Help! AHI in 20's and 30's

[MGoBlue]

Purchased card reader and software. Prescribed pressure was 14, but I found that my AHI was 55. I have experimented with different ranges of pressure on auto, but AHI is in the 20's and 30's with the 90% pressure always being 20.

Do I need a stronger machine? Do I need something to keep my lower jaw forward in addition to CPAP?

Leak data is always around:

Max Leak: 98 LPM
90% Leak: 65 LPM
Avg. Leak 54 LPM

[Treehorn]

What is the leak rate for your mask. I think you should be around 48, no? Perhaps you need to address the leaks first. Others with more experience will jump in I am sure.

Good luck.

[MGoBlue]

The mask leak rate is 54 at 20 (which is the pressure I am at most of the night). I really don't think that leaks are the issue, but I am new at this.

[Treehorn]

Do I need something to keep my lower jaw forward in addition to CPAP?

Glad to hear your leaks are under control.

This is an interesting idea about bringing the jaw forward and one I have just begun experimenting with but my numbers are not as high as yours.

I just took a training course over the weekend on treating sleep apnea for dentists (my wife is a dentist and I went with her as one of her staff).

Oral Appliances (OA) are typically used in only mild to moderate sleep apnea cases however there seems some indication that using a OA in conjunction with CPAP may help provide better therapy and/or allow some to lower thier pressure - depending on the individual.

I have an oral appliance but it was not good at treating my severe apnea, so I got CPAP. The last few nights I experimented with using my appliance with CPAP and it allowed me to lower my pressure 2 cmH2O and maintain a good AHI.

The thing is that it will be expensive to find out if it works for you. Most dentists who have the proper equipment to diagnose you and fit you with a OA charge $2500-$3000. (ouch!) But if I exhausted all other solutions and was given the choice to live with an AHI of 20-30, I would try it. A good dentist who makes these devices can tell if your a good candidate - others just slap the thing in your mouth and hope for the best.

If you have any further questions about oral appliances let me know.

I bet others here can help you with other more conventional ways to help you tweek your CPAP therapy.

Good Luck!

[Treehorn]

Forgot to ask. Do you sleep on your back? Perhaps you will get better results if you can get yourself on the side or stomach?

[Wulfman]

Purchased card reader and software. Prescribed pressure was 14, but I found that my AHI was 55. I have experimented with different ranges of pressure on auto, but AHI is in the 20's and 30's with the 90% pressure always being 20.

Do I need a stronger machine? Do I need something to keep my lower jaw forward in addition to CPAP?

Leak data is always around:

Max Leak: 98 LPM
90% Leak: 65 LPM
Avg. Leak 54 LPM

Please tell us how your machine is configured. What pressure or pressure ranges are you using when you are getting those results.

Have you actually set the machine to CPAP mode at your prescribed pressure of 14 and used it that way for about a week?


Den

[MGoBlue]

Yes, I do sleep on my back and would undoubtedly do better on my side or stomach.

I just have a really tough time sleeping on my side or stomach for any length of time. I think I can rig up some pillows for side sleeping, but I am a weight lifter/bodybuilder with really wide shoulders, so sleeping on my side results in a bend that is uncomfortable. That and my shoulders get aggravated from having too much weight focused on them, arm falls asleep, etc.

Stomach works okay for a while, but invariably I will switch to side or back after I fall asleep.

It is also tough to not cause the mask to leak when on my side or stomach.

I may try a wedge pillow for starters, but otherwise sleeping on my side may be the way to go.

[Pugsy]

What is your minimum pressure set at?

Edit: Nevermind, I see you have now posted your settings.
Listen to Wulfman.

Any history of centrals in either your initial sleep study or the titration study?

Can you post one of your daily detailed reports that show the leak, pressure and OA, HI, VS and Flow Limitations?
Maybe someone could then spot something that might be impacting the numbers.

[Sleeprider]

Your AHI numbers are dangerously large still. What portion of that is HI as opposed to OA? Is the vibratory snore rate large (VS)? The thought being here that if your pressures are that high you could be experiencing complex apneas or central apnea. A lot of people move to a BiPAP machine when the pressures get that high or they experience centrals. Your doctor is probably the one to consult on this, and you should be evaluated professionally in another sleep study. Your therapy is not working based on the AHI you are seeing. Someone probably needs to help verify the machine's data and help you find a more effective solution.

[Wulfman]

Yes, I do sleep on my back and would undoubtedly do better on my side or stomach.

I just have a really tough time sleeping on my side or stomach for any length of time. I think I can rig up some pillows for side sleeping, but I am a weight lifter/bodybuilder with really wide shoulders, so sleeping on my side results in a bend that is uncomfortable. That and my shoulders get aggravated from having too much weight focused on them, arm falls asleep, etc.

