Low AHI - still struggling. Need advice.

[Charina]

About a year and a half ago I was finally diagnosed with OSA. I believe I've had it for more than 15 years and it has really affected me. Life was just getting worse and worse . . . AHI was about 25.

So, last summer after the CPAP didn't work, I had a UPPP and septoplasty/turbinate reduction. Helped some, but I could tell I just wasn't sleeping as necessary. A third sleep study confirmed that I still had a AHI of 13 or so, so tried CPAP post surgery for the first time last Dec. I've missed 2 days on the CPAP since - been very faithful. Rarely do I get less than 7 hrs of sleep, and almost always get >9 hrs each night.

Each AM, I check my machine and see what it tells me about my AHI from the night before. I don't know how accurate the numbers are, but they correlate perfectly with my pre-check guess, and how I feel during the day.

Some of you might tell me to quit complaining when I tell you that my AHI is typically <4 each night. But I'm not getting along, and I'm quite sure sleep is the issue. Here is why I believe sleep is the issue. Every once in a while, I have a night where I wake up and feel reasonably good. When I check the machine, it reports an AHI less than 2.5. That seems to be the magic number. Above 2.5, and I struggle through the day. Right at 2.5, and I can deal with it. Below 2.5 and life is good.

There have been a couple days when it reports 1.6 or 1.8, wow! I feel like living again. I can think without forgetting, I can dismiss depressing thoughts that have no basis, I don't want to eat every morsel of food within my zip code, and I don't feel like I HAVE to nap.

What is killing me is I cannot find any rhyme or reason as to why I have the nights with the lower AHI. I have started a spreadsheet to track diet, exercise, sex, etc, etc to try to find a correlation, but nothing! The good days typically only come along once every second or third week.

The pressure on my machine has been increased and decreased, the EPR settings adjusted, and I tried nasal sprays to open up my nasal passages. Nothing seems to work!

The questions for the viewers here are:

1) First - am I just crazy thinking that there is a difference in result between 2.0 and 4.0? Anyone else have similar experiences? (even if its placebo, I'd like to keep that placebo effect going!)

2) Are there any suggestions on what might cause the lower AHI results and how I might achieve them more consistently?

Any help you might give would be greatly appreciated.
Ryan

[Goofproof]

One you need to fill out your profile, and the pressures you are using and what you do to be successful at sleeping.

Having a machine and the sorfware would help, it takes finding what works best for you we are all different, but there are basic things to help. Jim

[Guest]

Without more info, best guess is mouthleaks.

Or if it's not that then it's probably the cycles of the moon. I've heard that the moon affects sleep the saem way it effects ocean tides. Whenever the moon wanes, then gravity decreases slightly to the point of letting your airway stay open on its own (since gravity is less at that given time and will pull you throat closed a little less). I know you think this is loony or that I'm a lunatic but I assure you this is a legitimate theory.

[Mile High Sleeper]

I've had similar results. AHI of 5, tired by 5 pm. AHI of 2.5, feel good until 7 pm. AHI of 1.8, feel great all day, life is good. I first noticed how I feel, then looked at the numbers so that my beliefs about the numbers wouldn't influence me.

Sleep doc didn't have any answers about the variance in numbers, just said it was a very narrow range that was OK.

[inacpapfog]

Mouthleaks could very well be culprit!
If you just had data to investigate more throughly!

[Charina]

Thanks for pointing out bits and pieces I forgot. It's so hard to think.

Sorry, I don't use nasal mask - I've tried, but cannot breath adequately. And after a few days on a nasal spray, I just become more clogged up than I was without it. So I use an ultramirage full face mask.

I haven't been recording the leak rate on my spreadsheet. I do look at it each morning, and rarely is it greater than .1 liter. I think I have a pretty good seal, althought that took months to refine and accomplish.

My current pressure is 8.5. Pressures as low as 6.0 and as high as 10 have been tried. No difference in AHI. Lots of aero-however-its-spelled (air in stomach) if I get above 9. Once in a while I get some at 8.5, so that has been my limit as of late.

