My AHI and mouth taping etc.

hogdaddy · Post by **hogdaddy** » Wed May 24, 2006 12:12 pm

I have been on CPAP for about three months now and feel good. I look forward to going to bed and as I say, "turning on(CPAP) and Tuning out(sleep)". I am very happy with my Remstar Auto with CFLEX(3) and mirage swift nasal pillows. I currently have it set on auto with a range of 9-10. I know that is not much range, but if I go higher or lower my AHI's go way up. 9&10 give me the most consistent low AHI's. I use the HH, but at a setting of 1.

I have been sleeping well, but I know it can get better, but I can't figure out the next step. I have tried mouth taping, but it seems that I get about the same Ahi, about 6.2, no matter if I tape or not. I can tell that my leaks are virtually nonexistent with the tape, but why are my numbers not significantly better than without tape. I really like my nasal pillows and they do not leak, except under certain circumstances, so they are not the problem.

I have tried running on auto with settings between 6-20, tried strait Cpap at 8, where I was titrated during my sleep study, but I get very high AhI numbers at 8 and if I go above 10 I get very high numbers as well. 9 seems to be my best setting, but I did not sleep well at a constant 9.

I generally only have one open sinus every night and I have a deviated septum, but I make do through the one nostril. My best AHI ever was 2.2 and that was without mouth tape if I remember correctly. In looking at the graphs it shows that I had lots of leaks during the night and that the average leak was36.64(what does that mean? So, I don't understand how my AHI could have been so good with so many leaks. There has only been one morning during my treatment where I awoke and felt that I was truly energized and that was just a couple of weeks ago.

Does anyone have any suggestions on what I can do to get my numbers down. In summary, I have tried adjusting my auto settings, tried taping, tried cold water and no HH, tried strait CPAP at several different settings, and tried different masks. The last time I saw a Doc about this he said any AHI below 10 is considered good. That didn't sound right to me.

Any help would be greatly appreciated. I will have to deal with this until I can lose enough weight. I have lost at least 40 lbs. so far, but still have about 70 to go to reach my goal weight. I know lots of you think apnea is not weight related, but I would imagine that mine is as I was 350lbs. plus(beyond limits of scale, so I don't know actual max weight). Please no comments about apnea not being weight related, I have heard all the arguments. All I know is that I have been fat for 30 years and it is time to live the rest of my life as an in shape person. If I have apnea when I am skinny, so be it, I kind of like the flow of air. It has become kind of soothing.

Thanks, Bobby G

jcarn · Post by **jcarn** » Thu May 25, 2006 7:41 am

Try setting your APAP with a range 7-11 .. normally you go 2 above and below your titrated pressure as a starting point. It sounds like you have the software so try it out for a couple of weeks and check your results. Keep using the tape. Keep your HH at 1.

Have you tried the full face masks? I personally can't stand them, but I am a mouth breather trying to adapt, so I have one as a backup just incase. That may be your "fix" for lower numbers.

As far as leaks .. I have the same problem with my Aura .. I still occasionally breath through my mouth, but a DIY mouthpiece has cut that down considerably. It also prevents teeth grinding. There's a link on this forum somewhere on how to make it (very easy).

Congratualtions on the weight loss. I am a firm believer that the more overweight you are, the more apnea issues you'll have. I've noticed a great improvement in my life just by dropping 10lbs.

Keep the faith .. you're on the right track.

oldgearhead · Post by **oldgearhead** » Thu May 25, 2006 8:10 am

Do you think you may have 'positional' issues. I think most people snore
louder & longer on their backs, than on their sides. Therefore, maybe that ties to your AHI readings.

As far as mouth 'blow out' is concerned, mouthpieces and chin straps, or a combination of both do not help me at all. Furthermore, the paper tape only
works for me if the pressure is below 10cm/H2o.

I use both nasal pillows (CL2) and a UMFF. My gut feeling is nasal pillows are much more efficient than full-face-masks, and deliver the same benefit
at lower pressure. Currently, I run the UMFF at 10cm, and the CL2/nasal pillows at 8cm.

