For experienced xPap users, your AHI and how long it took?

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 2:18 pm

Hi, I'm a new user of an APAP machine. My first night, I had an AHI of 10.1, and during my 5 hour sleep, the last hour had an AHI of 23.7

Question to all you experienced xPap users:

What is your AHI? and how long did it take you to get down to that level?

I would LOVE to get down to <5 AHI. Any ideas how I can achieve that? Is there anything I can do?

roster · Post by **roster** » Sat May 10, 2008 2:30 pm

[quote="SleepIsHell"]Hi, I'm a new user of an APAP machine. My first night, I had an AHI of 10.1, and during my 5 hour sleep, the last hour had an AHI of 23.7

Question to all you experienced xPap users:

What is your AHI? and how long did it take you to get down to that level?

I would LOVE to get down to <5 AHI. Any ideas how I can achieve that? Is there anything I can do?

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 2:34 pm

I use an Ultra Mirage Full Face Mask.
I use a Flex setting of 3 ( highest ).

Last night, my pressure range was 7-10, as prescribed by my Sleep Doctor.

During my sleep Study, a pressure of 10 treated my Sleep apnea to ZERO AHI.

I'd like to get it down to <5 AHI.

LavenderMist · Post by **LavenderMist** » Sat May 10, 2008 4:17 pm

I've had my best numbers on straight cpap (less than 1 on ahi). With apap my pressure kept going up being driven by snores i think and my ahi was awful and i felt like crap. Everybody is different though. Some do well with apap.

Snoredog · Post by **Snoredog** » Sat May 10, 2008 4:40 pm

First question I have is did you have a PSG?

Did that PSG have any mention of CA or Central Apnea events?

AHI=23 is too high, the ONLY way that can happen is either:

-Your pressure requirement is higher than 10 cm and current settings on the machine is limiting any response OR

-That AHI is partially made up of Central Apnea being confused by the machine.

So, without knowing what the PSG said as it relates to Central Apnea seen, I would:

Plan A:
-Increase the Auto:Max pressure from current 10 to 15. New machine range becomes 7-15 and I would observe the next day AHI to compare.

IF the events seen that make up that AHI=23 were truly "obstructive" then the AFlex should NOT allow your AHI to climb that high, so I suspect that the "10" limit imposed by your doctor is the cause of the increased AHI OR

Plan B:

If those events that make up the AHI=23 are central and being incorrectly scored by the Remstar, then I would:

IF they ARE Central then what you do is lower the Auto:Max setting from current 10 to 9.0 and observe next day AHI. If some improvement, further reduce Auto:Max=8.5.

Note: IF you have already started with it lower Max setting before and/or no mention of CA or MA on your PSG summary, then open the machine up and let her rip.

It is not rocket science, just common sense.

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 4:56 pm

Snoredog wrote:First question I have is did you have a PSG?

Did that PSG have any mention of CA or Central Apnea events?

Yes, I had a PSG twice. Second time, a pressure of 10 was prescribed. There were no CA events, only Hypnoea.

AHI=23 is too high, the ONLY way that can happen is either:

-Your pressure requirement is higher than 10 cm and current settings on the machine is limiting any response OR

-That AHI is partially made up of Central Apnea being confused by the machine.

I'm not really sure what Central Apnea is. I know what Hypnoea and Obstructive Apnea is, but as I look at my Sleep report, there were no CA events. The report said I had OSA, not central.

In case I do have CA, how does CA cause AHI to increase wiht regards to pressure?

Last night, I slept for 5 hours, and I only encountered a high AHI in the 4th - 5th hour. The machine tried to solve the increased AHI by increasing the pressure up to maximum. But it did not stop the AHIs from occurring. Is this CA?

So, without knowing what the PSG said as it relates to Central Apnea seen, I would:

Plan A:
-Increase the Auto:Max pressure from current 10 to 15. New machine range becomes 7-15 and I would observe the next day AHI to compare.

IF the events seen that make up that AHI=23 were truly "obstructive" then the AFlex should NOT allow your AHI to climb that high, so I suspect that the "10" limit imposed by your doctor is the cause of the increased AHI OR

Are you saying I should turn off the AFLEX? I read that AFLEX can lessen the pressure.

During the SLeep study, the machine I was using was a straight CPAP, and a pressure of 10 was prescribed. So why would an APAP machine not solve my sleep apnea wiht a 10 also?

Plan B:

If those events that make up the AHI=23 are central and being incorrectly scored by the Remstar, then I would:

IF they ARE Central then what you do is lower the Auto:Max setting from current 10 to 9.0 and observe next day AHI. If some improvement, further reduce Auto:Max=8.5.