Stomach works okay for a while, but invariably I will switch to side or back after I fall asleep.

It is also tough to not cause the mask to leak when on my side or stomach.

I may try a wedge pillow for starters, but otherwise sleeping on my side may be the way to go.

If you use a "standard" type of pillow, I'd suggest looking into a different type. I also have pretty broad shoulders and I use the Chiroflow water-based pillow and it's great to use with this therapy (at least it is for me). I think it would also help with learning to side-sleep because you can adjust the height of the pillow by adjusting the amount of water in it. With a standard type of pillow, usually a person's head sinks down into the pillow and then the part that doesn't sink, pushes the mask out of alignment and promotes leakage.


Den

[MGoBlue]

Please tell us how your machine is configured. What pressure or pressure ranges are you using when you are getting those results.

Have you actually set the machine to CPAP mode at your prescribed pressure of 14 and used it that way for about a week?

A week? No, I had three readings at 14 -- AHI= 59, 47, and 54 and then started experimenting.

No A-FLEX, or ramping used:

8/24 APAP 14-20 --> AHI=11.4, OAI=5.8, 90% pressure = 20, avg = 18.4
8/25 No data, forgot to put card in machine
8/26 APAP 19-20 --> AHI=22.9, OAI=16.4, 90% pressure = 20, avg = 19.9
8/27 APAP 15-17 --> AHI=28.3, OAI=21.0, 90% pressure = 17, avg=16.9
8/28 APAP 13-20--> AHI=21.5, OAI=17.4, 90% pressure = 20, avg=19
8/29 APAP 13-20--> AHI=24.2, OAI=19.7, 90% pressure = 20, avg=18.8
8/30 APAP 13-20--> AHI=34.5, OAI=31.4, 90% pressure = 20, avg=18.4

Sounds like I should stick with a given pressure for a longer period of time? My results are less consistent than I would have expected and frankly I am baffled at this point...

[Wulfman]

My advice for new users (who buy Autos) is to at least TRY their prescribed pressure for awhile in the beginning to either prove or disprove that it's valid.

I see you're showing that you have Encore Viewer software. That should tell you what's causing your pressure increases. The problem with using ranges of pressures is that the leaks and snores can drive up pressures that may not be needed......consequently skewing the pressure numbers.


Den

[ozij]

Since your readings at 14 were that bad, you should try higher pressure.
It seems weird the Rx was 14 when the results are that bad for you at home. -- Makes me wonder how in the world they arrived at it.

Your best night (although this could have been a fluke) was 15-17 -- I'd try that for a few more nights. But only for few.

You should be aware the when your pressure need rises above 15, you're eligible for a bi-level machine. Bi-levels give you different pressure for inhale and exhale -- and have a maximum of 25. If I were in your place, and didn't get better results soon, I'd contact my doctor to discuss a bi-level titration.

Are you using AFlex or CFlex?

O.

[Wulfman]

Yeah, I'm wondering how they came up with that pressure, too.
Did you sleep on your back during your titration portion of the sleep study?

There are a lot of people who have positional sleep apnea (their apnea is worse when sleeping in certain positions.....usually on their backs), but they have overcome it by training themselves to sleep in other positions.
I still think it would be advantageous to set the machine in CPAP mode at a single pressure, but to make every attempt to sleep on your side......and then see what the numbers look like.
If (while sleeping on your back) your pillow has much height to it and pushes your chin toward your chest, that can further cause restricted airflow in your neck. Keeping the neck in alignment for the least restricted flow of air is desirable.

As ozij said, you're approaching Bi-Level/Bi-PAP pressures. But, if you can learn to change your sleep position, you may be able to avoid that.


Den

[MGoBlue]

Since your readings at 14 were that bad, you should try higher pressure.
It seems weird the Rx was 14 when the results are that bad for you at home. -- Makes me wonder how in the world they arrived at it.

Me too! In their defense it was only a partial night study (the first part to determine if I had sleep apnea, the second to try me on a machine). I do have a follow up sleep study scheduled in a few weeks, but I am trying to get the most benefit until then.

Your best night (although this could have been a fluke) was 15-17 -- I'd try that for a few more nights. But only for few.

Actually my best night was an AHI of 11.4 with a pressure of 14-20, but it was definitely a fluke. I must have slept on my side a lot as well.

You should be aware the when your pressure need rises above 15, you're eligible for a bi-level machine. Bi-levels give you different pressure for inhale and exhale -- and have a maximum of 25. If I were in your place, and didn't get better results soon, I'd contact my doctor to discuss a bi-level titration.

Thanks! That is goo info to have and I will certainly bring it up.

Are you using AFlex or CFlex?

No. It was initially turned on, but as I getting horrible results -- and it wasn't prescribed by the doc so I turned it off. I don't need it anyway. Exhaling even at a pressure of 20 is no big deal for me.