Some apparent AHI anomalies - Can anyone help????

GrizzlyBear · Post by **GrizzlyBear** » Tue Jan 15, 2008 11:18 pm

Hiya, Folks.

I have been prescribed an apap range of 8-15. Because of mask problems, I dropped the upper level down to 11. I have been really suffering from EXTREME tiredness (far worse than before I went onto cpap). There were a wide variety of issues that could have been involved, but one I decided to try out was that my upper apap level may be too low. So, to heck with the mask problems, I increased back up to 15.

So, blow me down if I haven't apparently limited my previous mask problems at higher pressures (although sometimes it squirts out into my eyes, and if it gets very bad I have to hit ramp, which takes it back down to 8; and it causes discomfort below my nose because I've had to increase the strap pressure on the lower part of the mask).

AND, even more puzzling, while I seem to be sleeping better, and my previous EXTREME tiredness seems to have dropped away, my AHI level has been increasing, and seems to now be over 5.

Can anyone advise what might be happening, and what I can do? I really don't want to have a stroke (as if anyone does!!!!), and my risk levels are already higher because of my diabetes.

I am unsure what numbers might help, but here are some 'before and afters' from Encore Pro Analyzer:

When on an upper pressure level of 11:

Max APAP - 11
90% APAP - 10-11
Avge APAP - approx 9
Max leak lpm - 65-70
90% leak lpm - 46
avge leak lpm - 36-38
avge total apneas - 9.9
avge total hypopneas - 22.9 (although the rate had dropped to around 15, just prior to my change)
avge flow limitations - 6.6 (although they had been up to 8-10 just prior)
avge snores - 30.4 (although up to 45 prior)
avge AHI - 3.4 (although down to 2.8 prior)
Avge OAI - 1
Avge HI - 2.4 (down to 1.5 prior)
Avge FLI - 0.7 (up to 1.0)
Avge SI - 3.2 (up to 4.5)

When on upper pressure of 15 (only a couple of days!):

Max APAP - 14
90% APAP - 12
Avge APAP - 9.9
Max leak lpm - 59
90% leak lpm - 40
avge leak lpm - 38
avge total apneas - 14
avge total hypopneas - 38
avge flow limitations - 5
avge snores - 20
avge AHI - 5.4
Avge OAI - 1.5
Avge HI - 4
Avge FLI - 0.5
Avge SI - 2.2

I'm sorry to be a pest, but I can't help worrying. Can anyone explain this for me - am I worrying too soon, is there something I can do? Is there other information that would help more?

Regards,

Fussy GrizzlyBear

Goofproof · Post by **Goofproof** » Tue Jan 15, 2008 11:46 pm

You would do better with the real software and reader, trying to get true numbers from the lcd can be misleading espessally if you don't zero them ever day. Jim

GrizzlyBear · Post by **GrizzlyBear** » Wed Jan 16, 2008 3:01 am

Hiya.

My numbers aren't from the LCD display. They've been downloaded from the smartcard onto Encore Pro, and then re-worked by Encore Pro Analyzer.

If the direct information from Encore Pro would help, tell me what stuff to check out, and I'll pass the information along. The problem is, I don't know what information is important, and what is not, and I don't know what some of the terminology means. I thought that the Encore Pro Analyzer stuff would be okay, but if not, let me know what you need to help me.

Regards,

GrizzlyBear

Wulfman · Post by **Wulfman** » Wed Jan 16, 2008 7:05 am

My opinion is that your bottom pressure is too low.....allowing events to take place before the pressure can move up. It probably needs to be set to around 11 or 12 to be more effective.

Den

jjposey · Post by **jjposey** » Wed Jan 16, 2008 8:59 am

I can't be of any help with the numbers, but having switched to the mask in your profile about 3 weeks ago, I've found that the looser the mask is the better a seal I get.
I had lots of problems with mask leaking with my profile lite, but it has been SOOOOO much better with the comfort gel.
Hope that is a little help.
joanna

DreamStalker · Post by **DreamStalker** » Wed Jan 16, 2008 9:19 am

Adding to what Den said, your lower pressure setting is likely to low especially if you are using the CFLEX option of your machine.

Leave your upper number at 15 for now and try increasing your lower pressure setting in increments of 1 cm once each week ... then re-evaluate your data once a week to see where to go from there.

