Newbie with AHI question

[jamieay]

Hello! I'm a newbie with a question about AHI. I've been using my BiPAP for 2 weeks and my AHI is running about 10. Is this normal only 2 weeks into treatment, or is something wrong? I mentioned it to the DME lady that called after the first week, but she kinda blew it off. Just sounds high to me.

Thanks!

Jamie

[Julie]

Yes it is higher than you want it to be (>5) but without more information it's a little hard to say more (except don't expect DME's to give you much help). What is your pressure set at? Do you have software so we can see a summarized graph? Whatever you can think of in terms of how you sleep, whether or not you take any meds, how well your mask fits, whether you can track leak rates on your machine, etc. etc. would really help us to help you.

[jamieay]

Hello! Here's a bunch more information about my situation -
- 36 yrs old
- Medication for hypertension and depression (although I wonder how much of both of those are really OSA)
- pressure is at 10 / 6
- the mask is fairly comfortable. Biggest complaint is having to unhook the headgear when I get a nose itch.
- the "info" section of my display shows no large air leaks (0.0%), and an AHI of 9.5 (very steady)
- I've been getting around 7 - 8 hours a night with the mask.
- Definitely feeling better than I was, but still a little tired some mornings.

I'm trying to get the SW up and running - when I do I'll post some data screenshots.

Update - Here's a .pdf of the data from my machine - please take a look and help my decypher it! http://www.mediafire.com/?eddev9ym38nof9n

Thanks!!

Jamie

[jamieay]

And is there any way to upload the results right to the forum? I didn't see any sort of "upload" button or option.

Thanks!

Jamie

[BleepingBeauty]

And is there any way to upload the results right to the forum? I didn't see any sort of "upload" button or option.

Thanks!

Jamie

Hi, Jamie.

Re: your data, I see a lot of Central Apnea (CA) on your reports (which is factored into your overall AHI). Were central apneas noted in your sleep study reports? If so, you may need a different machine - one that can treat you for centrals. (FYI, central apnea occurs when your airways are open and you're physically able to breathe, but you don't, because the brain is slow to send the signal to your lungs.)

If central apneas were noted in your sleep study, talk with your sleep doc about it. For some of us, central apnea needs a whole different treatment algorithm than a standard BiPAP provides, called auto servo-ventilation (or ASV).

Second, in order to post your graphs here on the forum (rather than link to them), you first have to save the pertinent page(s) from your software program on your computer as .jpg files. Here's what I do (with a PC). These instructions may seem a bit convoluted, but it's an easy process and takes very little time, once you're used to it. BTW, summary data is of no use here. Forum members want to see the Daily Details reports.

When you have one of your Daily Details graphs on-screen:

1. Be sure your viewing window on the pc is at full-size, so all the data is visible. Scroll up/down or adjust the size of the graph, if need be, so that all the data is on-screen.
2. Hit the Print Screen key on the keyboard. (That copies the entire image you see.)
3. Open your photo editing program. (I use MS Photo Editor.)
4. Open a new file in your photo program and paste (Ctrl+V) the image in.
5. Scroll down enough that the Toolbars in the image disappear and you only see the graph, and then crop the image to remove extraneous info (like your name, for instance).
6. Save the cropped image to your pc as a .jpg file (perhaps on the Desktop, so it's easy to find).
7. Upload the .jpg to a free photo-sharing site (like Photobucket or flickr).
8. Name and save the image.
9. Copy the Image code on the newly-uploaded file (on Photobucket, hover the mouse over the image, and then copy the [IMG] code from the drop-down that appears).
10. Open a new post here, and paste the Image code into the post. Make sure the [ Img ] [/Img ] codes surround the link.

Then click on the Preview button to see if the image shows up correctly in your post. If it does, hit Submit.

Hope that helps.

[snoreguy]

I'm about 10 days into this journey, and my AHI numbers are usually between 5 and 10. When I look at the detailed data, it looks like most of my events are happening within about 30 minutes of putting the mask on. I'm sure that for most of the time I'm not really asleep and probably fidgeting around. I asked my doc about the numbers and he did not express a lot of confidence in them as they really are dependent on the software of the machine and how it is interpreting things your are doing. He had absolutely no problem with me pulling off data and examining them further. I think his main concern at this point (again, 10 days in) is that I'm using the thing. I guess my point is that it is entirely possible that (in my case) the high number of events right after I put the mask on are skewing my results.

