AHI vs. Snore

[Jcochran]

I was running it in APAP mode on a fixed pressure as suggested by RestedGal to get a look at the flow limitations. I was titrated at 6cm, with a nasal mask, and I am a severe mouth brouther. The DME originally set my machine up from 6cm to 13cm. I tried for over a week, and never got a complete nights sleep. The machine would go into "runaway" and wake me up. Research led me here, and I learned how to adjust the machine. Turned the max down to 12, still runaway. 11 and still runaway and waking me up. Miserable to say the least. No help from DME or doctor, purchased reader and encore pro and have been experimenting ever since. Was recommended to me in another thread to put in CPAP mode and try. Realized that I was not giving any one pressure a good try by leaving it there for more than one night, but from all attempts, 9cm gave the best numbers. I have my machine set to CPAP mode now. Tried 9cm for 1 week. Have never gotten another nights data like the one below. That is definitely the best leak line I have had. I can't get anything to be consistent, even after making no changes. I think the 7 day avg. was AHI of right at 7. Some nights ~3, others ~8. Figured that even at AHI of 3 is not good enough, so tried to make small adjustment and see what happens. I am under the impression that I should not be snoring with CPAP, but my sleeping partner still complains of my snoring most every night. I figure that the snoring may have been what was causing the APAP to runaway, and why I get my AHI under control. Just really trying to get a handle on this. I have been taking provigil now for 2 weeks if that makes a difference in my treatment. Getting to sleep is not a problem, even with the provigil. Any suggestions??

[ozij]

Thanks for the recap, Jeff - now I remember. Insofar as your snores are precursors to obstruction, yes, it would be good for cpap to stop them. Sometimes, though, snoring remains without obstructions.

A few thoughts:
The first thing that strikes me is your statement that you've never been able to repeat that leak line, and that those were your best results.

Higher pressure makes leak management more difficult - so I would stick to 9 for the time being, and concentrate on getting control of leaks.
How do you manager your hose? Have you tried dangling it from above you head?
Are you capable of breathing through your nose? Open mouth breathing tends to make your airway more collapsible. Many of us adapt open mouth breathing as a response to apneas - others have congestion problems,
If you can at all breathe through you mouth - how about trying a chinstrap - even with your full face mask, to keep your jaw from dropping?
Some, with their OSA properly treated learn to sleep with their mouth closed.
Others tape their mouth shut while using a nasal mask or a nasal pillows mask.

If you've got chronic congestion, you may want to try nasal irrigation (http://www.neilmed.com) and if that doesn't help, contact an ENT.
Mask management (and leak management) become easier when air can pour through your nose smoothly.

O.

[Snoredog]

I would watch this video:
http://www.resmed.com/en-us/patients/ab ... 40x380.swf

and pay attention to the snoring part and learn how it leads to an apnea. When you snore you are on the verge of having an apnea,
one flutter away from a vibratory snore and wham you have a frank apnea. Snoring is like letting the air slowly out of a ballon.

Increase the pressure to eliminate the snore you can many times eliminate the follow-on apnea.

When you look at that report, about the only thing you should be paying attention to is the OA and leak. Snore and Hypopnea are indicators that you are only a breath away from having an apnea.

I say IGNORE Hypopnea and snore they are only indicators of minor apnea, they are partial or residual obstructive events. That report is actually arranged upside down.

OA should be first at the bottom, pressure increases until OA goes away,
Pressure further increases until snore goes away,
Pressure further increases until Hypopnea goes away,

However, Hypopnea may INCREASE before the others go down, that is why you ignore HI until OA is under control, then use fine pressure adjustments in .5 cm increments to eliminate the rest. If OA goes up it can mean you have reached better stable sleep and are relaxed more or you have gone too far with pressure inducing unstable sleep and if at risk possibility of central apnea.

But sometimes you cannot eliminate all the snore, some times that snore is from a flabby soft palate and if CPAP pressure is high the velocity of air traveling over it from the cpap machine itself can show up as vibratory snore. Remstars are overly sensitive to snore in my opinion.

[LoQ]

I say IGNORE Hypopnea and snore they are only indicators of minor apnea

What do you mean by "minor"? Do you not agree that hypopneas can be deadly?

I posed the question once before to this forum that somehow some people seem to think that apneas are more of a problem than hypopneas and was totally shot down for it.

So what do you mean when you say hypopneas are only indicators of minor apnea? Are you saying that hypopneas are not as bad as apneas? It sure sounds like it. These are the kinds of statements that confuse me.

Also, is is just Resmed machines that score hypopneas too high, or is it all machines?

....still trying to figure out the whole apnea vs. hypopnea thing.......

[Jcochran]

Thanks for the reply ozjj and snoredog. Promptly after getting my CPAP, I went to an ENT and had my deviated septum fixed. I was told that I am definitely predisposed to apnea because I have a large uvula and smaller opening. I have opted to not do the UPPP surgery unless it becomes a last choice scenario. I sleep 100% of the night in the supine position, which also makes me more succeptable to apneas. I sleep very close to the edge of the bed with the cpap on night stand next to bed. I tried a chinstrap, but with a nasal canula mask only. I haven't tried it since getting the liberty. I've tried to breath through my nose, but always end up opening my mouth while I sleep. Should I try taping, even with a ffm? thanks again guys.

