AHI - should I be doing something about it?

[jenk]

Please excuse this newbie question, but this is bothering me. I've only been using the CPAP for 1 week and love it! I'm not sure it's doing what it's supposed to be doing, tho. I'm trying to understand the readouts on the machine, still working through that. But I see people here mentioning AHI of 1 and such but my machine is showing a range of 58 to 30's for the past week since I started. My setting for the machine is set at 7 for air pressure, starting at 4 and ramping up to 7 but I don't use that feature.

Does this mean the machine is not set up properly? I called the DME and she told me not to worry about the readings, just get used to the machine and we'll see where it's at on my checkup in a month. If there is an adjustment to be made, I'd rather do it now than to wait a month. Should I make a call to my sleep doc (to see if maybe some adjustments should be made), or is waiting a month ok?

[Pugsy]

my machine is showing a range of 58 to 30's for the past week since I started.

Do something about it now by using the software and let's see what is going on.

Start with using the software and let's see what that AHI is made up of.....3 different categories
Central apneas
Obstructive apnea
Hyponeas
Also need to evaluate leak data.

Software information in my signature line.

How to post images of your reports so we can see what you see is discussed here
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779

[jenk]

Thank you pugsy. I have to become familiar with the program to get a screenshot. I chose to get a screenshot but don't know how to them post it here. Her are some statistics from last night.

AHI 38.50
clear air apnea 178 events
hypopnea 64 events
obstructive apnea 45 events
periodic breathing 2 events
pressure pulse 281 events
vibratory snore 15 events
leak rate had a spike up to 42 for ~1/2 hour then around 15'ish the remainder.

Do these numbers tell you anything?

[Pugsy]

How to insert the image link for posting screen shots is explained in the Screen shot thread above.

Do these numbers tell you anything?

The total number of events doesn't tell me how many hours of sleep though I could back track it and figure it out with the AHI number but that involves some work and my mind isn't awake yet.

The number of events in all categories is too high.

Did you have an in lab sleep study where they used a machine to figure out your pressure needs?

Are you sleeping solidly for the time you are using the machine or are you having a gazillion wakeups during the night?

[Julie]

Are you looking at the read-out for one night, or for an entire week/month, etc?

And what type of mask do you use?

[Pugsy]

leak rate had a spike up to 42 for ~1/2 hour then around 15'ish the remainder.

Fairly typical for a PR System One machine at your pressure. Large leak territory is up around 70 to 80 L/min with your mask at your pressure.
Leaks aren't an issue unless they are waking you up a lot.

[jenk]

Pugsy, the hours of sleep is 7:27 if I'm reading the correct number. I did an in-home study (couldn't afford the lab study on a fixed income). The first weekend, they got 2.5 hours of study from 2 nights wearing the machine. They had me take it another weekend and they said out of the 2 nights they were able to get 1 night of study. Wasn't feeling real confident about that to begin with.

I wake a few times during the night, nothing excessive.

Julie: the readouts are for one night. For the week since I've been monitoring with the machine, the AHI has been in the 30's~50'ish. That seems too high if people are saying on here their numbers are so low. Is it the air pressure setting that affects this?

I just edited my profile to list my machine & mask. I'm using a Nuance Pro pillow mask and love it.

[Julie]

Something is certainly wrong, whether it's with the machine or something else... Sometimes if leaks are large enough the machines don't record them at all, or they may appear as clear airways/centrals rather than leaks. Just for the heck of it if nothing else, are you willing to try taping your lips for 1-2 nights to see how that affects your numbers? Because if it makes a sizable difference, you might want to rethink your mask type.

[Pugsy]

Centrals (Clear Airway on the PR S1) are way too high if you aren't spending a lot of time awake on the machine. CAs can be flagged by mistake when the machine senses awake/semi awake breathing irregularities by mistake. It doesn't know if you are awake or not since it just is designed to sense breathing.

There's a small percentage of people who develop centrals as a response to cpap therapy. If you had an in home diagnostic sleep study they may have just used an oxygen sensor on the finger tip to measure oxygen levels and diagnosed sleep apnea based on that alone. Problem being is that central sleep apnea can also cause a drop in oxygen levels.
When you did the in home study did they just use a little sensor on the finger or did they have you wear a belt around your chest and/or put a little sensor thing in your nostrils or any sensors on the face?

Right now we don't know if the centrals were present before you started cpap therapy or if they are a result of the cpap therapy.
It's kinda important to know as you are having way too many of everything.
The obstructive apneas and hyponeas are averaging too many per hour which means that you need more pressure than you are getting but the centrals could be present because of the pressure and more pressure could make them worse. So damned if you do and damned if you don't in this situation with the limited information that we have at this time.

Really need to see a daily detailed report to get a feel for what is going on.
Is there any PB being flagged? That's Periodic Breathing and shows up in green bars on the reports.

