How Do I Get My AHI Under 5

Ray · Post by **Ray** » Sat Sep 30, 2006 8:08 pm

I have been using my apap for about a month now and I have managed to get my AHI under 5 on only one occasion (and that seemed to be random luck). I typically run around 12.

I was titrated at 7; re-titrated at 6. I initially set my apap for 6 to 10, and when it gets to higher pressures, my hypopneas and apneas increase. So, I decreased my range to 6 to 8. Same result ... I spend 1/2 my night at the higher end where I have the most hypopneas and apneas. If I set it only for 6 or 7, I still get an AHI of 12 or so.

I have changed masks and now have very little leakage (unfortunately, I'm now using a ResMed mask ... the Swift), and my mouth leakage is markedly reduced with a new chin strap. So, what else can I do to get my AHI down?

Guest · Post by **Guest** » Sat Sep 30, 2006 8:13 pm

Try switching it to straight cpap mode. Set it to 7cms and wait a week before you check the data.

Ray · Post by **Ray** » Sat Sep 30, 2006 8:19 pm

I can try that again, but that's how I started. My daily AHI ranged from around 12 up to 25 with no instances approaching the goal of 5. That's why I started experimenting with other settings.

CollegeGirl · Post by **CollegeGirl** » Sat Sep 30, 2006 8:21 pm

I have a question - I see you use nasal pillows. Is there any chance you're mouth-breathing? That could cause your pressure to keep getting higher than you need, and would also cause increased AHI.

Ray · Post by **Ray** » Sat Sep 30, 2006 8:24 pm

I used to have problems with mouth breathing with the Comfort Lite. I just switched to the Swift and am using a very effective chin strap. Overall, my leakage has decreased and my mouth is no longer dry in the morning. I can't say that I'm not leaking, but it is certainly better.

Full face masks seem impossible for me as the bridge of my nose doesn't get along well with traditional masks. I love the Swift.

CollegeGirl · Post by **CollegeGirl** » Sat Sep 30, 2006 8:27 pm

Any chance you could post all your stats? Maybe we can spot something wonky. That's just bizarre. My first reaction was that maybe your pressure's too low, but 7's pretty low as it is. Frankly, if my AHI were that high I might leave the pressure wide open for one night (4-20) to see where the auto goes when it's not reigned in.

Ray · Post by **Ray** » Sat Sep 30, 2006 8:33 pm

Is it true that I should be able to attain an AHI under 5? Or is that just a goal that most people don't attain?

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 8:34 pm

Ray,

Try taping your mouth shut for a awhile and see if it makes a difference.
Many folks report that chin straps aren't completely effective at stopping mouth leaking.
If you're using Encore Pro, you should be able to compare your leak rate to the stated Vent Flow Rate that should have been in a pamphlet that came with your mask.

Den

Ray · Post by **Ray** » Sat Sep 30, 2006 8:37 pm

I've been hesitant to tape my mouth. My leakage rate is a bit higher than the stated vent rate, but not significantly so. It does vary, so I know that I have some leaks ... possibly when I sleep on my side and dislodge the pillows just a bit ... or mouth leaks.

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 8:38 pm

Ray wrote:Is it true that I should be able to attain an AHI under 5? Or is that just a goal that most people don't attain?

Unless there are other "issues" (central apneas or other breathing disorders) MOST people should be able to achieve an AHI of less than 5.0.

I usually have a weekly average of less than 1.0.

Best wishes,

Den

CollegeGirl · Post by **CollegeGirl** » Sat Sep 30, 2006 8:41 pm

You should definitely be seeing numbers under 5. The majority of the people here get them. Those that don't usually have significant problems with their treatment that need to be remedied right away. That's why I'm so concerned.

My AHI most nights now ranges from 0.0 to 0.5. Not all folks have AHI's that good, but most have under 5.0... those over 5.0 are quite rare.

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 8:48 pm

Like "Guest" suggested, if your titrated pressure was 7, set your machine for that pressure and tape your mouth for a night or two and see what the stats show. If there are still problems, you might need to contact your sleep doctor, explain the situation to him/her and get a copy of your PSG to see if there were any centrals in your sleep study.

Den

CollegeGirl · Post by **CollegeGirl** » Sat Sep 30, 2006 8:52 pm

Den,
Ray's already tried that. I don't think straight CPAP at 7 is the solution if he's already gone that route. UNLESS he was using the CL2 with significant leakage at that point. If so, it might be worth another try with the Swift.

I can try that again, but that's how I started. My daily AHI ranged from around 12 up to 25 with no instances approaching the goal of 5.

Ray · Post by **Ray** » Sat Sep 30, 2006 8:54 pm

Wow, I didn't realize that this was that problematic. Maybe I should try a full face mask for a bit (tolerate the discomfort) just to see how I would do.

Any suggestions for a full face mask. My DME strongly discouraged the use of the Hybrid stating that he hadn't yet seen anybody who didn't have significant leakage problems. I have a long face with an angular nose ... not a lot of padding on the bridge of my nose.

Goofproof · Post by **Goofproof** » Sat Sep 30, 2006 8:55 pm

To get the numbers down, as CollegeGirl and Den have said, Tape or FF Mask, Chin straps aren't good enough for most.

DeNile, Won't lower AHI numbers, If the leaks aren't controlled, the numbers stay up. Jim