Does anyone else have AHI in the 50s?

[sonogo]

Reading the posts here, I seem a lot higher (in a bad way) than most people. Just had another sleep study done last week, resulting in advice on a chin strap and a sturdier, tighter-fitting mask (Swift II). I've been on CPAP since Sept 06, then in April 08 got a Respironics Bipap and an Encore card reader, hoping for better results.

Now that I think I'm doing this week what I should have been doing the last couple years, I see an almost solid green bar in the OA category, and my AHI has soared from the single digits to the 50s. (Pressure is 4 to 18 at my latest setting; last doctor had me start at 4 to 12 in April, but that was her random Rx and not titrated.)

Quality of sleep is still same as before (not good). Does anyone have any advice on seeing a pulmonologist--how to find a good one, what to tell and ask them, what they could do, if anything? Or any advice on different equipment? (Mine maxes out at 20, and I don't know the upper limit in terms of safety.)

I think my new sleep doctor is better than the last one, but she was pushing the "behavioral therapy" angle on my 1st meeting with her (i.e., no naps, etc, which I know already), so I don't expect her to be a lot of help when we meet again.

I'd appreciate any advice. I've learned a lot from reading this forum since I got my machine (which someone aptly called an overpriced leaf blower) and really appreciate how helpful everyone is.

[DreamStalker]

Untreated mine is 102.

Treated mine is about 0.2


This therapy works when the patient takes control cuz the sleep pros just focus on getting paid as much as they can get away with.

Start by monitoring your leak rate get that under control then start adjusting pressures. It will take time but you can do it! ... we can help!

[jules]

Something is wrong if your treated AHI is still that high.

Do you have centrals?

You are using a bipap auto - what kind of settings do you have? If you have encore pro reports, you can post them too and get feedback.

If you post your general location, you might get some feedback on good and bad sleep docs in your area.

[Wulfman]

Along the lines with what Jules said......something is wrong.....either with your profile (machine you selected) or your existing machine setup.

If you ACTUALLY have an Auto CPAP, and your minimum pressure is set to 4, that could very well account for the high AHI. The machine can't respond fast enough from waaaaaaaaay down there to where it needs to be in time to head many of them off.

If that machine is actually YOURS, and not a loaner, I'd advise getting the card reader and software and take control of your own therapy. Your doctor(s) may be seriously "knowledge challenged" when it comes to this therapy.

Den

[sonogo]

If centrals means central sleep apnea, I don't think so. I still snore. But my first two sleep studies weren't the best and could have missed it; I'm not sure when I'll get the results from the recent one and need to nag them. (I live in Boston and had the 1st studies at Mt Auburn Hospital. Now I'm going to Tufts Hospital, where the sleep personnel seem better.)

I do rent the machine, but I've been adjusting the settings for the last year, and I check the card report every morning. I'll increase the lower rate--I'd been mostly messing with the upper one.

I'll post a report. My latest settings are 4-18, support = 8. I'm trying auto tonight to see what happens.

[jules]

one thing about making changes is that you need to have the settings in place for a week before you make the next change not keep making changes every day

a report would help people out - you can upload a screen shot to photobucket and link or post the image in a post

you are running 18 inhale and 4 exhale on an auto bipap, with PS of 8?

what were you titrated at the first time? I realize you don't have the second result.

Were you given a straight cpap at first or why the bipap? Do you have any other serious health issue?

[sonogo]

Thanks for the advice. Especially about not changing settings daily; I tend to scramble around in frustration.

Report posted at [url]http://i333.photobucket.com/albums/m390 ... go.jpg[url]

"you are running 18 inhale and 4 exhale on an auto bipap, with PS of 8?" --Yes.

First time I was titrated at 8, but that never did me much good. I never got any explanation, just "You'll get a CPAP." The sleep doctor is pretty breezy. When I went back in April to say nothing had happened for a year, she gave me an Rx for Remeron (already use Lunesta) and said to try a Bipap, end of appointment.

No other health conditions. 25 lbs overweight, but the apnea began years before the weight gain (in retrospect), and for 44-year-old, 6-foot male, it's not excessive.

I originally had the sleep study to figure out why I was having night sweats (head and chest). My regular MD had me tested for just about everything to determine the cause, including numerous blood tests, x-rays, ultrasound, and CAT scan, then referred me to the sleep doc, then concluded the sweats were a bodily reaction to sleep suffocation.

