Cannot lower apneas or AHI. PLS. HELP - DESPERATE!

[lennyten]

I have been on APAP for about 1 year now and have never gotten the AHI anywhere near the 5 level. Also, my apneas are always about 1.9 events per hour and about .8% for time in apneas. My HI is about 7.

My doctor thought that it must be a problem with the Resmed Sprit that I was using, so I recently switched to the Resmed S8 Vantage. There was no difference in the results.

My doctor finally relooked at my sleep study and said that it should have been set as a CPAP instead of APAP at level 10. We tried that with no better results. Then I tried it at level 8, with about the same results.

Now the doctor is saying that I might have central apnea, even thou it did not show up on the sleep study or hering breuer reflux.

Also, since I might be a mouth breather, I have tried a chin strap with my Swift, along with some nights taping my mouth both partially and/or totally.

In any event, sometimes I wake up feeling good and sometimes just as tired as I could be.

Any suggestions from anybody as to why my apneas and hypotneas have never gotten to low levels?

Should I try different settings on the machine? Use it as a CPAP or APAP?

I would really appreciate any help or suggestions you might have.

Thanks alot.

[Linda3032]

When you use it as an apap, what settings do you use? When the apap is set with a high of 12 or 14, what is your 95% pressure?

Leaks and/or mouthbreathing might be the major problem. Have you ever tried using a full face mask?

[Wulfman]

I was going to suggest a full face mask, too.....but I see Linda beat me to it.

You might get your doctor to order an overnight pulse oximetry test. (it's free)
Is your mask setting on you machine set correctly?

Do you wake up with dry mouth?

Just some random thoughts.....

Den

[lennyten]

When you use it as an apap, what settings do you use? When the apap is set with a high of 12 or 14, what is your 95% pressure?

I have been using 8 - 20 on the APAP. The 95% pressure was about 10.8.

I have only used the CPAP on 8 and on 10. The doctor said that at 12, it was causing apneas, so keep it at 10. Does this make sense?

Thanks.

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

[maskjkie]

I have been on APAP for about 1 year now and have never gotten the AHI anywhere near the 5 level. Also, my apneas are always about 1.9 events per hour and about .8% for time in apneas. My HI is about 7.

My doctor thought that it must be a problem with the Resmed Sprit that I was using, so I recently switched to the Resmed S8 Vantage. There was no difference in the results.

My doctor finally relooked at my sleep study and said that it should have been set as a CPAP instead of APAP at level 10. We tried that with no better results. Then I tried it at level 8, with about the same results.

Now the doctor is saying that I might have central apnea, even thou it did not show up on the sleep study or hering breuer reflux.

Also, since I might be a mouth breather, I have tried a chin strap with my Swift, along with some nights taping my mouth both partially and/or totally.

In any event, sometimes I wake up feeling good and sometimes just as tired as I could be.

Any suggestions from anybody as to why my apneas and hypotneas have never gotten to low levels?

Should I try different settings on the machine? Use it as a CPAP or APAP?

I would really appreciate any help or suggestions you might have.

Thanks alot.

Lennyten,
I suggest you try the new Hybrid mask to lower AHI. Since you are a mouthbreather, you need a mask that delivers air to both nares and mouth or a nasal interface (such as the Swift) with a chin strap and/or mouth tape. You say that you have tried the Swift with chin strap and/or mouth tape and it didn't consistently get better.

If you go through all the threads regarding the Hybrid mask on this forum, several users (who are mouthbreathers) are reporting that AHI is dropping from 4+ to less than 1 by using the Hybrid mask with an AutoPAP such as the ResMed S8 Vantage.

When you use a nasal interface (such as Swift) with a chin strap, the chin strap applies upward force and it actually narrows the airway and causes hypopneas. When you use a conventional full face mask (such as the Ultra Mirage FF), the seal is created beneath the lower lip by tightening the headstraps and this tightening forces the lower jaw to move behind, again causing apneas and hypopneas. Thats why AHI remains high.

