AHI still to high

[Bamafanatic56]

I have tried different masks, mouth tapping, pressure variations and I still can't get my AHI below 5. I'm averaging 6.1 over 3 weeks. My lowest AHI is at 11 but I still spend a considerable amount of time at much higher (AHI) pressures. Last night I set my min/max at 10-13 but I had 130 minutes at 8 with a 16 AHI. I don't understand why I spent time there at all other than the 30 min. ramp? Can anyone help?

Thanks

[Wulfman]

Try CPAP mode (CFLE setting) at a straight pressure of 13 and no ramp.

Are you sure your "split-night" setting is NOT on? See "C" below.
If your "Ramp time" setting is anything but 0:00 and there is a pressure setting for it, then you would be stuck in that setting for the first 2 hours.
If you're going to use the Auto mode, you do NOT want anything in those settings.

Den


REMstar Auto w/C-Flex Setup

When in the Setup Menu, the humidifier ^ and ramp v buttons operate as up and down keys to change the settings, the left/right user buttons < > allow you to go to the previous/next question or setting, and the pressure start/stop button is used to exit the Setup Menu. Holding the humidifier or ramp buttons down will cause the values to change more quickly.

To enter the Therapy Setup Menu, hold the two top user buttons < > down while plugging in the power cord.
Continue holding the buttons down until the REMstar Auto w/C-Flex beeps twice.

Note: The word "setup" will appear on all of the screens indicating that you are in the Therapy Setup Menu.
(If you press the Pressure start/stop button, you will exit the Setup Menu.)

A. Compliance hours/nights: (recommend leaving alone, but CAN be cleared at this point)
Select next setting with >

B. Therapy mode: (CPAP/CFLE/APAP/AFLE) select with ^ or v
Select next setting with >

B1. If CPAP or CFLE select pressure setting: Select with ^ or v
Select next setting with >

B1a. C-Flex mode (if you chose CFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

B2. If APAP or AFLE, select minimum pressure setting: Select with ^ or v
Select next setting with >

B2a. If APAP or AFLE, select maximum pressure setting: Select with ^ or v
Select next setting with >

B2b. C-Flex mode (if you chose AFLE mode): Select setting 1, 2 or 3 with ^
Select next setting with >

C: Ramp time setting: Select with ^ or v
(ramp time will be turned off with a setting of 0:00)
(if using APAP or AFLE mode, Ramp setting MUST be set to 0:00)
Select next setting with >

D. Ramp pressure setting: Select with ^ or v (use only in CPAP or CFLE mode)
Select next setting with >

E. Patient disconnect setting: 1 = on 0 = off Select with ^ or v
Select next setting with >

F. Buttons lights setting: 1 = on 0 = off Select with ^ or v

(Last setting. Use On/Off button to exit Setup)

[Goofproof]

What software are you using? What is your avg leak rate from Encore Pro? Jim

[Bamafanatic56]

I'm using the lastest Encore Pro. I'm not using split night. My average leak rate is 37.1...this has come down to the 32.5 range the last few days. I'm going to try CPAP at 11 tonight, that seems to be my best pressure

Thanks !

[Snoredog]

I have tried different masks, mouth tapping, pressure variations and I still can't get my AHI below 5. I'm averaging 6.1 over 3 weeks. My lowest AHI is at 11 but I still spend a considerable amount of time at much higher (AHI) pressures. Last night I set my min/max at 10-13 but I had 130 minutes at 8 with a 16 AHI. I don't understand why I spent time there at all other than the 30 min. ramp? Can anyone help?

Thanks

since you have the software, eliminate the events or issues one-by-one.

Leak?
KNOW what your mask leak rate is for your given pressure, any leak above that amount is external leak. If your external leak is 16L/m or less, don't worry about it.

We all have some leak from movement at night which can skew the leak data, that is what "Max" leak is, software should tell you what maximum leak is and duration, if duration is short then you know it came from movement during the night. Extended or long durations of large leak would indicate mouth breathing.