It never fails, I can predict the AHI score with reasonable accuracy before I roll over and look at the machine. There is such a difference between 4 and 2 it's unmistakable - and tightly correlated.

Its so frustrating to not understand how to combat this! The docs and DME just look at me like I'm crazy (perhaps). At least Mile High has had a similar experience.

Ryan

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CPAPopedia Keywords Contained In This Post (Click For Definition): DME, AHI, seal

[Goofproof]

I'll go along with you, mines not as close but when i'm under 2 is can tell it ams around 5 in two days I feel droopy. I am lucky I now can keep it under 1. Jim

[woozle]

I actually think there is a big difference in such a small (relatively) jump in numbers
my ahi's have changed w/ different masks and I feel pretty bad - almost pre cpap treatment bad - when mine are above a 5.0 - had that happneing recently with umff and oracle - but with swift when I can tolerate the pressure - and hybrid - my ahi's are 2.5 or lower - and I feel much better

have you ever tried a different mask? I swear the umff is evil - there is something wrong and I can't put my finger on it - I felt HORRIBLE after everytime I used it and after I got most of the leaks tamed
anyway - I see my doc in about 2 wks and plan on asking him the same thing - good luck!

[MandoJohnny]

My AHI's run from 1 to 3.4, never over 4. My leak rates are low also. I checked out mouth leaks and it was not the problem. But I still had day time sleepiness. My culprit was Restless Leg Syndrome, although I resisted the diagnosis for a while. Now that I have found the right med and the right dosage for that, problem solved. See your sleep doc. AHIs are not the only thing that can mess up your sleep cycles. You have to solve all the problems that are keeping you out of REM, not just some of them, or you won't get there.

[kteague]

I know that an AHI below 5 is supposed to be great, but when I think about the index is per hour (right?), every digit's difference multiplied times the hours slept seems pretty significant to me, especially if they resulted in arousals. Seems to me the 5 number just says, "Be glad it's not what it used to be, and settle for what you can reasonably get." Just my opinion.

I'm with MandoJohnny on checking out if anything else is affecting your sleep. I too have RLS as well as PLMD - interrupted my sleep more than the apnea. And when the jerks are at their peak, it interrupts my breathing, so surely it would show on the AHI.

At least you're not settling for just being better.

Kathy

[maskjkie]

2) Are there any suggestions on what might cause the lower AHI results and how I might achieve them more consistently?

Any help you might give would be greatly appreciated.
Ryan

Ryan,
I thought twice before giving you the recommendation to try the Hybrid mask to lower AHI because it does cost $175 if you have to pay for it out of pocket. There are several things that impact AHI and it can be quite frustrating to one by one eliminate the variables and still find that the AHI has not consistently come down.

The Hybrid mask does a number of things to lower AHI:

1. It delivers a generous amount of air directly into the nares thus more efficiently transfering the pressure to the upper airway. This I believe reduces apneas and hypopneas.

2. The chin flap of the oral part encourages you to keep the mouth closed but if the mouth does open, air/pressure is delivered and so mouth breathing/leaking is no longer an issue. Also, the chin flap prevents the lower jaw from being pushed back (when the lower jaw is pushed behind, it causes apneas/hypopneas).

3. The generous vent flow rate of the Hybrid flushes out CO2 and prevents CO2 re-breathing. For some people, this can work wonders.

4. Finally, the Hybrid has less surface area to seal compared to a conventional FF mask, so leaks (not to be confused with the vent flow) are far less. This can only help lower AHI.

If you try the Hybrid and are sucessful in lowering AHI, it will be very difficult to pin down which of the above factors was responsible but who cares at that point? You got what you wanted i.e. a lower AHI and hopefully will consistently feel great!

Good Luck!

[NightHawkeye]

I swear the umff is evil - there is something wrong and I can't put my finger on it - I felt HORRIBLE after everytime I used it and after I got most of the leaks tamed . . .

Yep, that was my experience with the UMFF as well, woozle. Turns out that I simply can't wear a full-face mask because it pushes my jaw back at higher pressures, hence increasing my apnea. I suppose there could be other reasons, but if you have TMJ issues then that's likely the reason the UMFF won't work for you.

Regards,
Bill