Want to get lower AHI's

[oldvaham]

Good Day, all:

I've been a visitor to this site since I started on CPAP for just about six month. My sleep study and titration was done last Nov. and Dec. with AHi's starting at 62 and increasing to 97 during the night. Since starting CPAP therapy, I've been showing AHI's averaging about 12 and for that I am thankful. However, the minimum reported was 8.7 while the highest was 21. I am using the AutoScan 5.7 software to get daily updates and see how the night has been, event-wise. As most have reported, some days are good and some days could be better. There have been a few nights that I would like to do over!

I find it a bit frustrating to be compliant and diligent about using my machine; but, I can't seem to get my AHI's below 8. Starting at the study titration of 10 cm, I've tried various pressure combinations and ranges, including auto, and still can not get it lower.
I'm not mouth breathing, (I made a strap to prevent it out of an older headgear). I have seen many folks report much lower AHI's. Why can't I? Can someone suggest or recommend something that could/would improve my AHI's ?

Thanks

[DreamStalker]

Can you post some of your AutoScan reports that show a typical night?

BTW - Your profile shows an Escape which does not have data capabilities other than compliance.

[JohnMudie]

I am still learning this stuff and don't really understand what a "good" leak rate is or even how to reduce leak rates, but what I have learned is that the old-timers keep telling us our leak rates are too high and that we need to reduce them.

So I will ask you

WHAT IS YOUR LEAK RATE ?

You can figure out your accidental leak rate if you use the information in
http://sleepapnea.wikia.com/wiki/Mask_Leak_Rate
As I understand it, a high leak rate reduces the efficiency of the treatment and also diminishes the ability of the APAP to sense events.

All I know is that leak rate seems to be important so how about posting yours for comments.

John M
(total leak rate in the 44's lpm and struggling to reduce it)

[track]

I posted yesterday on what a good night I had the night before with an AHI of 4.5 and an AI of .5. Last night it went to 8.2 with an AI of 2.6. Nothing changed other than I had a glass of wine 7 hours before bed time instead of one 12 oz beer the night before. I am of the opinion that some people will never get rid of a certain amount of AHIs. Some obstructions are just not taken care of by pressure. ..or if they are the pressure would have to be so high it would make sleeping unbearable. It's not always about having leaks. I have had Apnea events when there is absolutely no leak. Just take solace in the fact you have cut your AHI by 4 times or more.....that's a huge improvement and now you only have moderate instead of severe apnea.

_________________

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

[Goofproof]

You are using a nasal mask, and don't tape. You can't collect reliable data from your machine.

I say you are mouthbreathing, a strap doesn't cut it for most, the only sure way is to use a well fitting FF Mask, or tape correctly. You have to seal the hole under your nose. Jim

[WearyOne]

Hello and welcome!

The first thing I would say is that you may only think you're not mouth breathing, as even though your chin may not be dropping and your mouth wide open with the chin strap, the pressure from treatment can cause air to leak between your lips! Believe me, I know! Although many tape their mouth when using a nasal mask, I cannot stand to tape, so I went to the Hybrid mask and love it. I also use the Ultra Mirage Full Face (UMFF).

I don't know if your machine shows the leak rate or not, but the if it does, look in the manual that came with your mask and find the intentional vent/leak rate for your mask. Your goal would be to not have leaks greater than the intentions vent/leak rate for your mask, or at least not much greater.

The reason why this matters is if you're getting air at a certain pressure pumped in your nose and some of it's leaking out between your lips, then the pressure of the air in your throat that's needed to keep your airway open will be reduced below your therapeutic level. In other words, you won't be getting the right pressure that's needed to reduce that AHI.

I definitely understand your wanting to get that AHI lower, but you've reduced it a lot, so you should feel good about that, too!

Pam

[oldvaham]

Hello all and thanks for the replys.

I can't get make a copy of the nightly profile charts. However, I will provide the stats for last night and the previous night. Just for reference, I'll also show the last seven day summary info.

Treatment Leaks Events/hr Time in Apnea
5/31 95% 11.2 cm 0.0 cm AHI 12.6 1.6 %
med. 11.0 0.0 AI 3.8
max 11.2 0.6 HI 8.8

5/30 95% 10.8 cm 0.0 cm AHI 18.4 2.4 %
med. 10.6 0.0 AI 6
max 11.2 0.4 HI 12.8

7 days 95% 10.8 cm 0.0 cm AHI 16.5 1.4 %
med. 10.6 0.0 AI 3.7
max 11.2 0.6 HI 12.4

As you can see, I don't have leaks because I took care not to have that as an influence on the results. Nevertheless, I still have what I would say is high events/hour rates. I just don't feel all that great today. So, anything that will help me get a better night's sleep would be worth trying at least once or twice.

Thanks again for listening.

[oldvaham]

Opps, I forgot that http removes the spaces.