Residual AHI?
You say it is high or at 11? What makes up that 11? How many of those per hour are Apnea? How many are Hypopnea?

You can lower and even eliminate all your Apnea and drive UP Hypopnea as a result. Is that bad? Not when you think about, you may have given yourself enough pressure to eliminate the SDB event from being an apnea and turned it into a Hypopnea, eliminate the Hypopnea and you may turn it into a Flow Limitation.

So the thing to do is look at that AHI, break it down to what it is, if you increase pressure apnea should disappear, if they don't then they may be central vs. obstructive, but to determine that you watch what the Hypopnea do, if you are going the right direction AI should go down, HI should go up, continuance with pressure will eventually bring the HI count down, going further should reduce snoring.

If you are on an auto, don't put so many constraints on it with pressure ranges, keep the minimum up to where you can comfortably fall asleep and breathe and let the max go high enough to eliminate the event. Your minimum should be 6.5 or higher, if Aflex even higher.

[sharon1965]

We all have some leak from movement at night which can skew the leak data, that is what "Max" leak is, software should tell you what maximum leak is and duration, if duration is short then you know it came from movement during the night. Extended or long durations of large leak would indicate mouth breathing.

hi snoredog
can you tell me where i can locate this info?

encore pro tells me how high large leak is and for how long (though it's always zero) and average leak but i don't see any mention of max leak; encore pro analyzer tells me max leak, 90 % leak, avg. leak and large leak (duration, again always zero)...how do i read the length of the leaks?

also, i still can't seem to find out what 90 % leak means vs avg. leak and what is the relevance of the 90% leaks reading
thanks

[Bamafanatic56]

Thanks for all the great information!

Last night I sleep with straight Cpap set at 11 and my AHI was 2.0! Much better, I was a little dissapointed in the data collected by Encore Pro in that it was very limited. I was looking for the nightly summary for last night and there wasn't one...What's up with that? I had to dig just to find the AHI. Is this normal or am I overlooking something?

Thanks Again for all the help!!!!

[Wulfman]

Thanks for all the great information!

Last night I sleep with straight Cpap set at 11 and my AHI was 2.0! Much better, I was a little dissapointed in the data collected by Encore Pro in that it was very limited. I was looking for the nightly summary for last night and there wasn't one...What's up with that? I had to dig just to find the AHI. Is this normal or am I overlooking something?

Thanks Again for all the help!!!!

Glad to hear that!
All of the data is in the "Sleep Therapy Daily Details". There's a little less when in CPAP mode, but the main events and numbers are still there (if you selected "Full Details" when you opened your interaction download).

Now, give it a week and see what the numbers look like.

Den

[Bamafanatic56]

I didn't get any "Daily Details" for last night and I selected full report. I just got a little summary at the the end of the report

[Guest]

We all have some leak from movement at night which can skew the leak data, that is what "Max" leak is, software should tell you what maximum leak is and duration, if duration is short then you know it came from movement during the night. Extended or long durations of large leak would indicate mouth breathing.

Snoredog -- will all mouth breathing show up as extended or long duration large leaks? Or is it possible to have a reasonable leak rate and still be mouth breathing? My stats for last week showed avg max leak of 63.9, avg 90% leak of 42, avg leak of 38, and 0 sec of large leak. My avg 90% pressure was 9, avg pressure 8.1. At a pressure of 9, my mask info shows a flow of 34 L/min. I don't think I'm mouth breathing to any great degree, and have occasionally used polygrip strips, with no appreciable change in my results. I sometimes have a dry mouth, but that also happens when I know my mouth is shut, and when I'm awake! Just trying to figure out if I need to be concerned about mouth breathing or not.... Thanks!

[OutaSync]

Steve,
Regarding your full details being missing. The Remstar is notorious for loosing a couple days a month of data. Everything else is there, just the full details are missng. It always hits me for two days in a row and then it goes back to full details. Sometimes it happens twice a month, always two days in a row. Go figure!

Bev

[Bamafanatic56]

Thanks...things were back to normal today, All the data was there