Very confused on AHI and doctor increasing air pressure

[madgirl]

Hi - a total newbie here - My husband is the CPAP user - Resmed AirSense10 - first 2 weeks with a pillows mask and then switched to a full face one for the last 8 weeks.

Monday, we had our check up with the sleep doc. She looked at the data and showed us that a number was averaging around 7 and that number should be under 5. She said she was increasing his max air pressure from 15 to 20 in order to get him "under 5".

QUESTION _ IS THIS THE SAME NUMBER AS AHI??????
According to the Sleepytime report I just set up for the first time, the AHI number before going to see her was very low every night……under 2.
Then the night she increased the pressure it dramatically increased to over 8. He had lots of problems with the machine the next night with too much air pressure and lots of leakage and his AHI was 18!
I decreased the pressure slightly from 20 to 18 and noticed that the machine was still set to the original "PILLOWS" mask and never corrected to a full face mask, so I corrected that. The AHI has been 8, 18, 11, 6, 8 this week.

I signed him up for myAir to get the daily reports and it showed last night (first night of sending data to myAir) events per hour as 8.6! I'm pretty sure this is the number that the doctor wanted below 5.
Sleepytime has it as 8.57 (OI of 4.53 + CAI of 2.91 + HI of 1.13).
So again I ask, is AHI the same as events per hour…and is this what she showed us as being 7 and needing to lower under 5?
Confused….looking at Sleepytime reports, I don't see anything that resembles that 7+ that the doctor showed us.

Thought and insights? Could the machine have been reading pressure and events wrong because of the wrong mask setting? But the first 2 nights this week with the highest pressure setting on 10 and very high AHI numbers, I had not corrected the mask setting yet.

It seems that majority of the events are in fact Obstructive Events. He does not sleep the entire night through - up and taking make off sometimes to go to the bathroom - and sometimes during the middle of the night we will talk for a few minutes and he doesn't take the mask off since it's a full face one. Looking at last night it seems that the obstructive events are in clusters - once around the time when I came to bed (he was already in bed) and then a few times in the am. Could these be things recorded as OI events - and maybe the machine is picking them up now since the mask setting has been corrected?

Honestly, the doctor is good - but not someone I would want to go back to or ask these questions. To me it is very normal to investigate these things and be my own health advocate, but this is not a doctor who would appreciate any of this. And at this point in my life I do not feel like being scolded.

[Julie]

You might be confusing pressure setting numbers with number of events/apneas per hour (AHI) so would need to get that sorted out.

You refer to "Sleepytime" software - do you mean Sleepyhead?

It would be helpful if you posted some graphs - download to Imgur.com, size appropriately and leave that link on this thread so we can see what's going on. It's hard to comment otherwise.

It's not clear either if your husband was diagnosed only with obstructive events, or some centrals... and which machine - very specifically which full name and model # he's using - it matters to being able to know what's what.

[Gasper62]

I suggest that your husband should join the forum and start reading (a lot), if he really wants to be involved in and understand his apnea therapy. After a while, it'll become much clearer.

[Cardsfan]

The number the Dr. wants "under 5" is the AHI. When you are over 5 AHI, you are diagnosed with sleep apnea. Many of us will tell you try to get that AHI as low as possible- mine is usually under 1 AHI. If my AHI is 5, that means I am waking up 5 times every hour. That's still too high. Anything under 5 is considered treated.

[Cardsfan]

The nights that the AHI was 2, what was the pressure set at? The goal is to have the AHI as low as possible.

[madgirl]

Thank you for the quick replies. The machine is a ResMed AirSense10. He started with a pillows mask for 2 weeks and then switched to a Fisher and Paykel Simplus full face mask.

Going back to Sleepy Head (not Sleepytime, sorry!) I noticed that the doc must have changed some settings on the machine. Looking at the report from the days prior to her adjusting it, there is only summary info for those days….no graphs. But starting the night after our appointment, there is detail data for each day.
What setting would she have changed?

The original setting was 5 to 15. She changed that from 5 to 20. But something else must have changed - makes no sense at all to have your AHI go from under 1 on many nights to over 8.

[Cardsfan]

The AHI is Apnea Hypopnea Index. It is the average number apneas and hypopneas you have per hour while you sleep. (how many times per hour you do not breathe)
Adjusting the pressure settings to the ideal amount of pressure should lower the AHI.

[chunkyfrog]

Hopefully, your husband should have an Airsense 10 AUTOSET.
Read the small type on the little label on the lower right front.

[madgirl]

Let's give this a go……here are two images showing data.

One from a night before the Doc adjusted the machine and one showing data the night after…..






I've never used Ingmur before so I hope this works!

[Wulfman...]

Your doctor is an idiot. The MINIMUM pressure is what needs to be increased........NOT the maximum pressure.

I would suggest increasing the minimum to about 10 cm. and setting the maximum back to 15 cm......for awhile......and monitor the results. You might want to do it in smaller increments like setting the minimum to 8 for a few nights before going all the way to 10.
The minimum needs to be near where it prevents the majority of events.

Den

.

[lilly747]

Your doctor is an idiot.

I was thinking it...but didn't want to say it.....

[Wulfman...]

Your doctor is an idiot.

I was thinking it...but didn't want to say it.....

Well, after all, this IS the Internet.......feel free to say almost anything that comes to your mind........


Den

.

[madgirl]

Unraveling the mystery - I found some discussion online of a summary data problem with ResMed machines and Sleepyhead.
Likely that unless Sleepyhead has the detail data for each day that the total AHI number will not be correct - and the detail data is clearly missing from those days with the low AHI.

So that answers the incompatibility of data question! I have a Mac so I don't have access the running ResScan…..&^$p! I will have to assume the Doctor's number of 7+ for AHI for his first 2 months was in fact correct.

Then that leads to the next question……why is my husband's AHI over 5?

The machine is an "auto set" machine, so it is supposed to properly set itself. I assume that means that the settings - minimum of 5 and maximum of 20 - don't really matter if the machine is functioning properly.
In other words, if the min setting is 5 but he needs an air pressure of 10 to prevent obstructive events (he has mostly obstructive events and some clear airway events) the machine should figure that out and he should be getting that necessary air pressure of 10+. Am I correct here?

[BlackSpinner]

The machine is an "auto set" machine, so it is supposed to properly set itself. I assume that means that the settings - minimum of 5 and maximum of 20 - don't really matter if the machine is functioning properly.
In other words, if the min setting is 5 but he needs an air pressure of 10 to prevent obstructive events (he has mostly obstructive events and some clear airway events) the machine should figure that out and he should be getting that necessary air pressure of 10+. Am I correct here?

No it doesn't work that way. It doesn't chase an apnea in progress, it lets it happen and then tries to find a good pressure. It can end up chasing pressure all over the map during the night. The lower limit should be set near the needed limit to prevent that.

[flightco]

I am sure you get some more complete answers, but while you are waiting I will give you my experience.

I was diagnosed with an AHI of 8.5. Pressure was set from 5 to 10, my average AHI was now 10 to ll. Doctor said to give it time, I set my pressure from 8 to 20 and watched for a couple days, AHI dropped to a low of 3 to 4 and a high of 5 to 6 with my max pressure being about 14. I changed my pressure to 12 to 15 and AHI is not in the 1-2 range most nights with sometimes below 1. I am assuming the machine keeps you from dying by jumping up to the pressure needed but actually prevents the occurrences if your low number is closer to what resolves the AHI.

Anyway, this is how I understand it, will wait to see if this theory is corrected or confirmed.