[GumbyCT]

Sonogo if you have the reader & software I wouldn't delay treatment waiting for the results. But how long has it been since the PSG? Just so we know.

The reason for the HIGH AHI is your machine is set-up wrong. Get yourself a notebook write down the date & ALL the settings of the "Auto" menu in order. You need to use "AUTO" until you find your correct pressures.

Your last prescription was 8? If you can tolerate 10-12 with no troubles, I would set the EPAP there. The EPAP is what WILL eliminate your OA's. As you move the pressure up the separation will automatically change if there is NOT enuff room. Don't worry about that, just set it for max. The upper limit (IPAP) you can set at 20 for now.

3-4 days should be sufficient to see how you are doing. Well it was for me. You should see a remarkable improvement the very first nite.

fwiw the Settings in the AUTO Menu go like this Max IP, Min EP, Max Sup, BiFlex, Auto Ramp Time, Auto Ramp (Starting Press) then some other things we won't talk about right now, unless you need them. I wouldn't use the ramp unless you are having trouble getting used to the pressure while trying to sleep; If so use it.

So I would set mine up just like this 20; 12; 6; 3;

But you ALSO have to get your leaks down or it's all for nothing.

Any Q's - please ask.

Good Luck,
GumbyCT

[Babette]

[quote="DreamStalker"]Untreated mine is 102.

Treated mine is about 0.2[quote]

How can they tell what your UNTREATED count is? My PSG was done with a mask on.

Cheers,
B.

[rested gal]

I'll increase the lower rate--I'd been mostly messing with the upper one.

I'll post a report. My latest settings are 4-18, support = 8. I'm trying auto tonight to see what happens.

I'd especially try to get leaks under control as Roberto (DreamStalker) mentioned.

As Den (Wulfman) described, the lower pressure is the most important one to "get right"... to have set high enough to prevent the full OA's (Obstructive Apneas.)

I'm not a doctor, but these are the settings I'd try the non-M series BiPAP Auto machine if it were me:

AbFLE mode (Auto-titrating bipap mode with bi-flex turned on.)
10.0 Min EPAP
20.0 Max IPAP
8.0 PS
3 Flex
0:00 Ramp
0:00 Start (The SINGLE word "Start" refers to Split Night mode in the non-M series machine and must be set for zero. The single word "Start" is not the same as "Ramp Start" (which you would see if you enabled "ramp.")
0 Patient
1 Light
Nights - leave this number as is.

Here's a link to many topics about controlling mouth leaks or mouth breathing, if you're not using a FF mask:
LINKS to: Mouth leaks - Air Leaks - Tape - DIY Guard
viewtopic.php?t=8011

If you're not already hanging the air hose overhead, you might want to check out ways to do that. Can help greatly in keeping the main hose from tugging at a mask and causing mask leaks:
LINKS to Hose hangers and methods of managing the air hose
viewtopic.php?t=10640

Good luck!

[ww]

No one here is a medical professional, but there is some very good experience that may help you as you have suffered needlessly for the past 2 years or so.

Your machine setup really is wrong. No one with any experience would set it up that way because it cannot help get your AHI down like it should. The EPAP must be equal or greater than what your CPAP titration is or you will continue with your suffering as nothing is doing anything to help your apneas. You were adjusting the wrong parameter and getting zero help from it.

I posted some data today at: viewtopic/t33270/Thanks-quotAlmost-perf ... hieve.html showing what you want your leak line to look like and what mine used to look like!

You can use the bi-pap as a cpap, so once you get a night or two behind you, if you can't control leaks, the high ipap will simply blow the pillows out of your nose or your mouth open and you will get little if any therapy as a result, but you can go back to cpap at a setting of 10 and check your results Your leakage should be a flat line at 33 L/Minute at a pressure of 10. You must fix the leaks or nothing else will work!!!!! I don't see how a bi-pap will help you over a cpap. Fortunately yours can be set up for either mode.

Please read the links RestedGirl provided for leaks. It is very important.

[/url]

[Bonnie]

Babette,
After all wires are hooked up and you go to sleep (haha) the data is recorded. That data is your untreated AHI, along with other information. The pressure is determined (haha) when you are hooked up with a mask. So many variables happen during the PSG which is why a card reader checking your therapy is the way to go, making adjustments along the way until you find the right setting for you.

