Get AHI down

[W7SOT]

OK - so still fighting to get events down during the night - here are my graphs from the last few days, all of them for past 3 weeks looks just like this - what can I do get my numbers down a bit? my pressure is set to 10-18 - not sure why the pressures are lower than that on some of the graphs - but someone out their must have something I can try to make things better - I need sleep, and so far the CPAP just is not making any difference.

[robysue]

I know that you're looking for ideas on reducing the AHI, but the one thing that stands out most in the data to me are the hour long (plus) breaks in the data.

What about those gaps? Do they represent times when you took the mask off and got out of bed or do they represent times when you took the mask off and went back to sleep?

If you are getting out of bed for over an hour every single night and it's gone on for 3 weeks, the sleep maintenance insomnia is pretty bad and it's time to call the sleep doc and see if they can provide you with any kind of meaningful ideas and support. An appropriate sleeping pill may work wonders. Or some they may have some CBT ideas for trying to trim the length of that main, middle of the night wake.

If the gaps represent times when you took the mask off and went back to sleep sans mask, then that's the first issue to address in your therapy: Are you consciously doing this behavior? Or are you taking the mask off in your sleep and later waking up and putting the mask back on? In either case, there are folks here who have faced the problem and have come up with workable solutions.

Next, you've got some significant leaking going on: There are multiple periods of time where your unintentiona leak rate is very near or above the magic Red Line at 24 L/min for the ResMed machines. The leaks are probably not long enough for you to be seeing Mr. Red Frowny Face in the morning, but they are still pretty bad at times. More significantly, the worst of your apnea/hypopnea clusters seem to be happening during the periods with higher leak rates. Given the time frame of the clusters, there's also a chance that the clusters might be REM-related.

It's also worth noting that there are a fair number of "Unknown Apneas" being scored during the high leak periods. That means that the S9 was unable to figure out the patency of your upper airway with the FOT algorithm. And the problem most likely lies with the high leak rate. The machine is not going to respond to As and CAs with pressure increases by the way.

For now, I'd be a bit reluctant to just increase the pressure setting given the leak rates. My guess is that you need to focus on getting the leaks under control. Once the leaks are under control, the AHI may come down without any additional tweaking. If not, that's when it might be reasonable to consider a pressure increase.

Summary of my recommendations:

Task 1: Deal with what ever is causing those long breaks in therapy.

Task 2: Work on the leaks

[greg-g]

Re your pressures.
The green pressure line is the inhalation pressure and the pressure that's normally quoted.
The blue line exhalation pressure which is the set pressure less EPR which in you case is set to 3.
I suspect you minimum pressure is actually set to 9, not 10.
You could try increasing the minimum up to 12, but I suspect it won't make much difference, but It shouldn't cause any problems either. It would be worth a try.

[DreamStalker]

Before you attempt changing pressures .... get your leaks under control.