How Do I Get My AHI Under 5

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 9:01 pm

CollegeGirl,

I realize that. My point is that he was prescribed that pressure, and if it isn't working (and there is no leaking), then he may need to get in contact with the doctor that prescribed that pressure and find out WHY it isn't working.

Den

Ray · Post by **Ray** » Sat Sep 30, 2006 9:07 pm

So, what FF masks work well with a long face with a pointy nose?

CollegeGirl · Post by **CollegeGirl** » Sat Sep 30, 2006 9:08 pm

First, I will say that contacting your doctor is almost always a good idea, especially if your CPAP treatment doesn't seem to be working.

That being said, I'd probably want to try a few other things first,myself, because a doctor's answer is almost always "come see me," or "go for this test or that test," and I rarely have money to do that. But then I'm stubborn, and not likely to trust sleep doctors since I was titrated at 6 and the ACTUAL pressure I need is 11-12 (it varies between the two depending on the night).

The people here on this forum got me the right treatment. If I'd relied on my doctor, I would never have been properly treated, and I'd still be miserable.

Ray, if you want to keep trying to pinpoint the cause, give us a little more information, and we'll see what we can do.

If you want to contact your doctor and get his/her advice, that's great, too. Let us know how you make out!

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 9:24 pm

CG,

I also agree with the points you made.
If I'd have listened to my sleep doctor (and used that prescribed pressure of 18 cm) and taken one of the non-data-recording machines that the local DMEs wanted to "give" me, I'd still be blindly stumbling through my therapy, too.
But, if there's a point where nothing seems to be working.....then something else may be wrong.

BUT....you have to eliminate some of the obvious things (mouth-leaking) first.

Den

Wulfman · Post by **Wulfman** » Sat Sep 30, 2006 9:33 pm

Ray wrote:So, what FF masks work well with a long face with a pointy nose?

Ray,

Do you use a local DME? If so, is there a chance you could go in and see what they have? The brands/models of full face masks are somewhat limited in comparison to the number of nasal masks that are available.
The ResMed Ultra Mirage FF works for me.....some like the Respironics Comfortfull 2 and others like the Fisher & Paykel FlexiFit HC431 or HC432 masks. It's also important to get the right size. CPAP.COM has a mask sizing guide.

Here's a link that'll give you an idea of what's available:

https://www.cpap.com/simple-find-cpap-p ... /cpap-mask

Den

Snoredog · Post by **Snoredog** » Sun Oct 01, 2006 1:10 am

If you can tolerate breathing at 5.5cm, I would set it to:

Min.=5.5cm
Max.=7.0cm

Make sure you are in APAP/AFLE mode, Cflex at setting 1 or off. Make sure the timer is set to 00:00.

Ray wrote:

So, what FF masks work well with a long face with a pointy nose?

this one?

ozij · Post by **ozij** » Sun Oct 01, 2006 1:20 am

Ray,
Snoredog's point about the timer is extremely important.

If you've anything but 00:00 on it on Automatic, it means the machine is not doing anything for that duration. It's set up for a split night study, and will start reacting to your events only after 0X:00 hours have passed. It doen's do ramps in automatic mode.

O.

OwlCreekObserver · Post by **OwlCreekObserver** » Sun Oct 01, 2006 5:38 am

Ray wrote: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?

Ray, you're not alone. I haven't said much about it, but my AHI rarely drops below 5. Since I started back in May, I doubt that I've had a dozen nights in that range. I've used both the ComfortFull 2 (leaky and painful for me) and the ComfortCurve with taped mouth. I've experimented with pressures from 7 all the way to 12 and the only real difference seems to be the leak rate at the higher pressures.

Last night, for example, I had the machine set at 10, used the ComfortCurve and taped my mouth as usual. My AHI was 12.3 (OA=10.8, H=1.5, VS 0.0). Average leak=26.4 and no large leaks.

My numbers are generally much better with the ComfortCurve, but still not good enough on a regular basis. To make matters worse, I was titrated at 19, so you can see that this isn't exactly what you call great success.

Add to all this negativity the fact that I seem to be losing my hearing in my right ear. I thought it was an infection and have been on antibiotics, but it doesn't seem to be getting any better. I have no idea at this point if that and CPAP therapy are related.

