How to reduce my AHI numbers

[dexnjan]

I have been using my machine for about 3 months now. My AHI numbers average about 12-15. I like using my machine, I breathe better through my nose than ever, and I get up fewer times to go to the bathroom. I usually use it for 7 hours or so. They started my pressure at about 5 and after I communicated with them, they have put my machine on autosense with settings of 5-12. I am an older male (83) whose only real health problem has been high blood pressure, and it is under good control now. I would like my incidents to be lower. I use Oscar and an SD card, also My Resmed software.

[Pugsy]

Welcome to the forum.

Can you please post one typical night's detail report in this format
viewtopic/t158560/How-to-post-images-for-review.html

We need to know what kind of events you are having and when you are having them before we can do much more than guess at how to reduce the AHI.

[dexnjan]

screenshot-20190807-120457.png (84.45 KiB) Viewed 1612 times

[Pugsy]

Were you asleep from 12:30 to 1:30?
Do you have any known heart issues?
What medications do you take?
When did you last see your sleep doctor or regular doctor? Age 83...Medicare I assume?? Should have been a face to face appointment prior to the 91st day of being on the machine. Does your doctor know about these results?

Omit the mask pressure graph and put the regular pressure graph in its place.
Resize the graphs a bit so that the flow limitation graph is visible. Hover your mouse cursor on the bottom line of a graph and click and drag to resize a bit. You should be able to get Events, flow rate, pressure, leak and Flow limitation in one image and the graphs still be large enough for evaluation.

Turn off the pie chart so that the statistics and settings are better seen. (Preferences/appearance tab..remove the check mark for show pie chart).

No need to redo this image though. I can see well enough what I need to see right now. I mention the little changes for future images.

I would like a zoomed in section though...
Go to the events tab on the left hand side...click on Clear Airway apnea category...scroll down until you see a flagged CA/centrals at around 01:00....click on something timed around that time. The graphs on the right will change...you will bee zoomed in...I need a screen shot of the flow rate zoomed in.

[dexnjan]

I believe I was sleeping - time 12:30to 1:30 -- No known heart issues -- Only medications are for blood pressure , Amlodipine, Triamter .
I am not used to sleepyhead, they recommended Oscar. I know how to do screenshots, and will supply any needed in separate shots. If you find this too clumsy or using too much space I could send the screenshots via private e-mail. Yes, I am on Medicare. There is very little help or advice for me, the person assigned to my case is not an MD.

flowrate.jpg (104.78 KiB) Viewed 1586 times

[Pugsy]

OSCAR is based on SleepyHead. Any SH instructions will work on OSCAR.

You didn't zoom in...I need the graph that looks sort of like this example below at 01:00 or whenever there are 2 or 3 CAs/centrals flagged..
Ends up being around a 3 or 4 minute window maybe.

I want the green area for sure.

[dexnjan]

I will try to post the screenshot you want.

screenshot-20190808-122246.png (74.18 KiB) Viewed 1532 times

[Pugsy]

Still too big of a chunk...you have about 45 minutes there...I need around 4 minutes....small chunk.

Are you sleeping soundly or waking often and spending a large part of the night with mask and machine on?

How did they come up with these settings?

[dexnjan]

I will try to post the right screenshot you want.

flow copy.jpg (72.45 KiB) Viewed 1524 times

[dexnjan]

I think I am sleeping soundly, I do get up once or twice to go to the bathroom. I don't have much faith in my sleep person, I did send her a non-emergency message that I didn't think my AHI numbers were low enough, so she changed them to what they are now. Still not happy with my AHI data, but I do use the machine all the time and am comfortable with it.

[Pugsy]

You got it. Now can you get me one more like it but instead of showing hyponeas pick a group of ClearAirway flagged events.

[dexnjan]

Hope this is what you wanted.

[Pugsy]

Yes. That helps a lot.

I am unsure if those hyponeas are obstructive in nature or central in nature.

Central apnea or ClearAirway if looking at these software reports are when you just stop breathing...the airway is open but no air is moving. Hold your breath for 10 seconds. That's essentially a 10 second central apnea.
A few centrals we don't worry about but you are having more than a few and you are definitely having a breathing pattern that looks like CSR or Cheyne Stokes Respiration.

Do you take any medications that might suppress respiration a bit? Usually these are some sort of pain medication that are opioid based.

It does appear that you were asleep when these got flagged. I was hoping that the breathing looked more like awake breathing but it looks real asleep to me.
I was hoping that the hyponeas were causing arousals or awakenings but that doesn't seem to be the case.
If the hyponeas are obstructive in nature...a little more pressure might just clean them up.
Problem is I am not sure they are obstructive and I really am not comfortable telling someone your age with so much CSR breathing...just increase the minimum pressure. It might make things worse.

In all honesty...you need to have a face to face with your doctor about what you are seeing.
More pressure with your machine won't fix the central issue...and could potentially make it worse.

[dexnjan]

I am thinking that the technician who set my machine up really might not be qualified to do the things that should be done. My contact with the technician makes me think she really works for the DME provider, she is a APRN and CMA, I think. I found this in my files:

Mr. Dexter Wallace Henschel is a 83 y.o. year-old male who returns today, 07/23/19, for PAP follow-up. History was obtained from the patient.
Polysomnographic evaluation was in 2019 demonstrating moderately severe OSA with AHI of 21 per hour.
He uses CPAP therapy with 9 cmH2O with a full face mask. This was initially increased from 7 at the start of therapy due to an AHI of 10 0.1 with 3.7 being central in 3.2 being obstructive. He has not noticed any improvement in is really not noticed any change since starting the CPAP. He is fairly in tune to his therapy and watches his scores. Because he has had several days where his AHI was high he presents here today to discuss. He is noticing that he is sleeping better. Last night he slept the entire night without waking. He is not getting up to use the bathroom as often on other nights and is perhaps feeling more rested.

[Pugsy]

You really need to be talking to the doctor and see what he says.
You may have had treatment emergent central apnea pop up. About 10 to 15 % of the people put on cpap will have it happen.
Sometimes the doctors will just watch it and sometimes they elect to change to another machine that can deal with both obstructive apnea and central apnea.
It's very suspicious to say the least.

I don't know all your medical history and I just really think you need to be talking to a real doctor about your problem.
I don't want to tell you something that might make things worse.

What you have going on isn't good though. A few centrals we might let slide but not this many ...at least until the doctor weighs in on things.
Make an appointment to see either your primary care doctor or your sleep doctor so you can be evaluated and have a plan formulated on how to best deal with the centrals.
I have a strong suspicion that the hyponeas are central in nature...not common to have that happen but not impossible either.
I have seen it happen before.