Lowering HI events - Need advice

[jdwilson16]

I seem to have begun to get control over my total AHi with AI events under 5 but HI events are still over 5 . Last night AHI was 7.5 with AI at 1.7 and HI at 5.8. Any suggestions on reducing the HI events?

So far I have eliminated EPR on my S8 after a short ramp period. This really helped to get the numbers down. I have also increased pressure over the last 2 weeks from 10 to 11 which helped even more. My AHI was almost 30 with the settings the clinician setup. Any suggestions would be great.

[Maddcow]

I'm in the same situation....HI is always considerably higher than AI and leaks are not a problem. Any suggestions would be much appreciated.

[Claire]

In my experience (6 months), HI is always much higher than AI. However, any AHI over 5 makes me feel pretty bad and, on this forum, most people seem to feel that an AHI under 5 is desirable.

Are you breathing through your mouth perhaps? Are you sure your pressure is correct?

[Goofproof]

Hard to get HI's down with that brand of XPAP, they measure HI's overly agressively. Jim

[Guest]

You want to lower HI...then change machines...ditch the resmed.

[Sleet]

The lady at my DME says that snores = HI with the resmed. So you start to snore and the Resmed machine logs an HI and increases pressure to stop the snoring. I have a Resmed and simply follow the AI and ignore the HI.

[CUatX]

Try this: After your machine has reset the daily results (12 Noon on mine), use it for a couple of hours when you KNOW you'll be awake -- like sitting up reading or watching TV. Then check your readings. My AHI, AI, & HI were through the roof.

A plot of events over several nights showed clusters just after starting and just before finishing a night's run, and at times when I'd awakened for a "pit stop".

I asked the RT if there was a way to raise the trigger point for HIs. She said she'd have to ask. Presently I'm concentrating on lowering AIs and letting HIs fall where they may.

[freepostg]

I certainly wouldn't "ditch" the resmed. It's a fabulous machine. As was said in an earlier post, the s8 is extremely sensitive to snores et al. Just divide the HI recorded by two and you'll have a more accurate reading that will ignore snores and slight pauses in breathing. You will only be able to reduce your hi's on the s8 down to a certain am't. Hope this helps.

[track]

I agree. The resmed is a fine machine. The only reason to ditch it would be if you don't want to see a bunch of HI. If you can stand more HI being reported than on other machines,then by all means keep it.

[dsm]

Aha !

The psychology of numbers vs actual results

Yes the Resmed machines will score HI higher for an identical pressure and under almost identical nightly conditions to a Resp (in particular).

The divide by 2 rule will make take numbers closer to the other brands (obviously). And it helps in accepting the message.

But as someone else said if you don't like the language of the message, shoot the messenger (get another brand) but the results are going to be the same, but at least the numbers look better if that is whats more important than the results

DSM

[Sleeprider]

For those of us unfamiliar with how different machines register an Hypopnia event, it might be interesting to hear the difference between Resmed and Respironics.

[Bookbear]

As I understand it (and I am sure there are more knowledgeable people out there who will address this), the ResMed algorithm 'sees' slight pauses in breathing and snores as hypopneas and scores them as such; and raises pressures to stop them. Others, such as Respironics, wait a bit longer before attacking a breath pause, and are less sensitive to snoring. The 'trigger points' are part of the algorithm and are programmed into the firmware of the machine; they are not user (or clinician) adjustable.

Each company approaches apnea treatment a little differently, and their machines reflect those differences. The fact that some people seem to do better with one company's machines than another's is a strong indication of both individual differences as well as algorithm treatment patterns.

[Snoredog]

my basic rule of thumb:

1. Address any Apnea (AI) with pressure first, get it as low as you can.
2. Once AI has reached its lowest value HI will begin to fall

EPR: lowers the "Exhale" pressure. This pressure is the big hammer when it comes to addressing apnea. If you lower the exhale pressure it can allow an apnea to sneak in resulting in a higher AHI. EPR "should be" disabling itself in the presence of apnea, so if it is responding fast enough it should cease and become the same as straight CPAP and EPR off.

But to be honest, EPR doesn't work very good reason most people end up disabling it if a low AHI is what is wanted. If you have to increase your pressure by the EPR setting to make therapy effective then why use it?

For exmaple; If you go to the sleep lab and they determine your needed pressure is 10 cm, then you leave with a machine set to 10 cm and EPR=3, that is the same as lowering the needed pressure to 7 cm but only on exhale.

If you wanted the pressure to be the same and/or as effective as found in the lab at 10 cm, you would have to set the pressure to 13 and then EPR=3 which would then be the same splinting pressure as found in the lab, compared to bilevel you would be at 13/10. Set it up like most and you are at 10/7 using EPR at 3.

CFlex also lowers the pressure on exhale but it does so only "momentarily" at the beginning of exhale and then ramps up towards the end of the exhale breath.

[Maddcow]

Snoredog, that's the best explanation I've read yet. Your rule of thumb and EPR info makes a lot of sense. Thanks for that. You've helped me no end as I was pretty confused about some things and now I understand much better.

Cheers
Gary

EDIT: Boy I wish I'd bought the Respironics instead of the ResMed now.

[jdwilson16]

The effect of EPR does impact the total AHI and seems to impact HI even more in my experience. If EPR is used, you do need more pressure to get the same results when EPR is off. I have since reduced EPR to 1 and only use on ramp and that seems to work well for me. Last night was a great night . over the last 2 weeks i have increased my pressure to 11.4 (study was 10) and the results were AHI 4.8, AI .6 and HI 4.2. Only time will tell if this is repeatable, but I am encouraged by the lowering trend over the past few weeks.

I think the Swift LT has had a significant impact on lowering these as well. It leaks less and allows me to sleep on my side which helps.

I appreciate all the input on my question and will continue to learn from this group.