My AHI is VERY high

[mattmceza]

Hi all,

I am a new CPAP user - started about 2 weeks ago.

I have the ResMed Airsense 10 auto machine with humidifier.

After 2 weeks of use my AHI still ranges between 35-60.

My pressure is set minimum 10 and maximum 18.

looking at Oscar - the pressure seems to max out at 18 the whole night. My EPR is set on 3 by default.

Am I doing something wrong? It doesnt feel like its working for me at all.

Iv attached some screenshots.

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[Pugsy]

Increase your max to 20 cm.
Try reducing your EPR as much as you can comfortably bet by with.
You may end up needing a bilevel machine that will go over 20 cm.

[Miss Emerita]

Welcome, Matt. You're right, this isn't yet doing what it's supposed to -- not your fault in the least. After you open up the maximum to 20, it'd be helpful if you'd post another chart. When you do, could you take a screenshot of the daily page that includes the following:

Left panel, with calendar and pie chart turned off.

Graphs stacked this way:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

You can squash the graphs a little to fit these six in by grabbing the horizontal grey bar that separates them and moving it up.

But I'm seeing some good news, too. You're only two weeks in and you've been using the machine and mask every night; you seem to have leaks under good control; you're using Oscar; and you're coming to a good place to get advice.

Small housekeeping detail: the machine in your profile is a fixed-pressure machine. Your APAP is listed under the Rs in the drop-down menu. Confusing for everyone!

[Dog Slobber]

Welcome, Matt.

Your pressure is being limited at 18. As Pugsy suggested it can still go to 20, but should you require more pressure the next step is a BiLevel machine.

It's also important to get a more complete picture with some of the other key indicators.

So:

• set Max pressure to 20
• lower or turn off EPR. You may want to take advantage of RAMP and EPR in Ramp only
• post some proper charts. They may shine some light on other things. ie positional

[Miss Emerita]

DS scores again!

[mattmceza]

Thanks for the feedback.

I fixed the machine in my profile - I selected the wrong one by accident.

I will try disable the EPR tonight and see how it goes.

Here are the other screenshots:

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[palerider]

Review the procedures in the very first post in announcements about how to post charts, you're not giving us what we need, and you didn't say you understood to increase max pressure to 20.

[Miss Emerita]

Matt, that looks like a really lousy night -- so sorry to see it!

Do you know how to change the pressure? Here's how (from Apnea Board):

The "dial" can be turned or pushed. The button below the screen with the house icon is called the "home" button. To access the clinician menu, press the dial and the home buttons simultaneously for 3 seconds. The clinician menu will appear. Select parameter(s) you wish to modify with the dial (push down to select, turn to modify). When done, press the dial and home buttons for 3 seconds again, or find the "exit clinical menu" option in the menus.

The next chart you post, please include the left panel, which has a lot of important information. Turn off the calendar (little triangle next to today's date), and turn off the pie chart (file, preferences, appearance). Get those six important graphs into one screen shot, squishing them by grabbing and moving the horizontal gray line that separates them.

[Pugsy]

What is your primary sleep position? On your back maybe? If so, you could try to maybe stay on your side more if at all possible and I know it isn't always easy or possible.
That might lower your pressure needs.
If not...I expect you will need a different machine and if you don't have an appointment for follow up with your sleep doctor...be making one.

To be honest....I doubt 20 cm is going to be enough. I fully expect bilevel and pressures over 20 will be needed unless you are on your back all the time and you can change to side sleeping and side sleeping pressures needed are markedly less.

[mattmceza]

Thanks. I just changed it to maximum of 20 and minimum of 10 with EPR turned off. I will report how it goes tonight.

with regards to position I sleep mainly on my side.

Sorry about the screenshots, Here is the screenshot you want below:

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[Pugsy]

Your choices are going to be limited.

The machine is setting a new minimum for you. I could tell you to increase your minimum to 15 and max to 20 but I am betting the machine will do it anyway for you. Once you go to sleep the machine goes up and stays up.

Let's see what happens with the max of 20 but I will be surprised if it does much.

Your choices are likely going to be....turn EPR off which won't be fun at the pressures you need or a different machine that will go above 20 cm. I fully expect that you are going to need pressures in excess of 20 cm to hold your airway open and prevent those OAs.

But maybe you will get lucky and 20 cm will do the trick....I have my doubts but miracles do happen.

[mattmceza]

I have included a screenshot of the assessment from my Sleep Clinic - they are saying I need a pressure of 8.5 which is ridiculous as it does nothing for me. (*I live in South Africa - so the quality of healthcare is not as good as the US).

However when they did the sleep test they used a nasal mask and I'm currently using a full mask. Not sure if it makes any difference.

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[Pugsy]

Actually for some people the nasal vs full face mask can make a substantial difference in pressures needed.
I have seen reports where people needed 4 to 6 cm less pressure with a nasal mask than with a full face mask.

The general thought is of course with all things being equal then so and so pressure should give so and so results no matter which mask is used but all things aren't equal all the time when comparing a nasal mask and a full face mask.
The lower straps of a full face mask (which are obviously needed for anchoring the bottom of the mask) can actually slightly alter the airway itself a bit. Pulls that lower jaw back ever so slightly in some people and it can narrow the airway a bit and make it harder for the pressure to do it's job and hold the airway open.

If you still have a nasal mask in your arsenal...give it a try. See what happens.

South Africa...at this point in time I am not so sure that our medical system is any better than anyone else's. Sad to say.
Knowing where you are though...and the limitations does help me in what I might advise. It's not so easy for you and I have no idea what kind of insurance you may have to help with a different machine.

Do you have a nasal mask to try...of any kind?

[Dog Slobber]

Did the Nasal Pillows allow you to sleep on your side?

I might try a couple Hail Mary's before going to BiLevel, which might be inevitable.

Make an effort to try to sleep on your side, perhaps a change of mask might help.
Try a cervical collar with your CPAP.

[mattmceza]

also FYI - I breathe through my mouth 99% of the day and when I sleep, my breathing is very loud and people can hear me breathing from across the table or on the telephone. When I try breathe through my nose it doesn't feel like Im getting enough oxygen.

insurance does not cover the machine where I live - I had to pay for it myself.

Its quite annoying that they told me I only needed 8.5 pressure and should get the Airsense and now It looks like I need the Bilevel which means I will have to buy it myself and the Airsense was just a waste then.

I dont have a nasal mask - they used it for the sleep test, it was one of the clinics masks.

I might just buy a nasal mask and try it out and see if it helps. It might force me to breathe through my nose rather.

Any recommendations on a nasal mask that will work well under high pressure?