So...
Centrals are too high and more pressure won't fix them and might make them worse. Also we don't know if you are having them because you would have them even without cpap pressure.
OAs and hyponeas are too high but not horribly too high.....right now the centrals need more evaluation if at all possible.
If you has said you woke up a gazillion times a night then we might think the centrals are post arousal centrals from maybe the untreated OAs and hyponeas but since you aren't saying that...gotta think the centrals are the real deal until proven otherwise and that number of centrals is worrisome.

Can you please try to post an image of a daily detailed report?
Need to see the AHI bar graphs event category on the left side of SleepyHead report.

Leaks aren't the issue. You are well below half of where large leak territory begins.
Need to see the daily detailed graphs on the right side...these graphs...events, flow rate, pressure and leak (don't need the others)

[Drowsy Dancer]

With those nightly numbers I'm a little horrified that you're being told not to worry your pretty little head and they'll check with you in a month.

Can you post details from SleepyHead?

[torontoCPAPguy]

leak rate had a spike up to 42 for ~1/2 hour then around 15'ish the remainder.

Fairly typical for a PR System One machine at your pressure. Large leak territory is up around 70 to 80 L/min with your mask at your pressure.
Leaks aren't an issue unless they are waking you up a lot.

With all due respect, LEAKS are the #1 issue and make no mistake about it. When I refer to leaks I include things like mouth breathing. Anything that does not fit into the bill of "CONTINUOUS POSITIVE AIRWAY PRESSURE". Everything else is secondary but requires addressing as well. If you have a mask leak you are not getting a constant positive airway pressure and the gear is not NOT doing its job.

Fix that leak issue to start with. You need to be seeing an almost immediate response bringing your AHI below 5 before you begin to make the minor changes to aim for zero.....

I fixed the leaks as I was advised to do on this board with advice from this board and my AHI dropped to the 5ish range. Tweaking the pressure and using an APAP blower brought me down to about AHI=0. More info probably available if you do a search on my name. TorontoCPAPguy

DO NOT let ANYONE tell you that leakage is irrelevant. That is pure and simple... bullfeathers. It is the #1 concern in order to tweak everything else.

[palerider]

leak rate had a spike up to 42 for ~1/2 hour then around 15'ish the remainder.

Fairly typical for a PR System One machine at your pressure. Large leak territory is up around 70 to 80 L/min with your mask at your pressure.
Leaks aren't an issue unless they are waking you up a lot.

With all due respect, LEAKS are the #1 issue and make no mistake about it.

with all due respect (and, for you, that's decreasing with every post you make) Pugsy knows more about counseling newbies with cpap issues than you ever will.

a leak indication of 15-40 on a PR machine means the leaks ARE under control...

so, why don't you quit displaying your ignorance.

[PlinkerCraig]

I have nearly an identical machine. My experience was AHI of 80 during the sleep study, and well below 5 for the ten days I have now been using the new machine. Sleepyhead is showing me typical leak rates below 40 but spikes occaisionally higher. My mask has vent that provides a contnuous leak that the designers put in there for a reason. Even the manaul says not to obsess over leaks - they are normal. I fuss about leaks that bug me when I'm sleeping like a jet of cold air aimed right at an eyeball. Skipping shaving for a few days I get the smallest leak in my mostache area that does not concern me (using a nasal mask so far and liking it).

If you have a bed partner they can tell you a lot about how you sleep. No partner; then use an app on your iPhone or iPad that will record a whole night's audio and let you see it as an oscillograph so you can zero in on bad stuff and play it to hear how nasty you may sound. I used this technique months ago to convince myself I had serious problems - I sounded like I was drowning - seriously obscene crap to hear. The app I have is called "Quit Snoring".

[palerider]

My mask has vent that provides a contnuous leak that the designers put in there for a reason. Even the manaul says not to obsess over leaks - they are normal.

all masks have built in vent rate, usually in the 20-50lpm depending on pressure. there are charts, or graphs in the back of most mask manuals telling you what to expect.

as long as your total leaks (for PR machines) are somewhere in the neighborhood of what your mask normally vents, and other leaks aren't bothering you, then yah, don't worry about them.

[Pugsy]

With all due respect, LEAKS are the #1 issue and make no mistake about it. When I refer to leaks I include things like mouth breathing. Anything that does not fit into the bill of "CONTINUOUS POSITIVE AIRWAY PRESSURE". Everything else is secondary but requires addressing as well. If you have a mask leak you are not getting a constant positive airway pressure and the gear is not NOT doing its job.

Fix that leak issue to start with. You need to be seeing an almost immediate response bringing your AHI below 5 before you begin to make the minor changes to aim for zero.....

With all due respect you need to understand that different machines report leaks differently and the OP here has a machine that reports leaks differently than your machine.

Perhaps you should understand the differences before you go telling someone to fix a leak that can't be fixed and telling them that the leak is the cause of the high AHI because in this case....it isn't.

Your S9 machine reports excess leak only.....the Respironics machines report total leak which is the mask's vent rate plus any excess leak. It's impossible to have 0.0 total leak number from a Respironics machine.

So maybe you need to understand what you are talking about a little better instead of blasting me...huh???