Can't get AHI below 3

[Guest]

I've been using an a-pap for 2 months now. My mask fits fairly well. My normal leak readings are around 30. I try to sleep with the mask as much as I can. I don't seem to be able to get my AHI down below 3. I had my 7 day at a 2.9 average, but now it's back up to 3.5.

The only times I really have leak issues is when I'm on my side and the pillow presses the mask. My average pressure is about 10 and I have my machine setup to go from 8.5 to 12.

What can I do to move towards the 0 AHI level? Any ideas would be appreciated. Thanks.

[Hawthorne]

This is not a bad AHI. How are you feeling? That's the question you need to ask first. If you feel rested then all is going well. Under 5 AHI is considerd "treated" apnea.
If you want to try and get a lower AHI a pressure adjustment may do that though. What was your titrated pressure?

Setting your minimum pressure close to, or at, your titrated pressure may get your AHI lower. Your pressure range may also be too wide. A narrow range often works better for better sleep. My range is 2 1/2 cm.

You should register and fill in your profile so that we can see what machine and mask you have. Do you have software and a reader so that you can monitor your sleep more closely?

[bdp522]

Did you ever go back for your titration?

THIS FORUM IS NOT A PLACE TO GET MEDICAL ADVICE.

You should see a sleep doctor.

Brenda

[gailandartie]

I have an APAP and my pressure is right in the middle of my min - max settings and I also cannot get an AHI under 4. My mask leaks show about .1

Does any one have any ideas why this is happening, even with an APAP?

Gail

[jules]

Did you ever go back for your titration?

THIS FORUM IS NOT A PLACE TO GET MEDICAL ADVICE.

You should see a sleep doctor.

Brenda

agree and maybe a shrink or two also

not everyone can get their AHI that low especially if they have mixed apneas not just OSA.

you know the software and card reader can give a ton of insight too not just the 7 and 30 day averages - the m series machines have tons of bad programming for computing the averages - I wouldn't trust them for anything

[bdp522]

Hi Gail,

You might try raising your low pressure by 1 or 2. The low pressure might need to be closer to your titrated pressure to make sure the machine has time to stop the apneas. The machine doesn't do a sudden jump to a higher pressure when needed, but moves the pressure up slowly. Without the software and card reader you don't really know whats happening. I would try to get the lower # closer to titrated pressure and see what happens for a week. Be sure to post and let us know how you're making out.

Brenda

[Wulfman]

I've been using an a-pap for 2 months now. My mask fits fairly well. My normal leak readings are around 30. I try to sleep with the mask as much as I can. I don't seem to be able to get my AHI down below 3. I had my 7 day at a 2.9 average, but now it's back up to 3.5.

The only times I really have leak issues is when I'm on my side and the pillow presses the mask. My average pressure is about 10 and I have my machine setup to go from 8.5 to 12.

What can I do to move towards the 0 AHI level? Any ideas would be appreciated. Thanks.

As much as I'd like to "Ditto" what Brenda said.......I'll play along......

Need more information:
Which machine?
Which mask?
Is the leak rate for the mask and pressure about what you're seeing in your numbers? (There should be a graph in the user manual you got with it)
Did you set up the machine or did "someone else"?
Why have you limited your maximum pressure to 12?
Do you have a copy of your sleep study (polysomnogram) and if so, did it show any Central Apneas?
What was your titrated pressure?

Your "average pressure" may indicate your minimum probably needs to be set higher.....probably closer to the 90% pressure.
More often than not, APAPs will produce higher AHI numbers when the minimum pressure is not set high enough and therefore more events will happen before the machine can react.

For most people, the AHI you're showing would be "OK" (it's less than 5.0), but since you asked for help.......I'll contribute my 2 cents worth.


Den

[RafterRattler]

I've been wondering about this same thing. I've had my APAP for 2 weeks now....and as many of you already know, I was on CPAP for 5+ years before that. This is the first that I've had a data capable machine. My AIs are running at 0, but my HI fluctuates between about 1.9 and 4.5. My leakage is always very low (.06 L/s, Resmed S8 Autoset II). I've tried a variety of experiments with the upper and lower limits, settling time, EPR, etc. Last night I even set my machine to CPAP only, and at my titrated pressure (13cm). Again, my AI was 0, and my HI was 3.8 - so I think I've ruled out the APAP influence.

So what are some other factors? I've heard people mention nasal congestion. How big of an influence is it? I am frequently congested (septum and swelling issues), which is the reason why I'm a mouth breather and using a Resmed Quattro. Maybe this is the best I can do?

