is likely not counting AHI's the same as your machine.

But, as for you getting the lowest number of events you can get on your machine, what some people do is raise their min pressure to their 90%ile value.

Hi, from where did you take this:

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

I am asking b/c it does not make sense to me that one kind of CPAP would show an AHI which is 10 times larger then on another CPAP, especially mfg by the same company. If it would be correct then the Sleep Studies would be useless b/c the Doctors Owners responsible for these studies acquire the test equipment to closly match their results to the CPAPs available to us on the market.

Also, what did you mean by: as for you getting the lowest number of events you can get on your machine, what some people do is raise their min pressure to their 90%ile value.

Why reduce a sensitivity of a machine if you are really interested in the actual true values?

wolewyck wrote:I recall reading that for some significant proportion of individuals (~50%?), apnea is partly positional, and that side-sleeping rather than supine sleeping reduces the number of events. Some people sleep with something on their back to try to keep themselves on their sides.

Hi, I recall reading it too and that's why in sleep studies they titrate while you're on your back. Probably b/c of the following study done by Israelis showing that you need 2 cm H2O higher pressure to equal the effects of lowering the AHI then in other body positions:

http://www.ncbi.nlm.nih.gov/pubmed/11035672

http://www.talkaboutsleep.com/sleep-dis ... ract90.htm


Oy, those Israelis make problems also for CPAPniks. What I suppose to do to lower my AHI being at 24 and taken by S9 Elite CPAP while lying supine? Does it pay to build a coffin 12" wide inside, and lie in it on my side, instead of raising the pressure by 2 cm H2O?

Treppenwitz, where are you?

avi123 wrote: Hi, from where did you take this:

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

I am asking b/c it does not make sense to me that one kind of CPAP would show an AHI which is 10 times larger then on another CPAP, especially mfg by the same company. If it would be correct then the Sleep Studies would be useless b/c the Doctors Owners responsible for these studies acquire the test equipment to closly match their results to the CPAPs available to us on the market.

The reason for the difference is because the sleep lab uses something like 24 sensors to evaluate your condition where the xPAP machine only uses 1. Each manufacturer tries to come up with their "best guess" as to what is going on, but as more research is done, better algorithms are devised. If an older machine is using an older algorithm, a newer machine with a newer algorithm may come up with a different number.

avi123 wrote:I am asking b/c it does not make sense to me that one kind of CPAP would show an AHI which is 10 times larger then on another CPAP, especially mfg by the same company.

Edited my remarks. I see that there are still discussions about one machine vs another. I will only make this statement below since I have not read any of the other. Looks like we will always have the one machine scores differently thing......

Here is some history. There has been numerous discussions and cussings about the difference in the ResMed and Respironics machines. Specifically how it appeared that the criteria for the HI indexes may be a little different. It seemed like ResMed users consistently would score a few more slightly elevated HI indexes. This was mainly discussed back a couple of years ago when the main machines used were the M Series Respironics and the S8 series with ResMed. I won't reopen that can of worms. Don't know if there is that much of a difference in the way each company addresses their event criteria now with the new machines. I have been gone for the past year. There are differences in how each company chooses to address events or hints of events. The gurus here can dig a whole lot deeper than I ever thought of going to explain it. Some ResMed people (users) on their own used to sort of do a mental 50% reduction in HI.

avi123 wrote:

Hueffenhardt wrote:I think it is a great goal to give yourself the optimal treatment you can give yourself, and there are many knowledgable and experienced users here that I am sure will offer you great ideas on how you can reduce events with your equipment. But, I do want to point something out in case it is playing a role in your desire to lower your AHI (and maybe this isn't playing a role at all, but it is good for people to know).

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

So, if you see ResMed S9 users getting AHI's like 0.3, and you are getting AHI's of 3.5 with a different machine, and you are wondering how you can get your AHI under 1 like the S9 users are getting, just remember that the S9 is likely not counting AHI's the same as your machine.

But, as for you getting the lowest number of events you can get on your machine, what some people do is raise their min pressure to their 90%ile value.

Hi, from where did you take this:

I can't find the thread right now, but you should know that it is not very helpful to compare AHI's between different machines because they count events differently. For instance, a person's AHI's on a ResMed S8 are likely to be higher (maybe as much as 10 times higher) than their AHI's on a ResMed S9 at the same pressure and with the same mask.

I am asking b/c it does not make sense to me that one kind of CPAP would show an AHI which is 10 times larger then on another CPAP, especially mfg by the same company. If it would be correct then the Sleep Studies would be useless b/c the Doctors Owners responsible for these studies acquire the test equipment to closly match their results to the CPAPs available to us on the market.

Also, what did you mean by: as for you getting the lowest number of events you can get on your machine, what some people do is raise their min pressure to their 90%ile value.

Why reduce a sensitivity of a machine if you are really interested in the actual true values?

