AHI still over 10, suggestions?

CPAPBoy · Post by **CPAPBoy** » Mon May 28, 2007 4:29 pm

Still trying to get settled after a few months.

I started with a fixed machine set to 9cm. Switched to a variable machine at 7-12 (my suggestion, basically to get some visibility). This showed AHI around 10-15 and plenty of time at 12cm. So much for the sleep study titration of 9cm

Doctor/DME raised the top pressure to 16. Doesn't seem to make a lot of difference, but the MyEncore pressure curve bottoms out around 12-13.

I've tried a respironics fullface mask in the past with not much difference.

DME is suggesting swiching to a nasal mask - seems like it would be quite an adjustment since I'm partially a mouth breather and would need something to keep my mouth closed (??). the other potential (to me) step is raising the minimum pressure to 10 or even 12 - in eyeballing my charts, it seems like I have most of my apnea bursts at the lower pressures, and
once they get started, the 3 steps algorithm often dosn't get me to a high
enough pressure to eliminate them.

[The CPAP is certainly helping - no more morning headaches - but it's
not perfect - I still drag a bit, especially at weekends]

Comments on these choices? Other suggestions?

Here's a couple of sample nights:

http://i201.photobucket.com/albums/aa11 ... ample0.png

http://i201.photobucket.com/albums/aa11 ... ample1.png

http://i201.photobucket.com/albums/aa11 ... ample2.png

[The apneas seem to be bursty which concerns me a bit - presumably the CP system is under pressure at bursts like these and I'm more likely to get oxygen desaturation.]

Wulfman · Post by **Wulfman** » Mon May 28, 2007 5:06 pm

Do you have a copy of your sleep study?
If not, I would urge you to get one and see what it says.
Any Central Apneas?
Your bottom pressure might be a tad bit low, but you've got a serious leak problem that needs to get resolved.

Den

Goofproof · Post by **Goofproof** » Mon May 28, 2007 5:07 pm

Until you get your leak rate down, it isn't going to work..... Your avg leak rate should be 30 to 35 to work good 40 to work fair. You aren't close. Jim

rested gal · Post by **rested gal** » Mon May 28, 2007 5:34 pm

I'm no doctor or anything in the health care field, but if it were me I'd set the pressure range at 10 - 16, and I'd work on controlling the leaks. If you were using a FF mask on those linked nights, it looks like the mask might have been leaking pretty badly a lot of the time.

If you do switch to a nasal mask and you mouthbreathe or leak air out your mouth... and if a chin strap doesn't stop that... check out the topics here:

Links to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

Wulfman · Post by **Wulfman** » Mon May 28, 2007 5:47 pm

In view of the fact that you're apparently using a ResMed Ultra Mirage Full Face mask, there are also two options that may have possibilities. Either your mask is the wrong size and/or it's not adjusted properly.....too tight or too loose will cause problems.

Den

.

jules · Post by **jules** » Mon May 28, 2007 5:50 pm

Leaks won out big time - notice all the OA's around the leak oscillations - who knows what is going on there but sure isn't adequate treatment

Snoredog · Post by **Snoredog** » Mon May 28, 2007 8:09 pm

an awful lot of residual OA's. Leaks are problem, most likely the mask is the cause, it probably cannot hold the pressure once the machine ramps up, either that or your jaw is dropping causing the leaks. Once report shows Large Leak at the top of the Leak chart (solid black tics), those are a problem, machine will stop responding to events when that happens and actually start dropping pressure.

I would try a nasal mask to see if the number of events seen reduce. You may also do better on a Bipap machine than autopap. You can bump the EPAP up and take care of those OA's without having to deal with so much pressure.

Using a mask that retains more CO2 may also help you.

CPAPBoy · Post by **CPAPBoy** » Sat Jul 28, 2007 9:27 pm

An untimely followup. When I showed the same graphs to the DME,
they talked to the doctor and suggested raising the top pressure to 20 (!).
The recommendation surprised me since the RT has previously
mentioned a possible nasal mask. I did try the pressure change and as
you might guess, leaks went up but AHI did not go down.

Then I went to Sydney for a month and left the connector for the facemask at home . Turns out that in Aus one can just buy the machines
and parts in pharmacies (not all pharmacies .. I think they have to
have someone trained on staff). So what the heck - I bought nasal
pillows (optilife) instead of getting the semi-working system back
in shape.

I love the optilife, and the numbers back me up. My average leak
rate has gone from 60+ to under 40, the AHI from 12 down to 4, and mean
and 90% pressures are down significantly also (90% is 10 instead of 15+).
Most importantly, I can feel the difference.