The Hybrid mask delivers air directly into the nares through the nasal pillows and into the mouth through the oral part. So, the pressure applied is efficiently transferred to the upper airway and prevenys apneas and hypopneas. It has a soft chin flap that gently supports the chin and prevents the lower jaw from dropping back too much. It also has a generous exhaust port flow rate, so it flushes out the CO2 and reduces CO2 re-breathing. If you re-breathe less CO2, you will have less hypopneas.

[Snoredog]

[quote="lennyten"]I have been on APAP for about 1 year now and have never gotten the AHI anywhere near the 5 level. Also, my apneas are always about 1.9 events per hour and about .8% for time in apneas. My HI is about 7.

My doctor thought that it must be a problem with the Resmed Sprit that I was using, so I recently switched to the Resmed S8 Vantage. There was no difference in the results.

My doctor finally relooked at my sleep study and said that it should have been set as a CPAP instead of APAP at level 10. We tried that with no better results. Then I tried it at level 8, with about the same results.

Now the doctor is saying that I might have central apnea, even thou it did not show up on the sleep study or hering breuer reflux.

Also, since I might be a mouth breather, I have tried a chin strap with my Swift, along with some nights taping my mouth both partially and/or totally.

In any event, sometimes I wake up feeling good and sometimes just as tired as I could be.

Any suggestions from anybody as to why my apneas and hypotneas have never gotten to low levels?

Should I try different settings on the machine? Use it as a CPAP or APAP?

I would really appreciate any help or suggestions you might have.

Thanks alot.

[WillCunningham]

One other thing to consider is Acid Reflux or GERD. Apparently the cPAP keeps your soft tissue airways open....but if it is irritated by acid reflux or gerd, it swells an becomes more like hard tissue and cpap can become ineffective or less effective. That was a tip I saw mentioned in another thread and was totally surprized by. My doctor didn't mention it either, though we did talk about it recently and he was glad that I brought it up.

[haynow2b]

Hi WC! I also had been using the Swift nasal pillows & had problems w/ mouth leaking. I used a chin strap but I don't believe it was much help. One of the folks where I had my sleep studies done gave me a Hybrid F/F to use & I too am sold on it. I have a full beard & mustache & w/o having to tighten straps so much as to crack a skull, I am having very good success @ not having leaks. My #'s from my Encore Pro software show my average AHI down .5 as well as snores. I have only been using the F/F since Sat. but so far - very good! Good luck!

[maskjkie]

Hi WC! I also had been using the Swift nasal pillows & had problems w/ mouth leaking. I used a chin strap but I don't believe it was much help. One of the folks where I had my sleep studies done gave me a Hybrid F/F to use & I too am sold on it. I have a full beard & mustache & w/o having to tighten straps so much as to crack a skull, I am having very good success @ not having leaks. My #'s from my Encore Pro software show my average AHI down .5 as well as snores. I have only been using the F/F since Sat. but so far - very good! Good luck!

Haynow2b,
What is your pressure? What was your average AHI with the Swift and chin strap and what is it now with the Hybrid? Do you also feel more energetic since you started using the Hybrid?

[lennyten]

Thanks to everyone for all of your help.

I reset my machine to 6.6 - 10.4, and I had an increase in AHI and apneas, etc.

So now increase the settings or decrease them?

Thanks.

[maskjkie]

Thanks to everyone for all of your help.

I reset my machine to 6.6 - 10.4, and I had an increase in AHI and apneas, etc.

So now increase the settings or decrease them?

Thanks.

Lennyten,
After reading all your experiments with changing pressures, I'm of the opinion that changing pressure settings in not going to help. I think the Swift + chin strap is not working for you. I suggest that you try the Hybrid mask.

[Snoredog]

[quote="lennyten"]Thanks to everyone for all of your help.

I reset my machine to 6.6 - 10.4, and I had an increase in AHI and apneas, etc.

So now increase the settings or decrease them?

Thanks.