I'm trying to get a different mask, but I'm not too optimistic that it will make any difference. Frankly, if it wasn't for the fact that my wife is spared the hassle of my snoring and gasping for breath at night, I'd just drop the whole thing. I fully understand why most others have done so.

All I can say, Ray, is to hang in there. There may be a aolution out there for both of us, but right now I'm not terribly optimistic.

OCO

rested gal · Post by **rested gal** » Sun Oct 01, 2006 6:02 am

Ray, I second (or third! ) what Den and ozij said about checking your settings to be sure you don't have a time set for "ramp".

The newer "M" series machines can use "ramp" in auto mode, but the previous REMstar Auto cannot. The regular size older Respironics REMstar Auto with C-flex absolutely needs to have the ramp time set for 0:00.

To check this, get into the clinical menu. If you have the mode set for APAP or AFLE, continue forward in the clinical menu until you get to the screen with these words on it: "Ramp Setup." The numbers on that screen should read 0:00. If you see 2:00, 3:00, or 4:00 (hours) on the "Ramp" screen, change it to 0:00.

rested gal · Post by **rested gal** » Sun Oct 01, 2006 6:50 am

OwlCreekObserver, what's the highest single pressure you've experimented with? You mentioned being titrated at 19 cm. What was your diagnostic AHI before the titration, and what was the AHI with the sleep study titration? Was it a split night study, or was it two separate nights (one diagnostic night and one titration night?)

In your post you mentioned trying single pressures up to 12 at home. I suppose you've tried pressures higher than that? If you've been having massive air leaks at higher pressures, I can understand why you'd be trying to keep the pressure lower than 19, but perhaps you really are going to need considerably more than 12 to prevent apneas and hypopneas.

What I'm getting at is....in addition to taping your mouth as you've been doing, you may be right about needing a different mask that will be able to handle higher pressures than 12. Nasal pillows masks seem to be able to seal at high pressures better than traditional masks --especially with a homemade strap across the front of the nasal pillows. I know...I sound like a broken record about adding a strap around the head. I'm able to use the ComfortLite 2's "simple cushion" (nasal cushion) that way, but would not be able to at all, without.

Maybe you've already tried other masks that way. Or maybe you had to stop using higher pressures for other reasons like aerophagia?

You mentioned:

Frankly, if it wasn't for the fact that my wife is spared the hassle of my snoring and gasping for breath at night, I'd just drop the whole thing. I fully understand why most others have done so.

I truly can understand the frustration. And I know you already know this: it's not just your wife being spared the hassle, important though that is for her sleep. More important is that your own body is also being spared the life and death struggle of gasping for breath all night.

Whatever your AHI was during the diagnostic part of the sleep study, are your present AHI's on cpap considerably lower, even though not yet as low as the ideal of "under five AHI"? If so, then the treatment is helping you, as well as your wife.

You're a very intelligent man, OCO. I know you know all that perfectly well, and I can sure sympathize with feeling it's futile after trying, trying, and trying, but not getting the results some others get. I'm just thinking out loud here more for the benefit of others who may be discouraged too, that their AHI is not coming all the way down to the "ideal."

Hope you're able to find a mask that works at higher pressures, OCO. I really think that's going to be the key for you. It's too bad we have to go through so many keys on the ring before finding the one that really "fits." Darned expensive keys, too!!

Wulfman · Post by **Wulfman** » Sun Oct 01, 2006 10:59 am

Ray,

Please check out your machine settings with the following setup instructions and let us know what you find. (particularly in C. "Ramp time setting")

Den

REMstar Auto w/C-Flex Setup

When in the Setup Menu, the humidifier ^ and ramp v buttons operate as up and down keys to change the settings, the left/right user buttons < > allow you to go to the previous/next question or setting, and the pressure start/stop button is used to exit the Setup Menu. Holding the humidifier or ramp buttons down will cause the values to change more quickly.

To enter the Therapy Setup Menu, hold the two top user buttons < > down while plugging in the power cord.
Continue holding the buttons down until the REMstar Auto w/C-Flex beeps twice.

Note: The word "setup" will appear on all of the screens indicating that you are in the Therapy Setup Menu.
(If you press the Pressure start/stop button, you will exit the Setup Menu.)