Celic · Post by **Celic** » Thu May 25, 2006 10:57 am

My AHI seems to goe up with CFLEX on. I found that with a setting of 2, I would wake up shortly after falling to sleep and had the feeling that I had stopped breathing. I ended up turning CFLEX off. I also seem to be comfortable with it off.

Since I don't read about similar issues from others, I suspect what is happening to me is rare but you might consider trying a lower CFLEX setting if you are still comfortable at a lower level.

Steve

roztom · Post by **roztom** » Thu May 25, 2006 7:48 pm

C-Flex is really a comfort thing and really makes a difference as your pressure rises.

But if you are going to adjust the variables why not try the C-Flex but try not to introduce to many changes at once - you won't knwo what is causing the changes in numbers.

When you say you have mouth leaks - do you wake up with a dry mouth? does your leak alarm go off (if it's activated)?

Have you tries different pressure ranges? While the general consensus is to have a range 2 above and 2 below your titrated pressure, I know of some who kep it at a narrow range of 1 cm (ex 7-8

I'm not saying that's right for you but if you spend most of your time at the number witht he lowest AHI and only go up occasionally, less than 40% to the higher number than you're probably found your sweet spot.

If your AHI goes up with the pressure than you might have missed the best number.

Everyone is different whoich is why one size doesn't fit all.

"Best,

Tom

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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, AHI

mikemoran · Post by **mikemoran** » Thu May 25, 2006 9:40 pm

AHI 5 or below is a goal but not a necessity. The more important number is your AI ( Average Apnea events) 1 or below is great. If your auto is doing the job on the apnea events then don't be as concerned with the Hypapnea events. Your weight may be the isssue that causes the machine to not be as responsive to restricted breathing. If I recall from other threads the Respironics algorythmn is not as agressive on HI as other equipment algorythmns.

One key to remember is the numbers are just numbers. The true test for treatment effectiveness is how you feel when you wake up. Do you have more energy? Are the overwhelming moments of drowsiness reduced?

Masks and mouths will leak to some extent, but if you aren't cutting off your oxygen at night and you don't feel like hell, then its working.

roztom · Post by **roztom** » Fri May 26, 2006 6:35 pm

Mike:

OSA is the biggie, however, Hypop's should not be minimized. The reason I suggest that is my AHI pre-treatment was apx 71, almost all Hyppop's. Only a few OSA'a. but the disruption and my quality of sleep was seriously compromised. In addition my Oxy Desat went into the 80% level - all from Hypop's.

Hypyop's aren't as sinister as OSA I agree but Hypop's aren't a walk in the park either.

.02

Tom

mikemoran · Post by **mikemoran** » Fri May 26, 2006 6:40 pm

Tom,

Not disgreeing with you at all. But an AHI of 10 that is 1 AI and 9 HI isn't as dangerous as the other way around. My point was that until the weight gets down he may not see better HI. Also the algorythmn on the Respironics is not as agressive with HI as other brands.

roztom · Post by **roztom** » Fri May 26, 2006 6:59 pm

Not disagreement Mike. However, whether Hypop's or OSA OXY Desat ends up doing the same damage. CO2, stress the the bodies systems. IS there really a difference on how you get a lousy AHI? Is a lower ratio of OA to HI more desirable? Does it make a difference ? I really don't know but AHI is AHI ands a bad AHI is bad no matter how you get there.

No debate here, Mike. As one who suffers form HI, it is no picnic and oh yes, I do throw a few OSA's in just for good measure.

Best,

Tom

Bingo · Post by **Bingo** » Fri May 26, 2006 7:34 pm

Hiya Hogdaddy!

I'm brand new around here myself, but I wanted to offer a few things to you.

One would be to ask if you have discussed this with a Sleep Disorder Specialist, usually a good Pulmonologist.

This is really the best first step. Everyone is different and no 1 answer can be applied across the board to everyone. An AHI of 10 or less for you may be stellar and a wonderful goal to have achieved.

Remember that up until very recently, an AHI below 30 was considered healthy and did not require treatment barring any extenuating circumstances!

Even now an AHI below 5 is considered healthy. You are talking about being only a episode or two above that even now!!

Also, if you are having issues or even just concerns about leaks, talk to your provider. Ask them questions. That is what they are good at!

Take care and good luck -

Bingo

Humidifier

Additional Comments: Auto range 11-15