Did you really have the test with a mask on from the begining?

P.S. My untreated AHI was also 100+ and about .5 treated.

[GumbyCT]

I don't see how a bi-pap will help you over a cpap.

Bipap can provide significant exhale relief.

To the extent where I'm on 18/15 using nasal pillows and can breath like normal.

Where on CPAP @17 I couldn't get my ahi down cuz i couldn't exhale. Oh plus massive leaks.

[ww]

I don't see how a bi-pap will help you over a cpap.

Bipap can provide significant exhale relief.

To the extent where I'm on 18/15 using nasal pillows and can breath like normal.

Where on CPAP @17 I couldn't get my ahi down cuz i couldn't exhale. Oh plus massive leaks.

Thanks Gumby, I certainly agree. I was just amazed at 50's AHI when cpap at 10 cm should be much better than this as most apneas should be removed at 10 cm. Guess that affects only AOI.

[Snoredog]

Thanks for the advice. Especially about not changing settings daily; I tend to scramble around in frustration.

Report posted at [url]http://i333.photobucket.com/albums/m390 ... go.jpg[url]

"you are running 18 inhale and 4 exhale on an auto bipap, with PS of 8?" --Yes.

First time I was titrated at 8, but that never did me much good. I never got any explanation, just "You'll get a CPAP." The sleep doctor is pretty breezy. When I went back in April to say nothing had happened for a year, she gave me an Rx for Remeron (already use Lunesta) and said to try a Bipap, end of appointment.

No other health conditions. 25 lbs overweight, but the apnea began years before the weight gain (in retrospect), and for 44-year-old, 6-foot male, it's not excessive.

I originally had the sleep study to figure out why I was having night sweats (head and chest). My regular MD had me tested for just about everything to determine the cause, including numerous blood tests, x-rays, ultrasound, and CAT scan, then referred me to the sleep doc, then concluded the sweats were a bodily reaction to sleep suffocation.

I just looked at your report, do you have a Bipap Auto or just a Bipap Pro?

Your problem is right in the report, machine is NOT set up correctly. The 4.0 cm EPAP is totally wrong so is IPAP. The OA shown in that report is caused by the high IPAP pressure, those are machine induced OA's, most likely central (they would show up as obstructive apnea).


Here is what I would do as your doctor doesn't sound like they know what they are doing:

1. Use your reports to determine what settings to use, don't change settings blindly.
2. Refer back to your old CPAP titration of 8 cm. that has some significance in your Bipap settings. It is all about getting the machine where you can tolerate using it comfortably and having it effectively treating you.
3. Since you CANNOT go by that report you posted (too much leak seen, data NOT reliable). Start with last CPAP pressure, set your EPAP pressure to that pressure or a bit lower. So I would set EPAP=6.5 (reason behind doing this).
4. I would set IPAP 4 cm higher or at 10.5.
5. I would set Biflex=2. Set it at 3 and you cannot go higher if needed, object is get pressure set where it is working then set Biflex.

If your machine IS the Bipap Auto I would set it at:

Mode=Biflex Auto
IPAP Max=20
EPAP Min=6.5
Flex=2
PS Max=4

If your machine is the Bipap Pro, I would set it at:

IPAP=12
EPAP=8
Flex=2

Reports:
Then observe the Encore reports, make changes to machine based upon data on the report. if Leak is shown over 50 L/m you cannot go by the data, you have to use another mask, tape or use a FF mask. With leak under control (under 50L/m)

Observe OA or Apnea: If OA is >5 then increase EPAP by 1 cm until it goes down lower, if you increase EPAP by 1 cm, then also increase IPAP by 1 cm maintaining 4 cm higher than EPAP or 4 cm pressure support (PS).

FL, Hypopnea and VS: After OA gets below and down to 1 (if you can get it there), begin increases IPAP slowly to bring HI down below 5, if you increase it and it begins to climb (make take several days to determine that) then stop with iPAP.

The "OA or AI" of apnea is the most import value to look at other than leak, HI may go way up (over 12) and down as you make changes to EPAP, just ignore that until you get the apnea under control, then work on the Hypopnea.

EACH pressure on a Bilevel addresses a different event as they approach each other becoming CPAP then the single pressure addresses all. So having a high PS=8 is not necessarily good. Increase EPAP up a bit more and you don't need such a high IPAP.