A. Compliance hours/nights: (recommend leaving alone, but CAN be cleared at this point)
Select next setting with >

B. Therapy mode: (CPAP/CFLE/APAP/AFLE) select with ^ or v
Select next setting with >

B1. If CPAP or CFLE select pressure setting: Select with ^ or v
Select next setting with >

B1a. C-Flex mode (if you chose CFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

B2. If APAP or AFLE, select minimum pressure setting: Select with ^ or v
Select next setting with >

B2a. If APAP or AFLE, select maximum pressure setting: Select with ^ or v
Select next setting with >

B2b. C-Flex mode (if you chose AFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

C: Ramp time setting: Select with ^ or v
(ramp time will be turned off with a setting of 0)
(if using APAP or AFLE mode, Ramp setting MUST be set to 0:00)
Select next setting with >

D. Ramp pressure setting: Select with ^ or v (use only in CPAP or CFLE mode)
Select next setting with >

E. Patient disconnect setting: 1 = on 0 = off Select with ^ or v
Select next setting with >

F. Buttons lights setting: 1 = on 0 = off Select with ^ or v

(Last setting. Use On/Off button to exit Setup)

quilterB · Post by **quilterB** » Sun Oct 01, 2006 12:25 pm

What is the difference between APAP or AFLE? Should the machine be set to APAP if a range is used?

Wulfman · Post by **Wulfman** » Sun Oct 01, 2006 12:30 pm

quilterB wrote:What is the difference between APAP or AFLE? Should the machine be set to APAP if a range is used?

APAP is for pressure range settings WITHOUT C-Flex
AFLE is for pressure range settings WITH C-Flex
CPAP is for fixed pressure setting WITHOUT C-Flex
CFLE is for fixed pressure setting WITH C-Flex

Den

OwlCreekObserver · Post by **OwlCreekObserver** » Sun Oct 01, 2006 1:30 pm

rested gal wrote:OwlCreekObserver, what's the highest single pressure you've experimented with? You mentioned being titrated at 19 cm. What was your diagnostic AHI before the titration, and what was the AHI with the sleep study titration? Was it a split night study, or was it two separate nights (one diagnostic night and one titration night?)

Thanks for the support, RG. I wasn't very clear about the numbers I was throwing around in my last post.

The 19 that I referred to was the apnea index recorded during my first night (no mask). I was never told what my second night numbers were, but the doc prescribed CPAP with C-Flex, a ComfortFull 2, and a pressure setting of 7. I called a couple of days later and said I was starving for air at 7 so he raised it to 8. A few weeks later, after I started using EncorePro, I told him that I'd like to raise it further because I was getting lousy numbers. He told me to raise it to 10.

Two or three weeks ago I called him back and said that I'd like to start gradually raising the pressure to see if I could get the numbers down to an acceptable level. I eventually had one night with a pressure of 12, with the ComfortFull, and the next day my right ear felt clogged and I could barely hear in that ear. I wasn't too concerned because I was just getting over a cold at the time. The condition was still there last week so the doc decided there was some sort of infection and gave me antibiototics. It's now a week later and the hearing is still gone. Related to CPAP pressure? I have no idea.

So that's my tale of woe (excrutiatiingly detailed version) and I still can't hear very well in that ear, and my AHI is still bad. I'll call my primary care guy again tomorrow and ask about a referral to either an ENT or the sleep doc.

In the meantime, I'm trying to get a script to buy the F&P 432 when it's available in a few days. The 431 felt good when I tried it on at the DME and I'm (as always) hopeful that this might be the thing that brings it all together.

Grumblegrumblegrumblegrumble....

OCO

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, Titration, CPAP, DME, AHI

rested gal · Post by **rested gal** » Sun Oct 01, 2006 9:01 pm

Ahhh, ok...gotcha'. Sorry I misunderstood the "19". It was the AHI, not the pressure. Thanks, OCO. I was really getting worried if you had had a prescribed pressure of 19, but 12 is as far up as you could take it.

Think you could get the doctor to let you have a trial on the BiPAP Auto? Or if not that, on the REMstar Auto? Given the ear problem you're having now, the greater exhalation relief of BiPAP might be a good thing. I'm thinking about how it feels to try to breathe out against pressure coming in. And how it feels to try to breathe out against congestion. if I hold my nose and try to breathe out even lightly through the nose, I can feel my ears feel like they are stopping up.

How Do I Get My AHI Under 5

Re: How Do I Get My AHI Under 5