[skjansen]

I understand where you are coming from. I could never get my AHI below 5 until I started sleeping exclusively on my side. I discovered this about a week ago when I reviewed my sleep study and found that my AHI was 78 while on my back and around 7 when I slept on my side. So, I bought a wedge pillow from JC Penney and use it every night. I sleep on my right side just leaving enough room on the bed to lay on my stomach if I choose or to sleep just on my right side. I have one pillow under my head and I sleep on the very end of it where my full face mask hangs off and I have a king size pillow that I hug throughout the night. My AHI has dropped from somewhere around AHI of 7-8 on the nights I slept on my back to about .17-.4 on the nights of sleeping only on my side. I finally feel like myself again.

Try this to see if it works for you. Also, you might want to try a full face mask if you think you are mouth breathing. Good luck...this is worth the experiment!!!

[DreamStalker]

Hello all and thanks for the replys.

I can't get make a copy of the nightly profile charts. However, I will provide the stats for last night and the previous night. Just for reference, I'll also show the last seven day summary info.

Treatment Leaks Events/hr Time in Apnea
5/31 95% 11.2 cm 0.0 cm AHI 12.6 1.6 %
med. 11.0 0.0 AI 3.8
max 11.2 0.6 HI 8.8

5/30 95% 10.8 cm 0.0 cm AHI 18.4 2.4 %
med. 10.6 0.0 AI 6
max 11.2 0.4 HI 12.8

7 days 95% 10.8 cm 0.0 cm AHI 16.5 1.4 %
med. 10.6 0.0 AI 3.7
max 11.2 0.6 HI 12.4

As you can see, I don't have leaks because I took care not to have that as an influence on the results. Nevertheless, I still have what I would say is high events/hour rates. I just don't feel all that great today. So, anything that will help me get a better night's sleep would be worth trying at least once or twice.

Thanks again for listening.

Well since your leaks are ok and changes to your pressure does not make things better, then you must have something else going on ... perhaps central apneas or some other sleep disorder. Maybe SD or RG will chime in and give some input.

[Snoredog]

my guess is:

1. Your leak is fine, maximum leak is only 36 litres per minute. That is not enough leak to skew the machine data.

2. Go back to your original PSG reports and look for any notation of CA or MA events. Could very well be a valid reason behind them stopping at 10cm pressure.

Then ask yourself WHY did they stop at 10cm pressure on my titration?

Here are some reasons they may have stopped there:

1. you are sleeping fine and dandy and no more SDB events were seen,
2. alloted time for study expired, hey its 12 noon, time to get up anyway,
3. they seen central apnea which takes you back to a wake state which can terminate the titration study, so they back off to next lowest pressure that offered good quality sleep. That may mean it lets a few apnea or snores go by.

4. Your machine will not respond to an apnea if the pressure is at or over 10cm.

my suggestion:

1. go back to the PSG report, find out if you are at risk of CA or MA events. If you are leave it at 10cm pressure and say AHI=8 is not all that bad.

2. If no notation on PSG report of CA's, then increase pressure to 12cm and observe new AHI. IGNORE the HI indice on the Resmed machine, that machine only responds to:

-Flow Limitation
-Vibratory Snore
-Apnea

If you are experiencing apnea at or above 10cm pressure that machine won't respond directly to them. That can result in a higher AI score.

If increased pressure doesn't eliminate or lower the AI score then those AI's are most likely central events not obstructive. That machine doesn't listen for cardiac oscillations in an open airway so it cannot accurately differentiate a central event from an obstructive one. It avoids them by NOT responding to apnea at or above 10cm pressure based upon its A-10 algorithm.

So the AI's seen on the LCD display may very well be central not obstructive. Again, refer back to your PSG report to see if you are at risk of CA events.

then go from there. If none were noted increase pressure until AI score goes down. If it doesn't go down, then drop pressure and see what happens.

Also: it may be wise to look for chronic snoring seen on that report. With that machine while it may not respond to apnea at or above 10cm pressure, it will continue to chase a snore. So if you are having CA's and you snore, you can be at 10.5cm pressure and if you snore the machine will chase it, increasing pressure chasing the snore and at the same time firing off more centrals (if you are at risk of them). Since you are over 10cm pressure, it won't respond to those centrals it may be causing chasing the snores rest assured it will eventually back off in like 10 minutes time.

[mhacker]

I don't know if your machine shows the leak rate or not, but the if it does, look in the manual that came with your mask and find the intentional vent/leak rate for your mask. Your goal would be to not have leaks greater than the intentions vent/leak rate for your mask, or at least not much greater.

Pam

Thank you, that is one really useful piece of information. Lo and behold, on the back of my ComfortGel "instructions for use" is this handy, itsy, tiny chart THAT NO ONE POINTED OUT TO ME showing that at my pressure I should expect a Leak Rate of 30. So I am going to assume that one of my peaks at 117 is probably a bit high. I have more data to crunch now.

And they wonder why we want access to the software to read this kind of info. I have a great doctor, but really, can he know what the expected leak rate is and read/adjust the chart/data accordingly? He does not have the time so I must be proactive in my health.....

Now is there a place to put that baseline in the software?

[oldvaham]

I want to thank you all for your comments. I tried the pillow tip on my side of the bed and I seem to be doing better. At least until my wife came in and took it away for her use! I have to try that one again because for the hour or two it was good breathing.

Again thanks,

Ken