[Snoredog]

I say IGNORE Hypopnea and snore they are only indicators of minor apnea

What do you mean by "minor"? Do you not agree that hypopneas can be deadly?

No I do NOT agree they are deadly, sounds like you need to watch the video also. Hypopnea is a 50% reduction in flow lasting >10 seconds and associated with at least a 3% drop in SAO2 to be classified as such. It is a partial blockage you are still breathing.

Machine doesn't have pulse oximetry to determine it is a hypopnea with a 3% desaturation in SAO2, so it is technically possible that the Hypopnea scored is only a flow limitation. Flow limitation doesn't have to have any SAO2 drop to be classified as such, in fact they are not even scored on most PSG reports. They can be seen on EEG data but they don't score them.

So what are you looking at when viewing HI scored tics on your report?

50% reduction in flow lasting 10 seconds or longer. You have no idea if they are associated with a drop in SAO2 levels. By contrast, if you have a obstructive or central apnea where there is NO flow, you can assume there will be an associated drop in SA02 levels.

So Hypopnea are not deadly at all. The heart attack or stroke might kill ya but not the hypopnea.

[ozij]

Thanks for the reply ozjj and snoredog. Promptly after getting my CPAP, I went to an ENT and had my deviated septum fixed. I was told that I am definitely predisposed to apnea because I have a large uvula and smaller opening. I have opted to not do the UPPP surgery unless it becomes a last choice scenario. I sleep 100% of the night in the supine position, which also makes me more succeptable to apneas. I sleep very close to the edge of the bed with the cpap on night stand next to bed. I tried a chinstrap, but with a nasal canula mask only. I haven't tried it since getting the liberty. I've tried to breath through my nose, but always end up opening my mouth while I sleep. Should I try taping, even with a ffm? thanks again guys.

I'd check a chinstrap with the FFM first. It may be able to keep your chin up and the mask more stable and thus and have better control of leaks. I found that routing the hose from above made a big positive change in my ability to stablilze masks - but I've never used afull face or a hybrid.



O.

[ozij]

Some people's sleep obstruction are comprise of hyponeas. The can cause bad sleep fragmentation, and a drop in oxygen saturation.
They have to be treated with proper pressure.

Once treatment is taking place, we depent on the machine's reports, and the way the various machines identify events is not standard.

Resmed's data reporting machines frequently report hypopneas where other machines do not. Furthermore, you don't get snore reports from the Resmeds. Puritan Bennett's data reporting machine reports flow limitations where a Respironics does not - and they sometime respond unnecessarily to "flow limitation runs" where other machines keep stable. Respironics' machines tend to be twichy in response to what they identify as "snores" even when the "snore" is actually the sound of the hose dragging accross across your bedside table.

No machine is perfect, and you've go to learn to understand the relationship between what your machine reports, and what is going on for real in your sleep.

O.

[turbosnore]

So one 7 hour episode gives SNI 1/7?
Such a person is better off than 7 different episodes, say 1 min each = 7/7min = 60?

Sorry for the confusion ... 167 min = 2.78 hours ... 330 episodes / 2.78 hours = 118 index for snoring (episodes per hour).

Oh, I found it: Snore index (SI) is snores per hour.
So I guess the snore means snoring inhales not episodes. If the calculated events are short in time compared to the
tallying time, it makes sense, since they can be thought as non-lasting events or points in time.

[LoQ]

No I do NOT agree they are deadly, sounds like you need to watch the video also.

Yeah, I did watch the video.

So no matter how low your oxygen level goes, as long as you only have hypopneas and not any apneas, it's not deadly? I'm not sure I understand why it makes a difference. I guess in my mind, at the end of the night, it didn't matter whether it was apneas you had or hypopneas, if your oxygen is going too low, it could kill you, or at least be dangerous.

[LoQ]

No machine is perfect, and you've go to learn to understand the relationship between what your machine reports, and what is going on for real in your sleep.

O.

OK, thanks. I'm not sure how one does that, but perhaps when I get a data-capable machine it will make more sense to me.

[Jcochran]

Wulf, I put my pressure on 10cm last night and my AHI increased to 14. I'll post dailies tonight. I guess I need to go down now, maybe to 8.5 and try?

[Jcochran]

bump

[Jcochran]

Ok. Dropped pressure to 8.5cm. I know it was only one night, but AHI is lower than it was on pressure of 9.5 or 10, but snore was up around 26. So, higher pressure gives me higher AHI and less snore, lower pressure gives me better AHI, but snore out of control. Pressure of 9 gave me decent AHI and snore ok, but have not been able to get AHI lower than in the 3's, and it is rare that it was that low. What adjustment or changes do I need to make now??

[echo]

If I were you, the first course of action i would try would include:
1) Get your detailed PSG and titration results - check for any mention of central or mixed apea
2) Take this data to your sleep doctor and explain that the APAP isn't working due to the run-away pressure, and the straight CPAP isn't stopped snores at low pressure and is causing a higher AHI at higher pressures.