Hypopnea question

[Rumur]

At the suggestion of some folks here (which was greatly appreciated by the way) I raised my IPAP pressure to 16 (from 14) and my EPAP pressure to 11(from 10). My AI number is great (0.2) but my AHI was 8.4 this morning, what can I do to lower my HI?

The machine is set to automatic and this morning my pressure reading was 13, and leak was .2 L/s.

Any thoughts??

[Wulfman]

At the suggestion of some folks here (which was greatly appreciated by the way) I raised my IPAP pressure to 16 (from 14) and my EPAP pressure to 11(from 10). My AI number is great (0.2) but my AHI was 8.4 this morning, what can I do to lower my HI?

The machine is set to automatic and this morning my pressure reading was 13, and leak was .2 L/s.

Any thoughts??

Your post implies that you have a Bi-PAP/Bi-Level machine......you don't, according to your profile.....you have an S8 Vantage which is an APAP/Auto CPAP. They're not the same thing.
If you raised your MINIMUM pressure to 11 and MAXIMUM pressure to 16, then I'd believe that.
You might need to increase your MINIMUM pressure some more to get your AHI down.......or try CPAP mode with a single pressure.
According to the "knowledgeable" folks on the forum with regard to the A10 algorithm of the S8 Vantage/Autoset machines, they won't respond to an apnea event above the pressure of 10, anyway.......so going to single pressure may be your best option. You'd also be able to use EPR in CPAP mode for breathing relief.....which is not available in Auto mode.

Den

[DreamStalker]

What Den said.

Also, what were you titrated at? Do you have a copy of your PSG sleep lab study report?

[Rumur]

I was titrated at 14 and 10

[Wulfman]

What specific model of machine do you have?


Den

[Rumur]

Resmed S8 VPAP Auto w/ humidifier and Ultra Mirage II Nasal Mask

[Wulfman]

Resmed S8 VPAP Auto w/ humidifier and Ultra Mirage II Nasal Mask

OK. Your profile shows the S8 Vantage Auto/APAP.

"Rule of thumb" (or Bi-PAPs) is that EPAP pressure takes care of Apneas and IPAP pressure takes care of Hypopneas.

So, if you're still having a high number of hypopneas, that would indicate that your IPAP pressure is not sufficiently high enough.


Den

[Snoredog]

you have a couple options, but understand which pressure addresses which event:

IPAP: addresses Flow Limitations, Hypopnea, vibratory snore
EPAP: addresses Apnea, vibratory snore

So if your AI is down to .02 is that low enough? maybe or maybe not, if HI remains higher than liked then you can either increase iPAP to eliminate those residual HI's or increase EPAP 1 cm and leave IPAP where it is at.

Unfortunately, that machine doesn't report vibratory snore so you don't know if EPAP is high enough to be eliminating those.

You have to determine which you could better tolerate, higher IPAP is easier to tolerate than a higher EPAP pressure. EPAP acts as a "big" hammer and IPAP is the little hammer, so by bringing EPAP up it may mean a lower IPAP, however if the events seen are residual either pressure can take care of them. With CPAP all you get is the big hammer.

Because I like lower pressure vs higher, I would try:

Increasing IPAP by 1 cm to 17 for a night or two observe HI score, if HI drops to 5 or below you have your answer. If it doesn't change then I would put IPAP back down to 16 and increase EPAP by 1 cm to 12.

You should also base what pressure works best by how you feel. AHI is meaningless if you feel better at current higher AHI results, then don't worry about it.

If you have a form of UARS you may like the higher IPAP and possibly even lowering EPAP for a wider spread. You have to determine what events make up that AHI score, breaking it down with AI and HI is the way to do it.