On a mission to lower my AHI - treatment suggestions?

[AliClick]

I've been in treatment just over a month, so I'm looking for some advice. Here's the deal:

I'm a 58 yr old male, generally good health (few extra pounds), get regular exercise. Symptoms that led to diagnosis were major snoring that disturbed partner’s sleep, reports of gasping/choking at night (never woke me up), chronic morning headaches and general fatigue. I generally fall asleep very quickly but frequently experience restless sleep.

GP ordered at-home sleep test, which reported overall AHI 17, overall RDI 31, 34% snoring over 30db, Mean Sp02 95.3. Apparently I'm 3.7 times more likely to have apnea/hyp when supine (I’m a stomach sleeper). This led to a prescription for autoPAP, 4-20. I’ve since changed the settings to 7-20 and have the flex setting at 2.

After a month, I feel things are going fairly well. I'm accustomed to the mask (just switched to a replacement cushion since it seems the seal was no longer doing its job). I’m sleeping more soundly, generally right up to the alarm (previously I’ve always woken up about an hour before alarm. Frequent morning headaches have disappeared. No more early morning bathroom breaks. Sometimes longer periods of restful sleep, as supported by my Sleep++ watch app.

I’m just now starting to feel (occasionally) much better rested upon waking up. Mostly I still feel a bit in a fog and not all that energized.

I know it’ll take time, and that’s the point of this post. I’d love to get some feedback based on the Sleepyhead data I’ve posted, in hopes of getting my AHI lower (most recent 3.42 / 30 days - 4.4). Wondering if there’s any suggestions to get me in the AHI 1 club. Appreciate any suggestions to put me on that path. Screenshots below.

Thanks!

http://imgur.com/hHWazWq
http://imgur.com/E2S8jxe
http://imgur.com/OI5dwFk
http://imgur.com/Spzq1Xh
http://imgur.com/LYBrZ9r

[LSAT]

The easiest change would be to increase your minimum pressure to 9...maybe even 10. You can do it gradually if necessary. That should bring your AHI down.

[Julie]

Agreed.

[AliClick]

The easiest change would be to increase your minimum pressure to 9...maybe even 10. You can do it gradually if necessary. That should bring your AHI down.

Agreed.

Thanks - I'll nudge it up over the next few days. I wondered about doing that, but thought that at some point it almost removes the "auto" part of the AutoPAP? Have my first followup with my PCP in a week or so - curious to hear what his thoughts are. Knowing him, I'm probably going to get raised eyebrows that I changed his prescription settings, but it seems the info on this board are more informed than the average non-specialist caregiver.

[Julie]

Most docs prescribe Apap, too often at machine defaults of 4 and 20, and think the machine will magically increase pressure fast enough to deal with any events, no matter how high, in time to be useful. They know the science of apnea, but not much about the tech stuff! Your script might be for a somewhat higher (than 4) low level, but still not enough to be aggressive enough for a night's work and so many of us tend to end up long term around 10, the upper one either left at 20 (it doesn't do much really) or a few cms lower. Using Sleepyhead is a great way to see what really goes on over time (one night is not indicative of much by itself) but so is how you feel, and we've gotten pretty good at tweaking things, usually by 1-2 cms at a time for a few nights each, on our own. Good luck!

[Cardsfan]

I don't know if the people on here are more informed than the Dr. But, we have the desire to monitor results and make adjustments to get the BEST settings, regardless of how much TIME it takes. I think Dr's are satisfied with AHI less than 5, which is considered treated.

[AliClick]

Using Sleepyhead is a great way to see what really goes on over time (one night is not indicative of much by itself) but so is how you feel, and we've gotten pretty good at tweaking things, usually by 1-2 cms at a time for a few nights each, on our own. Good luck!

Granted, it's only one night, but last night I increased my min pressure to 8.5 (from 7), and my AHI was the best yet, 1.33. And that was after a social evening that involved a few cocktails, which generally pushes the AHI in the other direction. Hoping that trend will continue.

Another datapoint - was time to swap out cushions, so I tried the small Amara View cushion (was originally fitted for medium), and I think that's possibly providing a better, more comfortable fit. Might just be the new cushion effect, we'll see.

Here's the Sleepyhead data from this first night with raised min pressure (8.5, up from 7)
http://imgur.com/STOy9da

[Cardsfan]

Will you post a screen shot of your results last night?
Raising your lower pressure helped- keep tweaking the lower pressure up to where you get the best results.

[AliClick]

Will you post a screen shot of your results last night?

Thanks - I've updated the post with that data. Very much appreciate your feedback.

[Cardsfan]

If the higher pressure does not bother you, I would raise the lower pressure to 9.5. In your statistics, that is the Med. pressure your machine runs at anyway. You just need to find what minimum pressure is enough to hold your airway open, and that helps prevent the obstructions and snores you see in the graph.