As to how I feel, I feel ok. I feel roughly the same as I've felt for the last several years on CPAP....but I can't help but wonder if I could feel even better if I wasn't dealing with flow restrictions multiple times per hour. Are there any other things to try?

Thanks,
Mike

[Wulfman]

I've been wondering about this same thing. I've had my APAP for 2 weeks now....and as many of you already know, I was on CPAP for 5+ years before that. This is the first that I've had a data capable machine. My AIs are running at 0, but my HI fluctuates between about 1.9 and 4.5. My leakage is always very low (.06 L/s, Resmed S8 Autoset II). I've tried a variety of experiments with the upper and lower limits, settling time, EPR, etc. Last night I even set my machine to CPAP only, and at my titrated pressure (13cm). Again, my AI was 0, and my HI was 3.8 - so I think I've ruled out the APAP influence.

So what are some other factors? I've heard people mention nasal congestion. How big of an influence is it? I am frequently congested (septum and swelling issues), which is the reason why I'm a mouth breather and using a Resmed Quattro. Maybe this is the best I can do?

As to how I feel, I feel ok. I feel roughly the same as I've felt for the last several years on CPAP....but I can't help but wonder if I could feel even better if I wasn't dealing with flow restrictions multiple times per hour. Are there any other things to try?

Thanks,
Mike

Considering that ResMed machines (basically) lump Flow Limitations and Hypopneas together (or don't separate Hypopneas at all) your AHI may be about as low as you're gonna get it.
Have you read the thread about "Humidity and AHI"? You might try different humidity settings.......if you're using much humidity with your congestion, it may be too much and creating more congestion.


Den

[RafterRattler]

Actually I'm not using any humidification. I use the humidifier in the winter sometimes when it's really dry, but most of the time it makes no difference to how I feel in the morning.

So I guess I need to get educated on flow limitations vs hypopneas....time to do more reading.

Thanks,
Mike

[Wulfman]

Actually I'm not using any humidification. I use the humidifier in the winter sometimes when it's really dry, but most of the time it makes no difference to how I feel in the morning.

So I guess I need to get educated on flow limitations vs hypopneas....time to do more reading.

Thanks,
Mike

A Flow Limitation is a partial Hypopnea. Or.....a "Hypopnea Wannabe".
So, if it's counting Flow Limitations, it's counting Hypopneas.......it's just making it into a bigger number (especially if you have quite a few Flow Limitations).

Den

[Goofproof]

Rules for a lower AHI.

Stop mouthbreathing.

Stop congestion

Get the software and reader, so you can find the correct data and set the pressure correctly so the machine can do it's job. (3 C.M. Range on APAP or closer) Lose the Ramp....

Keep the leakrate low, over 35 LPM treatment and numbers suffer.

Make sure you do not have GERD.

Don't use a Resmed, they read high, and that shows up in the numbers.

Feel to add anything I've missed. Jim

[gasp]

Did you ever go back for your titration?

THIS FORUM IS NOT A PLACE TO GET MEDICAL ADVICE.

You should see a sleep doctor.

Brenda

While I agree with you Brenda, and many others including myself who have posted that this forum is not giving medical advice . . . if I would have depended solely upon my sleep doctor (whom I have not seen in person to this day - after being prescribed one year ago) I would have a much higher AHI. It is only with the advice and suggestions of valued forum members that allowed me to reduce my AHI.

I agree with Hawthorne, that you need to determine if your AHI needs to be lower based upon how you feel (given that it isn't high in the first place ). If you feel rested, do you need to lower your AHI? I chased the 0.0 holy grail last year and was able to get my AHI below 1.0, but not zero. Then I decided to stop, as I was feeling rested and frankly trying to get my AHI lower took more attention than it was worth to me : )

I reduced my AHI mostly by changing masks, adding Pur Sleep which allows me to fully relax into the CPAP process, and watching my numbers to see what else impacted my sleep.

Best wishes!

[RafterRattler]

Rules for a lower AHI.

Stop mouthbreathing.

Stop congestion

Get the software and reader, so you can find the correct data and set the pressure correctly so the machine can do it's job. (3 C.M. Range on APAP or closer) Lose the Ramp....

Keep the leakrate low, over 35 LPM treatment and numbers suffer.

Make sure you do not have GERD.

Don't use a Resmed, they read high, and that shows up in the numbers.

Feel to add anything I've missed. Jim

Hmmm....I'm not really sure what to make of this response. While I'm at it, I might as well just stop having apnea. I've already talked about some of those thing, and there's really nothing that I can do about the others. If this means the numbers are as low as they are going to get, then so be it and that answers my question...

Mike

[Chronitia]

My untreated AHI rate on my back was 72. Be happy with <5.