GrizzlyBear · Post by **GrizzlyBear** » Wed Jan 16, 2008 5:04 pm

Hiya, Folks (Perhaps I'd say 'G'day, mates', but I don't want to confuse anyone by using a foreign language!!!!!!!!! - thought I'd better add the smileys - actually, I wouldn't say 'mates' in that context, that's a common error people speaking my 'language' make - although I suppose another Aussie might write in to argue the point - we enjoy doing that!!!!)

Goodness, I do waffle on a bit, don't I. My students would identify with that!!!!

Actually, all I want to do is thank you people who have commented on my post very much for your advice. I'll try upping my lower pressure and see what happens - I wouldn't have thought of that.

I'm also wondering after last night, whether my hypopneas might be up because I have to surface a little to control the 'blowouts' I get around my nose at the higher pressures - so I might not be sleeping as deeply as I thought.

Regards,

GrizzlyBear

GrizzlyBear · Post by **GrizzlyBear** » Wed Jan 16, 2008 10:17 pm

Hiya,

Sorry to keep responding to my own thread, but I really want as much information as I can get.

I've read on some other threads that with machines like mine things like rolling over in the night, grunting, etc. can be registered as hypopneas; and on other threads that noises in the hose can be registered as snores.

Does this mean that the smartcard info I'm reading could be misleading if my higher pressure is interrupting my sleep a bit (to deal with leaks around the nose), therefore making me more restless, therefore registering as hypopneas and snores when they aren't really?

Am I worrying needlessly?

Regards,

Fusspot GrizzlyBear

NickD25 · Post by **NickD25** » Wed Jan 16, 2008 10:26 pm

I cannot say if you have to worry or not but maybe my example will help...

My worse AHI episodes are when I'm awake!! Every time I look at my results in Encore Pro, I see a lot of OSA before I'm even asleep!! Doesn't really make sense now does it? But I found the explanation, when I'm going to sleep I'm starting to take deep breath, the machine takes it for hypopnea. Also, I have hyperventilation since there's so much air push in and so little coming out, therefore, I don't breathe normally and it registered as apnea, even though I'm not doing apnea (how can I have sleep apnea when I'm fully awake?!?). Hopefully my BiPAP will be able to correct that but yes a higher pressure might messes up some numbers so they can be very misleading.

ozij · Post by **ozij** » Thu Jan 17, 2008 12:21 am

[quote="DreamStalker"]Adding to what Den said, your lower pressure setting is likely to low especially if you are using the CFLEX option of your machine.

Leave your upper number at 15 for now and try increasing your lower pressure setting in increments of 1 cm once each week ... then re-evaluate your data once a week to see where to go from there.

Guest · Post by **Guest** » Sun Jan 20, 2008 8:44 pm

I'd also suggest looking at the Encore Pro Analyzer graphs for AHI versus Pressure, OAI versus Pressure, HI versus Pressure, and FLI versus Pressure. (Found under the Pressure menu.)

When I looked at those event graphs individually, it suggested a slightly better range to set my Auto at. My Apneas were best at 5cm (went up at higher pressures, probably Centrals), but my Hypopneas needed about 9cm to be best handled. I set my range as 5-9, and my AHI results dropped to about 1.0 or so (although went higher the last few days, not sure why), from an AHI of usually 3 to 4.5.

(The drop in AHI didn't actually make me feel any better, but I think there's probably some other issue involved.)

Moby · Post by **Moby** » Mon Jan 21, 2008 1:18 am

GrizzlyBear wrote:Hiya, Folks (Perhaps I'd say 'G'day, mates', but I don't want to confuse anyone by using a foreign language!!!!!!!!! - th

GrizzlyBear

Like Western Australian?

Di

GrizzlyBear · Post by **GrizzlyBear** » Mon Jan 21, 2008 2:42 am

Whoops, sorry, Moby.

I wrote that to 'suck up' to our US cousins - and I forgot there were a number of Aussies on the forum. Put it down to being an ignorant easterner!!!!

Regards,

Contrite GrizzlyBear

Moby · Post by **Moby** » Mon Jan 21, 2008 8:37 am

Griz griz griz

Hope you read this and haven't totally signed off.

I didn't mean it in an "I'm Australian too" way.

I meant it in a "hey, that's a Western Australian expression, so I guess it is a foreign tongue to a Eastern Stater!!!!"

Probably too much meaning to put in an internet post, on reflection.

Absolutely no need for contrition.

Just look after yourself and keep yourself well and know I'm thinking of you - in a good way!!!!!

oh - and look out for Jasper Fforde books

regards

Di

Mask

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