Here is the thread: viewtopic/t56345/ResScan-UnderReporting ... g-or-.html

You'll see a poster posted his AHI scores on a ResMed S9 AutoSet and the Intellipap over the same time period. His AHI on the S9 were a tenth of his AHI's on the Intellipap (for instance 0.3 vs 3.0). The original poster in that thread lays out why he thinks the difference in AHI is not due to the S9 giving that much better treatment. In the midst of the thread a chart shows how different companies count hypopneas. There are other threads showing showing variations between the S8 and S9, etc. The consensus seems to be to not compare AHI numbers between makes and models, but one can compare one's scores from the same machine from night to night.

Crusher and Pugsy, I was told by my sleep doctor who as a partner in the group of doctors manages the sleep clinic owned by the group, that the purpose of sleep is to acertain that a CPAP could help patients overcome sleep disorders by checking about 20 parameters. The most important parameter is achieving " normal" sleep architecture, i.e. the stages of sleep including REM sleep. Check this about the stages:

http://web.mst.edu/~psyworld/general/sl ... stages.pdf

However, the Sleep Study's target data recipients are the patients themselves (plus their medical insurances). So when the Sleep Study Clinic does the titration the results are meant for the patients CPAPs home care, by using the available machines on the market at the present time. This is the Sleep Study objective.

So the question in my above post related to this issue and NOT to the latest progress in OSA CPAP treatment.

Here is the data from Hueffenhardt's
link:

Using both the IntelliPAP AutoAdjust and the S9 AutoSet for a while now, and alternating usage to get an idea of the differences between machines and reports. I am keeping the settings identical between the two as much as possible - so the min/max pressures, ramp time and start are the same. I *did* make an upward adjustment in the min/max settings to both machines - raising the min to 6.0 and the max to 12.0. As best I can tell both devices and software are using the same parameters for event detection, hence, that should not be causing any differences.

Anyway - here is a table of results - just showing AHI for now. ResScan consistently reports MUCH lower AHI. That would be a good thing *IF* it can be believed. Since SmartLink reports considerably higher AHI, it calls BOTH into question. My numbers even on the high side do not seem to be a serious concern, but the large differences in reported AHI between the two devices is at least curious.

Sep 27/28 - AHI 1.33 (IP)
Sep 28/29 - AHI 2.86 (IP)
Sep 29/30 - AHI 0.6 (S9)
Sep 30/Oct 01 - AHI 0.3 (S9)
Oct 02/03 - AHI 0.2 (S9)
Oct 03/04 - AHI 0.7 (S9)
Oct 04/05 - AHI 5.19 (IP)
Oct 05/06 - AHI 3.43 (IP)
Oct 06/07 - AHI 4.03 (IP)
Oct 07/08 - AHI 3.25 (IP)
Oct 08/09 - AHI 3.55 (IP)
Oct 09/10 - AHI 0.2 (S9)
Oct 10/11 - AHI 0.2 (S9)
Oct 11/12 - AHI 0.3 (S9)

A while back I watched the excellent DeVilbiss tutorials on their process for identifying and responding to events. It inspired confidence that DeVilbiss has it 'right' - which makes me concerned that ResScan is UNDER-reporting events.

Any thoughts on how to determine which of the two (or neither) are accurate?

Reply, IMO, all the above data is almost meaningless b/c all the values of AHIs are below 5. It could be within the "allowed deviation" for such type of medical equipment.

Let me ask this: why an OSA patient on CPAP should be "dying" to reduce his/her AHI from 2 to 0.2, isn't it ridiculous?

OntarioKevin wrote:Finally more or less content with the fit of my Mirage Liberty with the nasal pillows. The pillows still have to be adjusted multiple times in the night, and there's a little leakage around the mouth, but not bad. Got the CPAP pillow as well, which helps.

Last night AHI 3.5, 0% leakage, 90% pressure 10.5. Machine set to 9.5 low, 11.5 high. Heater/humidity set at 3 (out of 10).

My question is this: how have many of you gotten the AHI under 1.0? Just continuously fiddling with the settings? What settings?

As other poster's have stated, it's positional, machine related, and I'll add: Individualized.

You will find that certain medications you may be on, your sleep hygiene, the amount of food you ate for the last meal as well as the time of the last meal, the amount of alcohol in your system, the temperature of your environment all make a difference in contributing to your AHI.

Keeping your leaks low to zero, maintaining good sleep hygiene, standardizing your diet, minimizing alcohol intake, taking only necessary medications, what machine you are using, etc all will contribute to a standardized and individualized AHI for you.

Individuals on certain blood pressure medications and anti-depressants for example, are not seeing the lower levels around 0-2....but usually 3-5's.....

Look at all of these factors, and rely on how YOU feel.

avi123 wrote:Any thoughts on how to determine which of the two (or neither) are accurate?

Reply, IMO, all the above data is almost meaningless b/c all the values of AHIs are below 5. It could be within the "allowed deviation" for such type of medical equipment.

Let me ask this: why an OSA patient on CPAP should be "dying" to reduce his/her AHI from 2 to 0.2, isn't it ridiculous?

Sorry, I have no answer and to be honest, no opinion about differences in machines. I have been away from the forum for a year and way behind on sorting through all stuff. Even when I was current, much went over my head. I was always curious if my M series APAP would give me much different data from an S8 but I never had a chance to compare. Heck, would the new System One give me different data now? Toying with getting one but husband wanted a bigger TV for the Super Bowl so..... I had always thought that different companies could indeed score data differently but without emperical (sp?) data so very hard to tell and then we have to factor in each person may have many variable nights so would have to get lots of nights to compare from.

