AHI number, reason for concern

[iglehart]

First of all I would like to say hello to everyone on the forum. This forum is a great source of information and community.
I have read many pages and link. I have a good starting grasp of Apnea now.
Some background.

I found out I have sleep apnea about 2-3 weeks ago. I was a little surprised as I am not too overweight. Now as I read I understand
that weight is only one factor. Anyway, so I did 2 studies. First one I had a AHI of 53. The second I got an AHI of 3 or 4, but for most pressures it was zero.
My doctor set the pressure to 7 to 9 on a resmed escape auto. I am going back and asking for the AutoSet after reading more here.
So after a few nights now I do get the AHI number and it had been about 2-4 most night.
3 questions I have are.

Should I be worried its not zero?

I have been tweeking with pressure, is this ok? Not much just a little to see if I can hit zero. Changes from 7-9 to 6-8 then to 7-8.

At the beginning of the night right as I fall asleep I wake up and take a deep breath, like I have been holding my breath. It only happens once or twice till I fall alseep.
Is this just my body getting used to the pressure? Should I lower the pressure or use the ramp feature?

Thanks

[imfletch]

You will most likely NEVER have a zero. It just doesn't happen...not even for those who don't suffer with apnea. The general rule is, if your AHI is 5 or below, your therapy is working. If you awaken to taking a deep breath (as if you've been holding your breath) you've probably had an apnea event and you body is waking you to take a breath. If you were titrated at 7-9, then lowering the "9" could be causing your events. The machine doesn't really start raising the pressure until it senses you are asleep. I often have an "event" at the onset of sleep. Since you have an auto machine, why not try 7-11 and see what happens? The machine will only take you to 11 if it is necessary to clear your airways. Sometimes, higher pressures can make you have CAs, but that is something your data would tell you the next morning. Pugsy is the resident expert in this field and I only offer my ramblings until she can come along with some more professional advice. Welcome to the group and to the world of the hose-heads.

[nanwilson]

Please do not play with your pressures until you know and understand what you are doing ..... you can cause a host of "other" problems to crop up. Yes, an ahi of under 5 is what we "strive" for as that is considered normal, although some of us struggle to get there, you are one of the lucky ones to have gotten there after a few weeks of therapy .. congratulations.
Do some reading on here and you will gain valuable knowledge and learn how to achieve the best therapy for you.
Welcome to the land of hoseheads or hosers..... whichever you prefer
Cheers
Nan

[iglehart]

Thanks for the replies. I will set my pressure back to what the doctor did and count my blessing as the number is low.

A little more info on myself. My 2nd sleep study showed reduction of events at pressures of 4-9 and 10 brought them back again.
My snoring went down at 7-9 but the apnea events stopped as low as 4. I guess I am lucky.

Also for me the mask is not bothersome and I am comfortable with it. Now if I can get my father-in-law to get back on treatment.
After reading all the side effects on here I am scared for him. He think with positioning he has conquered his apnea, but he is always tired and
falling asleep. I hope he see the light before something bad happens.

[Pugsy]

When you get the Autset you will then be able to see the event category breakdown for the AHI that you are seeing.
Those little pressure changes you have been making with the APAP range...very tiny and to be honest, not going to make much difference even if there needed to be a change which with an AHI of 3 or 4 right now (and their isn't a need right now.

1...part of that AHI might be central in nature and no amount of pressure changes will fix them
2...part of that AHI might even be awake/semi awake events getting flagged (the machine doesn't know if you are awake or asleep) can't do anything about those if they happen.
3...before you go trying to fix something...make sure it needs fixing first and that what you are trying to fix is fixable.
4...evaluate the leak data (which your Escape Auto doesn't offer at all) before you go changing pressures because maybe it is the leak that needs fixing first.
5...Chasing AHI 0.0...will drive you crazy and is unneeded worry. Yes, a few people do attain that little feather in their cap but there are more of us who don't obtain it or get it very rarely. AHI can vary from night to night with zero changes in anything. I might have AHI 0.40 one night and the very next night 4.0...and never change anything. It happens. We don't sleep the same each night.
So quit worrying about 0.0 AHI..if it happens ...it happens and if it doesn't it isn't the end of the world.

Since you have an auto machine, why not try 7-11 and see what happens? The machine will only take you to 11 if it is necessary to clear your airways. Sometimes, higher pressures can make you have CAs, but that is something your data would tell you the next morning.

Unfortunately with the Escape Auto we don't have AHI event category breakdown. Don't get centrals flagged separately. No way to know if they happen or not.
We need the S9 Autoset for that data point.
7 to 11 range is a modest range but there is no way to evaluate the results except the gross AHI number and the average pressure used. The Escape Auto gives severely limited data.

Normally if the AHI is composed of excess obstructive apneas...the minimum pressure is the most critical pressure.
Have the minimum pressure set optimally and the maximum pressure is less likely to ever be needed. The machine works best by preventing the collapse of the airway in the first place. Playing catchup trying to fix things after the fact with higher maximums doesn't always work so great.

I would be using what the doctor prescribed for the time being and work on getting the AutoSet.