One month in and AHI Average of 9.9

[DouglasL]

I'm one month in to using my machine and I have to admit I do feel much better. I know that should be the real gauge of success and not numbers. But, my AHI is 9.9 (down from 69 during my sleep study). Apneas have almost completely disappeared, but hypopneas are obviously up there. As I said, I know I'm feeling better and have more energy than I have had in years, but if possible, I'd like to know if hitting 5 or less would get me to feel even better.

Or, do I accept where I'm at and be happy. I see my Sleep Doc in a few weeks but wanted to get some real-life feedback.

[apneawho]

Hi Douglas,
It is so wonderful that you feel much better. My AHI has been reading <2.4 for 2 months and <1 for 1 week and I don't feel better than when I started, so first of all, how you are feeling is a primo indicator! Second, I have been reading that the Intellipap may read a slightly higher AHI than the ResMed that I am on, but you still will want to see your AHI come down some. You are only one month into therapy so your AHI is likely to improve over time. Do you have your detailed data? Maybe you can talk with your sleep doc about your AHI and pressures, etc. Once again, you are so fortunate to be having such great results in how you feel and that is excellent.

[Julie]

Hi - if you end up with your mouth open even a little once asleep, you could lose all the cpap air that way and should look into a full face mask like the Quattro or Hybrid.

[Emilia]

Accepted 'good' therapy yields an AHI below 5. I would need to see an overnight report to try to assess why yours is still too high. I can tell you that even a minor change in AHI can make a big difference in how you feel. I average 1.5, but when I have a night that registers a 2.5 or 3, I know it. If you can get your AHI down to 5 or below, I believe you will notice a huge difference in how you feel.

Do you know how to convert your data reports from pdf to jpg? If you do, and can upload a jpg image to a photo sharing site like photobucket, Picasa, or Flickr and then capture the image location url, you can put that url here in a post and then highlight it and then click the IMG button above the editor box. Once you do that, click Preview to be sure you did it correctly and then Submit to publish.

[DouglasL]

Once again Emilia, thank you....

Here's last night's report - I k now I tend to to have lots of Hypopneas as I'm falling asleep... My prescription is for 17cm of pressure. I've set the lower to 15 and let the upper hit 20

[Emilia]

Hi,
Not sure what the acceptable leak rate is on the Swift FX, but for my Swift LT it is around 28-30. You had a lot of leaking with an average of 49 and a max at 75. The 90/95% leak was 60-62. I'd say you have some leaks that need to be addressed, and even though they aren't counted as Large leaks by the IP until you hit 95, you are way above what the acceptable rate for your mask it.

You have your pressure range set at 15-20 and you topped out at 19.9 (can't much higher, eh?)..... but your average pressure was 16. Generally, we go by the 90/95%tile and set the range to 2 notches below and 2 above. If that was a consistent reading for you, this report would mean you should have a range of 17-22, but that is impossible to do on an APAP machine. They only go to 20. If this is a consistent pattern for your 90/95th%tile pressures, you may need to move to a biPap machine, but it will most likely need to be demonstrated and documented that your 'failed' using this machine to allow you to move to the biPap. They are very expensive machines and require medical necessity documentation.

What you could try to do is tighten up the range a bit more with the lower range up to 16 or 16.5 since that was your average pressure last night. See what that does to the overall AHI tonight.... keep it there for 5-7 days to see if things level out more. Your AHI of 8.9 isn't terrible, but it needs to come down. I also see you have your SmartFlex set at 3 across the board. Remember, that impacts your pressure, too. But, with higher pressures I understand the need for that relief.

Let's see what an increase in your lower pressure does and then revisit this...... Good luck!

[Mary Z]

If your prescribed pressure is 17, I would set the low limit on your machine to 17, rather than 15. 15 was apparently not high enough to control your OSA, so why set the machine lower than 17?

[Emilia]

@ Mary.... interesting suggestion. I know I was titrated at 8, but my sleep doctor wanted my auto range to be 6-10. That goes along with the common practice of using the 90/95th%tile pressure as a guide to set auto range to 2 below and 2 above. Doug's Rx may have been 17, but his 90/95th is 19 and using that as a guide 17-20 may be what he needs. I suggested a more conservative increase in the bottom number to slowly see what it does when increased. I found that even .5 adjustments can make a difference. Moving from where he has it set now at 15 up to 16 or 16.5 is a good place to start and then maybe another bump up to 17. If he is adventurous, jumping to 17 is fine as he can always back down again if necessary.

[DouglasL]

Thanks for the insight, especially into leaks. I downloaded the Swift FX manual and a standard vent leak at my pressure setting would be above 40 l/min


I'll raise the lower pressure up to 16cm. I also adjusted the response parameters so that both apneas and hypopneas would be treated more aggressively. With that change, my AHI was 4.8 last night - the lowest it's been.

[Emilia]

Great progress, Doug! Let us know how tonight goes....

[chunkyfrog]

You lucky stiff!
I couldn't see my data until 3 months in, Bad DME!

[DouglasL]

Thanks to the adjustments suggested and ones that I made to response parameters, I'm happy to say that my AHI has been below 5 for the last three nights and last night was 2.5!

I can only hope it will stay this way. I have a follow-up with my sleep doc next week and will review everything with him, but so far so good! Thanks everyone!

[JohnBFisher]

Thanks to the adjustments suggested and ones that I made to response parameters, I'm happy to say that my AHI has been below 5 for the last three nights and last night was 2.5!

I can only hope it will stay this way. I have a follow-up with my sleep doc next week and will review everything with him, but so far so good! Thanks everyone!

Congratulations! You prove the position of a lot of members of this forum. The most effective therapy is provided when the patient closely monitors their therapy. Here's hoping you are able to keep up this trend and continue to attain great sleep!

[Emilia]

So happy for you Doug! Being pro-active and monitoring your therapy has made all the difference for you. After going through this, it isn't hard to understand why so many cpapers, who have no idea about software or cpaptalk, quit and never go back. I hope as you get more comfortable with all the technical stuff, you will jump in and pay it forward to a newbie or two!

Here's to many wonderful years of deep, restorative sleep!