Personally, I don't hold to the 5 AHI gold standard for everyone. Early on in therapy I saw 5 AHI often and felt like crap 99% of the time but on a rare occasion I would have something double that and feel the "miracle". Go figure. I discovered it wasn't so much my AHI average that gave me a better indicator of "how I should feel", It was only when I saw my reports that I realized that I often had some pretty nasty clusters in REM sleep but nothing else to speak of anywhere else. So even though for 4 hours out of 6 I was having essentially zero events, I would rock and roll in REM and it sort of skewed by overall average. Same thing goes for leak average in a way. This is entirely my own thinking about what I went through for months and months trying to sort through the numbers and the crappy way I felt 99% of the time. I discovered that if I was just looking at the AHI, I would have felt better with less than 2. AHI of 5 didn't get it for me.

Why do people with a 2 AHI want a 0.2? I never wondered so much about it as I wondered about the brand new people reporting a 1.2 on first and second nights and wanting to tweak to get below zero. I think that it gives our mind some sort of validation that we are doing the very, very best we can. The mind is a powerful medicine. The numbers didn't mean jack if I felt like crap. But when I felt better at 1.2 instead of 3.2 it gave me hope and more impetus to keep going. So I have a little bit different take on things as some people. I go about looking at things a little different. Different strokes for different folks has always been my thinking.

Oops, hubby has screwed up the new TV AGAIN, gotta go fix it AGAIN....

OntarioKevin wrote: Last night AHI 3.5, 0% leakage, 90% pressure 10.5. Machine set to 9.5 low, 11.5 high. Heater/humidity set at 3 (out of 10).

My question is this: how have many of you gotten the AHI under 1.0? Just continuously fiddling with the settings? What settings?
Finally more or less content with the fit of my Mirage Liberty with the nasal pillows. The pillows still have to be adjusted multiple times in the night, and there's a little leakage around the mouth, but not bad. Got the CPAP pillow as well, which helps.

Last night AHI 3.5, 0% leakage, 90% pressure 10.5. Machine set to 9.5 low, 11.5 high. Heater/humidity set at 3 (out of 10).

My question is this: how have many of you gotten the AHI under 1.0? Just continuously fiddling with the settings? What settings?

I have often had an AHI under 1.0 BUT it wasn't until months into treatment. Most of the time I now average between 1 and 2. My goal was never the number so much but how I felt. Geez, the good numbers came early but the good feeling was elusive. I have already mentioned my REM sleep increase in events. It was this way during sleep study too. I barely had 10 events per hour in non REM but well over 50 in REM with desats in O2 to 70%. So if we are looking at just numbers it really is just a guideline that has come about because we seem to need a number as a validation point, for diagnosis, as well as peace of mind and whatever. Normal blood glucose has a range, so do all the other stuff. So we have "normal" AHI and such.

So a good number doesn't mean we feel great. Lots of things besides OSA can and do monkey things up. We just have to keep plugging along and trying to improve. I did do some fiddling with the settings initially but it was because I was still trying to "feel better" and I had concrete evidence through the software that I wasn't getting effective therapy. I wasn't specifically chasing the AHI, I was chasing the good feeling that I couldn't catch. AHI under 2 and a report showing that the clusters were broken up along with some very minor improvements let me quit fiddling with settings and begin the great mask experiment. But that is another story.

Have I muddled things up too much? You are new to all this, does my backwards way of things make any sense?
We are individuals and often what fits one of us doesn't fit the next person.

I saw someone asked how do you feel? I don't remember if I saw an answer but how we feel is just as important as any number.
They may not correlate and make sense, but how you feel is the whole reason we go through this journey. To feel better and to stop the damage doing by the OSA.

Hi, I agree with this comment by Robert V (not on this website):

Robert V. on January 11th, 2011 6:26 am

Here is something that I think is very important to mention about the subgroup of CPAPers who are very successful with CPAP. (By successful I mean an AHI less than 5 and often less than 2, compliance 100%, and able to function normally during the day with little sleepiness most days.)

What members of this subgroup often have in common is an understanding of the devastating effects of sleep-disordered breathing (SDB); a desire to be personally responsible for their own treatment and not rely on medical professionals to optimize their CPAP treatment; a commitment to CPAP; a commitment to self-education about CPAP and SDB; the use of a CPAP machine which has software to track nightly details of breathing; and membership in an internet support group forum run by fellow CPAPers.

If your patient doesn’t fit this subgroup and is not doing well with CPAP, surgery might be a better option.

Source:

http://doctorstevenpark.com/sub-optimal ... ve-as-cpap

So in my case having an AHI of 24 it would make sense to look at sub-optimal- surgery to lower my AHI

avi 123: So in my case having an AHI of 24 it would make sense to look at sub-optimal- surgery to lower my AHI

Unless you are seeing Dr. Steven Park himself or another, equally competent physician, most people here wouldn't even consider such a thing.............it's pretty controversial with very limited success, plus much pain and a very long physical recovery.