AHI too high

[Jaz1943]

I have a Respironics Bipap AutoSV Advanced and amd getting AHI readings averaging 10. My settings are:
MAX PRESSURE = 25
EPAP MIN = 5
EPAP MAX = 15
BPM = Auto
PS MIN = 3
PS MAX = 15

Anyone out there a Sleep Therapist or Doctor who can suggest new settings. I am also using Encore Pro 2 and Sleepmapper to monitor my results.

Thanks in advance for any help

[djhall]

Anyone out there a Sleep Therapist or Doctor who can suggest new settings. I am also using Encore Pro 2 and Sleepmapper to monitor my results.

Typically you will need to post some screenshots of your nightly details in order for anyone to be able to hel. If your AHI is mostly from Centrals / Clear Airways that is a completely different situation than if your AHI is mostly from Obstructives. Since you are on auto mode, those events could be happening at any pressure from 5 to 15 and we currently have no way of telling.

[JDS74]

Do you have the reports from your sleep study and your sleep titration study?
What do they say about the distribution of the various types of apnea events?
What does the report page (Daily Details) have to say about the numbers of the different types of events?
Your obstructives should be almost zero and if they are not, then your doc should be asked what type of adjustment will get you there.

I wouldn't recommend fiddling with your numbers just yet. This machine is really very complicated and needs to be able to switch into ventilator mode with a pressure swing of 10 cmH2O more or less if it has to respond to central apneas and breathe for you. In a similar discussion with my doc, we agreed that I could safely play around with the MinPS in the range of 5 to 10, and the EPAP min in the range of 9 to 10 and nothing else. That left me with a possible ventilator pressure swing of 15 cmH2O. It works for me as I sometimes have more than an hour at a time in ventilator mode and I appreciate the large swing between EPAP of 10 and IPAP of 25.

Your doctor can discuss whether of not the EPAP min needs adjustment and whether or not then MinPS needs adjustment as well.
Print out some Encore Pro reports so you and your doctor can discuss what you are seeing and how to fix it necessary.

[Jaz1943]

Her'a one night example of even'ts with an AHI of 11.7:

% of night in PB = 1.0
CA = 1.2
OA= 3.3
H = 7.2
FL = 0.4
VS= 10.7

[JDS74]

Yep, OSA not zero means its off to the doc for some sort of pressure adjustment.

[Jaz1943]

Here's a screenshot of the daily report for previous post.

https://www.dropbox.com/s/mngaz8aidtx0a ... oto7-2.jpg

[Jaz1943]

JD, what do you mean OSI not 0? By the way we used to live in Greenwood, SC. Loved the town.

[SleepyToo2]

Yep, OSA not zero means its off to the doc for some sort of pressure adjustment.

Good luck with persuading any doc to make a pressure adjustment when the AHI is less than 5. Unless there are signs and symptoms that suggest a pressure increase might be needed.

[djhall]

Here's a screenshot of the daily report for previous post.

https://www.dropbox.com/s/mngaz8aidtx0a ... oto7-2.jpg

Okay, that should give us something to work with. The Respironics software displays things a bit differently from SleepyHead, so your data isn't laid out the way I'm used to seeing it, but there are plenty of people here used to working with that format. Am I correct in assuming we are looking at a night that runs from 17:00 - 02:00 machine time with a nap around 08:30 - 09:00? If so, something strange seems to be happening around the 19:00 and 21:00 marks... are you resetting the machine or using the ramp function in the middle of the night???

[JDS74]

JD, what do you mean OSI not 0? By the way we used to live in Greenwood, SC. Loved the town.

On your report, the OA (obstructive apnea) value is 3.3. That's too high for this machine. You should be able to get it down to 0.0

Your AHI for this report is above 10 with your Hypopnea index of 7.2.

That should call for some adjustment.

[djhall]

Your AHI for this report is above 10 with your Hypopnea index of 7.2. That should call for some adjustment.

Take a good look at his sleep report. I'm hesitant because I'm not used to the data layout, but his pressure is clearly auto adjusting and it looks to me like his EPAP is starting around 5 and he has a bunch of events while the machine climbs to roughly 15, but then it drops right back to 5. Then he has a bunch of events while it climbs up to 15 again, but then it drops back to 5 and climbs again. The majority of the OAs are occurring during the time the machine is climbing up from the starting pressure. My initial instinct is that his minimum pressure is set quite a bit lower than the effective pressure range and he is either restarting the machine or triggering the ramp function multiple times per session which is allowing a lot more events than would normally be allowed on auto.

[Pugsy]

Did you set the time zone in Encore to match your time zone where you live?
It defaults to GMT time and it gives fragmented reports when we are in the US.
Or are you taking lots of naps?

[Jaz1943]

I had the timezone set to GMT and changed it to Pacific Time with DST and reran the report. Deleted old report on Dropbox and added the new one with same name. The linked report should show accurate data now. Sorry about that.

[Jaz1943]

Here is the new link:

https://www.dropbox.com/s/u1yw8ravw0y0q ... 7-2.jpg?m=

[djhall]

Here is the new link:

https://www.dropbox.com/s/u1yw8ravw0y0q ... 7-2.jpg?m=

Thanks, that is much nicer. Can you take a look at the breaks in the pressure graph between the 13 / 14 and 15 / 16 time marks. What happened at that point? Are you waking up and turning off the machine to get up? Is the pressure waking you and you are ramping to get back to sleep?