Note: IF you have already started with it lower Max setting before and/or no mention of CA or MA on your PSG summary, then open the machine up and let her rip.

It is not rocket science, just common sense.

So, if I have CA, then a higher pressure can actually create more Apneas? I'm still not sure what CA has to do with the pressure?

roster · Post by **roster** » Sat May 10, 2008 5:00 pm

Before you start changing settings, what is your leak rate? Do you have Encore Pro software?

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

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 5:11 pm

rooster wrote:Before you start changing settings, what is your leak rate? Do you have Encore Pro software?

Yes, I have Encore Pro Software. My leak rate was 35. I used a Ultra Mirage Full Face mask.

But in the 4th to 5th hour ( last hour of my sleep when my AHI was highest at 23.7 ), the graphs show that the LeaKage was more unstable ( busy ), and the # of Obstructive Apneas ( no Hypos ) increased to 23.7 rate. The machine tries to compensate this by increasing the Pressure up to the maximum of 10.

Now, when I look at the graphs, in the 4th hour, there is an increase in AHIs. The machine then kickstarts the pressure up to 10, and I also see the Leakage increasing wildly. It doesn't look like the Apneas are caused by the Leakage because the Apneas occur first, then the machine increases the Pressure, and as a consequence, the Leakages also increase.

During this hour, my Obstructive Apnea increased to 23.7. Since I'm not breathing, it makes sense that the Leakages would increase, right?

Is it possible that maybe during this hour, my sleep is entering into REM sleep? I heard that Apneas increase during REM stage.

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CPAPopedia Keywords Contained In This Post (Click For Definition): mirage, Encore Pro, AHI

roster · Post by **roster** » Sat May 10, 2008 5:35 pm

SleepIsHell wrote:.....and I also see the Leakage increasing wildly. It doesn't look like the Apneas are caused by the Leakage because the Apneas occur first, then the machine increases the Pressure, and as a consequence, the Leakages also increase.

.....

1. What are the peak points of leak rate during the problematic hour?

2. Typically, do you sleep on your side or back? Did they tell you how you slept during the PSG?

3. Of course it is very hard to tell when you are sleeping, but do you have any idea whether you are sleeping on your back or side during the problematic hour?

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 5:40 pm

rooster wrote: 1. What are the peak points of leak rate during the problematic hour?

Peak points during the 4th - 5th hour varies wildly, from 25 to about 60-65. The average Leak rate was 35. The Viewer Software says, there were no LARGE LEAKS. So, during this period, the Leak Rates were higher than the other previous 4 hours. I can see the Leak Rate, # of OA, and Pressure all rising together. Lots of "green" bars ( OA ) and lots peaking Leaks, and the pressure is at the maximum of 10.

2. Typically, do you sleep on your side or back? Did they tell you how you slept during the PSG?

I only slept on my back during PSG. No body movement. If the Leakage in the 4th hour occurred BEFORE the rise in Pressure and # of OA, then I would think that the Leakage was the problem. But the Leakage occurred AFTER the increase in OA, and increase in Pressure.

3. Of course it is very hard to tell when you are sleeping, but do you have any idea whether you are sleeping on your back or side during the problematic hour?

I'm sure I was on my back.

roster · Post by **roster** » Sat May 10, 2008 6:08 pm

IMO, a leak rate of 60 to 65 with that mask is within tolerances and your machine should be able to maintain a pressure of 10 cm.

I know it is very popularly thought on this forum and among some sleep doctors that pressure needs vary with the sleep stages. In my case, I have never been able to see this, so I will let others comment on this point.

One more question, do you have any nasal congestion during the night? I suspect some people have some congestion which worsens after a few hours. This can cause the pressure requirements to increase and said requirements increase can be mistakenly associated with early morning REM.

Let me relate one thing about the A-Flex settings that I found in my case. After much experimenting, I found straight cpap at 8.5 cm gives me an AHI near zero. If I turn on the A-Flex setting to 3, I find that the pressure must be increased to a range of 9.5 to 11.5 to bring the AHI near zero. In other words, pressure needs are higher with A-Flex compared to straight cpap.

OK, that is probably not a lot of help but maybe some others will chime in.

Note: My pressure needs while back sleeping were titrated in the lab at apap 18 - 24 and I confirmed needing at least 18 cm with my machine at home. I wear a small backpack (what fun) at night to force myself to side sleep and as mentioned a pressure of 8.5 cpap gets me near zero AHI.

SleepIsHell · Post by **SleepIsHell** » Sat May 10, 2008 6:27 pm

rooster wrote:IMO, a leak rate of 60 to 65 with that mask is within tolerances and your machine should be able to maintain a pressure of 10 cm.