[quote="CPAPBoy"]Still trying to get settled after a few months.

I started with a fixed machine set to 9cm. Switched to a variable machine at 7-12 (my suggestion, basically to get some visibility). This showed AHI around 10-15 and plenty of time at 12cm. So much for the sleep study titration of 9cm

Doctor/DME raised the top pressure to 16. Doesn't seem to make a lot of difference, but the MyEncore pressure curve bottoms out around 12-13.

I've tried a respironics fullface mask in the past with not much difference.

DME is suggesting swiching to a nasal mask - seems like it would be quite an adjustment since I'm partially a mouth breather and would need something to keep my mouth closed (??). the other potential (to me) step is raising the minimum pressure to 10 or even 12 - in eyeballing my charts, it seems like I have most of my apnea bursts at the lower pressures, and
once they get started, the 3 steps algorithm often dosn't get me to a high
enough pressure to eliminate them.

[The CPAP is certainly helping - no more morning headaches - but it's
not perfect - I still drag a bit, especially at weekends]

Comments on these choices? Other suggestions?

Here's a couple of sample nights:

http://i201.photobucket.com/albums/aa11 ... ample0.png

http://i201.photobucket.com/albums/aa11 ... ample1.png

http://i201.photobucket.com/albums/aa11 ... ample2.png

[The apneas seem to be bursty which concerns me a bit - presumably the CP system is under pressure at bursts like these and I'm more likely to get oxygen desaturation.]

Snoredog · Post by **Snoredog** » Sat Jul 28, 2007 9:33 pm

If it were me?

I'd set your Min=8.0cm and Max to 9.0 cm and compare to what you have now, you don't win any prizes for having your pressure run higher.

And the guy telling you that you need to go to 20 cm? They don't know squat in my opinion.

Set your machine to 8-9cm range and I bet your numbers get better.

Gerald · Post by **Gerald** » Sat Jul 28, 2007 10:20 pm

Snoredog has my respect as one who is an expert....but, I think I'd be a little more conservative.

I think I'd try a setting of 8 cm on the low end....and 11 cm on the high end.

At the same time, I'd make a big effort to cut the leaks to an absolute minimum.

Gerald

rested gal · Post by **rested gal** » Sat Jul 28, 2007 10:54 pm

CPAPBoy wrote:When I showed the same graphs to the DME,
they talked to the doctor and suggested raising the top pressure to 20 (!).

That kind of advice from medical "professionals" is downright sad.

Stefernie · Post by **Stefernie** » Sun Jul 29, 2007 9:48 am

*points* You were leaky.

Just sayin'.

CPAPBoy · Post by **CPAPBoy** » Thu Sep 20, 2007 12:29 pm

OK, for a while I've been doing pretty well with the Nasal Pillows but lately I'm starting to wake up unrefreshed and drag. Encore Pro is still showing an AHI around 3 and mimimal leak rates.

One obvious thought - am I mouth breathing? I <had> assumed that mouth breathing would show up as a leak in EncorePro. But I thought I would double check that assumption with the experts ...

sleepngo · Post by **sleepngo** » Thu Sep 20, 2007 2:38 pm

[quote="CPAPBoy"]OK, for a while I've been doing pretty well with the Nasal Pillows but lately I'm starting to wake up unrefreshed and drag. Encore Pro is still showing an AHI around 3 and mimimal leak rates.

One obvious thought - am I mouth breathing? I <had> assumed that mouth breathing would show up as a leak in EncorePro. But I thought I would double check that assumption with the experts ...

rested gal · Post by **rested gal** » Thu Sep 20, 2007 7:05 pm

CPAPBoy wrote:One obvious thought - am I mouth breathing? I <had> assumed that mouth breathing would show up as a leak in EncorePro. But I thought I would double check that assumption with the experts ...

You're right that mouth breathing and/or mouth leaks would show up as "leaks" on the Encore Pro data. Neither the machine nor the software can determine where a leak is coming from (mask, mouth, leaky hose or connection.) We have to be our own detectives to track down the source of leaks. The software can only tell us, "there's a leak...somewhere."

Since you say you're getting a low leak rate and a low AHI, you'll have to do a different kind of detective work -- looking at other reasons for being draggy again. Possibly other health problems.

AHI still over 10, suggestions?

AHI still over 10, suggestions?

Re: AHI still over 10, suggestions?

Re: AHI still over 10, suggestions?