[jdm2857]

While Bleep's instruction for adding images to a post are excellent, her explanations of the details are a bit less so.

To be nit-pickingly clear, unlike some other forums, you can't upload images directly to this board. You can, as Bleep instructs, upload your images to a photo-sharing site and link to them using Img (image) tags. This will cause the forum software to display the image right inside your post. If you use URL tags, the reader will have to click the link to go to the sharing site to see the image(s).

[brazospearl]

Jamie, while your data doesn't show any large leaks (good for you!) your average leak looks high to me. This would be a lot of "little" leaks, which need to be dealt with.

Snoreguy, did your doctor explain where he is gathering data he has confidence in, since he believes the data off your machine is not reliable? I'm just curious...

[BleepingBeauty]

Jamie, while your data doesn't show any large leaks (good for you!) your average leak looks high to me. This would be a lot of "little" leaks, which need to be dealt with.

Sorry, but I have to ask why you say that? From the info I have, the Quattro's intentional leak rate at 6-10cms should be from 27-36 lpm. Jamie's leak line is nice and flat for the vast majority of each night (with little blips here and there), and the leak numbers are really good, IMO.

[jamieay]

brazospearl - I see what you're talking about - 26% does seem high. I don't feel the air leaking from around my face mask - where else should I check / how do I bring this down?

Thanks!

Jamie

[jamieay]

And another, bigger picture question - should I even care what my AHI is yet? I'm only 2 weeks into treatment and still getting comfortable. Should I say the heck with stats until I've used it for a month? And how much does your AHI normally vary day-to-day once the "getting used to it" phase is over? Within a week I'm going from 4 to 14AHI.

Thanks!

Jamie

[brazospearl]

Jamie, there's no reason to worry about any of your numbers because they all look pretty good and you're still figuring things out. It takes a while to work out all the little issues, and sleep will always vary from night to night. I think BleepingBeauty makes an excellent point about investigating whether Central Apneas were reported on your sleep study, as those can be tricky little devils. She may also be correct about your overall leak rate being acceptable; I was under the impression that the reported leak rate was in addition to what the manufacturers had deemed the acceptable level for a particular mask, but maybe I'm wrong. In any case, figuring out how to stop the microleaks is a balance of mask seals, pillows, and hose management. Figuring out where the leaks are coming from and when they're happening is the first step.

[jdm2857]

ResMed machines report only the leak above the expected vent rate from the mask. Hence the mask setting on the machine.

Respironics machines do not do this. You must subtract the expected vent rate for your mask at your pressure from the machines reported leak to get the actual correctable leak rate.

[BleepingBeauty]

Jamie, there's no reason to worry about any of your numbers because they all look pretty good and you're still figuring things out. It takes a while to work out all the little issues, and sleep will always vary from night to night. I think BleepingBeauty makes an excellent point about investigating whether Central Apneas were reported on your sleep study, as those can be tricky little devils. She may also be correct about your overall leak rate being acceptable; I was under the impression that the reported leak rate was in addition to what the manufacturers had deemed the acceptable level for a particular mask, but maybe I'm wrong. In any case, figuring out how to stop the microleaks is a balance of mask seals, pillows, and hose management. Figuring out where the leaks are coming from and when they're happening is the first step.

That's true with ResMed machines (which factor in the intentional leak rate for the mask that's programmed into the machine). That's why you're shooting for a zero leak rate on a ResMed machine. Any leak reported is over and above what it should be.

On Respironics machines (like Jamie's), the leak reported has to be compared to the expected leak rate for the mask at the pressure settings (in Jamie's case, 6-10 cms should produce an intentional leak rate with the Quattro of between 27-36 lpm). So Jamie's leak rate is excellent.

[jamieay]

You all are awesome! So, my leak rate is fine - one less thing to worry about.

What does worry me is the central apneas. I know that my sleep tests mentioned the central apneas - with a CPAP there were more CA's than with the BiPAP (that's why they went with the BiPAP, I guess). Is there an acceptable rate of CA's (other than 0)? The whole idea of my brain "forgetting" to tell my lungs to breathe creeps me out.

Jamie