Yes, I agree with you. If there was a large leak, the Viewer software would've reported a "large leak", and also the Machine itself would have some alert about it.

One more question, do you have any nasal congestion during the night? I suspect some people have some congestion which worsens after a few hours. This can cause the pressure requirements to increase and said requirements increase can be mistakenly associated with early morning REM.

Yes, I do have nasal congestion. I had it last night, and quite often I have it. That's why I can't use a Nasal mask. I use a Full Face mask ( mouth breather ).

Let me relate one thing about the A-Flex settings that I found in my case. After much experimenting, I found straight cpap at 8.5 cm gives me an AHI near zero. If I turn on the A-Flex setting to 3, I find that the pressure must be increased to a range of 9.5 to 11.5 to bring the AHI near zero. In other words, pressure needs are higher with A-Flex compared to straight cpap.

OK, that is probably not a lot of help but maybe some others will chime in.

Hmmm..that's interesting to read that AFLEX settings to 3 causes the Pressure to be deflated. During the Sleep Study, I didn't use a APAP machine, only a Straight CPAP machine. Maybe the prescribed 10 pressure is for Straight CPAP, and I'd need to either set the Machine to CPAP mode, or increase the Pressure during APAP.

Note: My pressure needs while back sleeping were titrated in the lab at apap 18 - 24 and I confirmed needing at least 18 cm with my machine at home. I wear a small backpack (what fun) at night to force myself to side sleep and as mentioned a pressure of 8.5 cpap gets me near zero AHI.

Well, anything that gets the AHI to near ZERO or < 5 is fine in my book. You've found a way that makes it work for you. Congrats.

I'm basically a back sleeper, and that was how it was during the Sleep study, and how I usually sleep. I also have nasal congestion. Maybe the solution is to use straight CPAP mode, and or increase Pressure during APAP mode.

I'll give the current settings a few more nights, and maybe reduce the AFLEX setting from THREE to ONE or turn it off completely. It does make sense that AFLEX would reduce the actual pressure because it's not constant.

Guest · Post by **Guest** » Sat May 10, 2008 7:03 pm

Being a betting man, if someone gave me some odds, I would bet if you do enough experimenting you will find a straight cpap pressure of 10 cm controls your apneas well.

Good luck.

Rooster

CentralScrutinizer · Post by **CentralScrutinizer** » Sat May 10, 2008 7:20 pm

I'm a technical guy, I troubleshoot stuff for a living... Auto PAP seems like it would be really hard to troubleshoot...

When I try and diagnose problems in my work, I like to eliminate as many variables as possible... I don't know exactly why they prescribe auto PAP, presumably for comfort.

Anyway... if it were me... I'd set the machine to straight CPAP... on pressure. I'd start somewhere in the middle of your what was prescribed... say 8CM... try that for a night or two, see if the AHI numbers are high or not... If the were high, I'd bump it up to 9 or so... try that for a night or two...

Me... I was only given straight CPAP... I do have RAMP and C-Flex. My AHI during my sleep study was 59. My sleep tech at my second study told me that my apneas were controlled pretty well at 8CM... The Doctor prescribed 9cm. I found 9CM to be difficult to get used to... I lowered my pressure to 6 one night, but my AHI went up and I was a bit concerned that I had gone too far in lowering the pressure, so I bumped it back up a bit over the next few nights, eventually stopping at 8CM. I do not use ramp any more, I don't need as 8CM straight is comfortable enough for me... I also set c-flex to it's lowest setting... I'm not at all sure I need it at all either, but find 1 to be fine.

My AHI at home has never been above 5. Even at 6CM it was bellow 5. I sleep on my side (I can't sleep on my back, never could) I use swift II nasal pillows...

Anyway.... Something IS wrong with your situation... I'm not sure what...

If I were you... I'd lower my pressure, not raise it. At least for a night or two and see if it got better or worse... I also would set it to a single pressure, just to eliminate the variability of the pressure from the picture...

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, swift, CPAP, AHI, Ramp, Nasal Pillows, auto

roster · Post by **roster** » Sun May 11, 2008 4:53 am

Scrutizener, I would agree with your approach if this one statement weren't sitting amidst SleepIsHell's story:

SleepIsHell wrote:......

During my sleep Study, a pressure of 10 treated my Sleep apnea to ZERO AHI.

............

I would work in the other direction. That is, set the pressure at 10 cm straight cpap, observe one night and if AHI is near zero, lower the pressure to 9.5 the next night and so on.

For experienced xPap users, your AHI and how long it took?

For experienced xPap users, your AHI and how long it took?

Re: For experienced xPap users, your AHI and how long it too