AHI too high

[Pugsy]

I did enlarge it...still a bit fuzzy to me. Likes it's a picture of a picture.
Anyway...Go slow with the increases in EPAP. ASV machine use takes more time getting used to and so be extra cautious with changes.

[Jaz1943]

Posting the complete report below. Thanks

https://www.dropbox.com/s/6ck2ggb5t90jm ... car.pdf?m=

[Jaz1943]

Thanks DJ. You're a great tutor. I really appreciate it.

All the Best

[Jaz1943]

Changed Epap min to 7 and PS min to 4, took a nap an display info showed AHI of 5.5. Will continue same settings tonight,

[JohnBFisher]

Greetings! If you don't mind, I'll jump into this conversation. First, I would like to point out some observations I made while looking at your data.

First of all, you, my friend, also suffer from pretty bad central apneas as you fall asleep. You can see that in the following graph. This shows that as you fall asleep your various scores also jump up in number. In fact, from looking at the scores over several nights it appears as if the obstructive apneas tend to trigger the central apneas. That is often the case. The lack of oxygen creates a swing back and forth in your respiration from hyper- to hypo- ventilation. And central apneas often result from the hyper-ventilation.

A little bit of an education is in order. During the hyperventilation your body blows off too much CO2, which your body measures by measuring the acidity of your blood. The acidity of the blood drives ventilation. If it becomes too acidic your body will breathe more rapidly to blow off the CO2. If it becomes to base (not acidic) then your respiratory drive decreases until the acidity climbs. This depression of the respiratory drive can cause the central sleep apnea.

As you can see your "Patient Triggered Breathing" falls as you fall asleep.



That leads to an increase in obstructive apneas and hypopneas during the same time period. Since these seem to proceed the central apneas, it would be wise to address the obstructive apneas and hypopneas.



Sometimes leaks seem to trigger the wakeup. You might find mask liners helpful with an ASV unit. You can find mask liners at the following websites:

http://www.remzzzs.com/
http://padacheek.com/



Finally, when we compare your Breaths Per Minute (BPM), you can see another confirmation of this correlation.



So, what to do about this? Well, you are on the correct path. Too often the sleep centers just leave the units "wide open" to allow them to dynamically address the problem. However, this can allow those obstructive apneas and hypopneas to make matters worse. You are doing the right thing. Gradually adjust your Minimum EPAP and Pressure Support. Since it's now at 5.5, I would wait another week before making further changes.

Why wait such a long time? Well, one day a trend does not make! There are several things you need to consider. First, it takes MONTHS before your body fully adjusts to the ASV therapy. It's not at all normal to have the pressure changing all over the place. However, as your body adjusts the AHI will naturally fall .. because your body is learning to use the ASV therapy as a reminder to breathe regularly and effectively.

Second, you need several days to really be able to see if you have a good trend. If at the end of the week your AHI remains above 5 then you should increase the Minimum EPAP by 0.5 (and no change to PS .. a PS of 4 is a fairly common separation between EPAP and IPAP).

Third, don't forget to let your doctor know the changes you've made. And show him the graphs so he can see that you are using the machine data to help guide the adjustments.

Hope that helps.

[Jaz1943]

Thanks John, that was really helpful. I will follow your advice. I have set the Epap Min to 7 and the PS Min to 4 yesterday and my AHI was 8,1 this morning. I will not change this setting for a week and see what happens. I have also created an Excel spreadsheet to track readings by graph. Which I will upload and share.

All the Best

[Jaz1943]

Here's the Excel spreadsheet and graph.https://www.dropbox.com/s/2duccmufld3xa ... NG.xlsx?m=

[Pugsy]

That's a good plan.
All to often people want to make changes based on last night's results and that simply is not the way to do things especially with the machine you are using.
And when last night looks awful the knee jerk reaction is to make a BIG change and we just shouldn't do that.
It is hard to "give it time" though.
With ASV machines especially we really have to stick to the "give it time" thing though. Your situation is much more complicated than a typical plain bilevel machine user's situation would be when they are only dealing with OSA.

Heck even with plain old OSA we shouldn't make huge changes all at once except in special situations.

[Jaz1943]

Thanks Brenda

[Jaz1943]

For those helping me with my bipap I am posting updated spreadsheet 3/25/14 that I created to help me track progress.

https://www.dropbox.com/s/2duccmufld3xa ... NG.xlsx?m=

[djhall]

For those helping me with my bipap I am posting updated spreadsheet 3/25/14 that I created to help me track progress.

https://www.dropbox.com/s/2duccmufld3xa ... NG.xlsx?m=

Nice way of tracking your info over time. You won't see big improvements yet, but its safer to go slowly than quickly. Of your most recent 10.4 AHI, 9.0 of it is OA and H, both of which are directly related to insufficient pressure, so you are on the right track. OA is improved only with EPAP. H is improved with EPAP & PS.

Keep making small changes and recording your data and let us know how its going.

[bwexler]

Jaz

I have been reading and learning from your discussion. I also have a PRS1 ASV machine since Oct. I have not changed any settings, because I was too ignorant until now to know what to tweek.
Now my AHI (0.2 last night) has often been below 1.
I now have little motivation to screw things up. I do get swings up to 3 on occasion but that is mostly H.
I was lucky to get used to PAP with an S9 Autoset for 3 years before switching machines.

I also noticed we are neighbors, I live in Hemet.

[Jaz1943]

Here's last nights report added to spreadsheet.

https://www.dropbox.com/s/2duccmufld3xa ... CKING.xlsx

Again, thanks for all the support. It really helps me work through this process.

All the Best

[Jaz1943]

latest report as of 4/2/14. It appears that I'm on the right track. Set Min Epap to 8 for the following week. Will post again next week.

https://www.dropbox.com/s/2duccmufld3xa ... CKING.xlsx

Have an appointment on the 16th to see my pulmonologist to review progress.