AHI 14 after 2 weeks - suggestions?

[Mask2sleep]

Good Morning!

Yesterday the DME tech came to the house. I was fitted with a new mask, the Resmed Mirage Softgel Nasal Mask. My original Quattro FFM gave me blisters and sores when tightened enough for a good seal. Pretty neat, I assumed they would take the Quattro back, but the tech said that the DME has a very good relationship with thir suppliers, and most of the time they just fill out a replacement mask form rather than send the actual mask back to the supplier. In my case since I am a new user, I was able to keep the Quattro, which is great because now I have a back-up mask and one for when I am all stuffed up. Since I had the FFM before, they also gave me a chin strap to use if I find I am mouth breathing. It is very uncomfortable. I hope I won't have to use it.

Anyways, he brought another SD Card and downloaded all of the data off my machine. He tried to reset the machine as well, so hopefully when I go home tonight I won't see "SD Card Error". Anyways, I got a call from their head tech last night with the results off of my card. He said that my leak rate with the Quattro was within acceptable levels, and it that it wasn't enough to affect therapy. The LED readout on my machine has a 7 day average of 14.x AHI. The detail data he got from the card agrees with that. He said he didn't know why my AHI was so high since I am being compliant, was not having bad leaks, and even if I were mouth breathing, with a FFM it wouldn't have mattered. He instructed me to try the new nasal mask for a few weeks and then send them another SD Card for them to look at. His two initial ideas on why the AHI is still so high is that perhaps my body is taking time to adjust to the therapy, or perhaps the pressure on the titration results is actually too low, since at titration I was at 1.1 AHI, and one would think I would be a lot closet to that with the same level of pressure at home.

Does anyone else have any ideas why the AHI might be so high? Thanks!

[jamieay]

Yup, I'm right there with ya. That's about where mine was after 2 weeks. Keep on going. Make sure the mask is comfortable with minimal leaks. For me, my AHI seems to not be on a steady decline so much as occaisionally it drops a point or two. I'm now in the 6 - 8 range (with twice hitting 4!) after 6 weeks. Make sure you're good and tired before going to bed. Avoid caffeine if possible. If you're on any other meds ask your doctor if they could affect your sleep. But most importantly, keep going.

Jamie

[Mask2sleep]

Thanks for the reply Jamieray.

I called the diagnostic center and explained the situation to them and asked them to confirm the titration study had a 11 / 7 pressure as the final result. Who knows, maybe someone transcribed it wrong onto the results memo?

The new mask, the Softgel, is awesome. I don't have to put it on tight and there were absolutely no leaks last night. It feels a little heavy and is a tad harder to breath with than the Quattro, but I am sure it just seems that way since I was used to having all that space in the FFM and now there's just the little nasal mask, so I will get used to that I am sure. It doesn't put too much pressure on anything and I didn't have a single strap mark today. Overall very pleased.

I get up at 4:30 for work and have a almost 8 month old, being tired going to bed is not an issue I can assure you! I only coffee in the morning and that is my caffeine for that day. I am on two meds - Enablex and 75mg of zoloft. Sometimes wine with dinner, should I avoid that?

[KatieW]

Do you have a copy of your sleep report?

Was the titrated pressure for sleeping on your back, and during REM? It could be you that you need higher pressure for those things. During my sleep study, I had very little REM, so now that I am sleeping so well, (I assume I am getting good REM sleep), I find I need more than my titrated pressure.

I like the SoftGel too. It is heavier than the Activa Lt, so I alternate between the two, since it fits the same mask frame.

[elena88]

Hi there!

oh, the wine thing... I dont drink wine, but my understanding is that alchohol relaxes all the stuff we dont want to
get clogged up and blocked even more..

so, drinking before bedtime can very well increase your ahi (from what I understand)

but hey, ya cant stop living, drink early!

[Mask2sleep]

Ughh.

Well after 4 nights on the Softgel my AHI is higher than it was on the FFM, 16 rather than 14. This is becoming quite discouraging. I do not know if I should continue with this or go back to the FFM.I send my chip to the DME again next week and if it is still high they will order a new titration. Perhaps I will try the darned chin strap tonight but I honestly do not see how it will be any help. As I am falling asleep I do sometimes notice puffs of air escaping from my mouth when I exhale , but my mouth is completely closed and it is puffing just through the lips.

I have really tried taking a proactive approach to all this but I am beginning to get quite frustrated. I naively assumed if I used it every night I be much improved by now.

[LSAT]

If you are noticing 'puffs of air' escaping from your lips...it is worse when you are asleep and relaxed. You will need to try the chin strap, go back to the FF mask or try taping your lips. Some people need to use the chinstrap along with th FF mask. Keep trying>

[jamieay]

Ughh.

Well after 4 nights on the Softgel my AHI is higher than it was on the FFM, 16 rather than 14. This is becoming quite discouraging. I do not know if I should continue with this or go back to the FFM.I send my chip to the DME again next week and if it is still high they will order a new titration. Perhaps I will try the darned chin strap tonight but I honestly do not see how it will be any help. As I am falling asleep I do sometimes notice puffs of air escaping from my mouth when I exhale , but my mouth is completely closed and it is puffing just through the lips.

I have really tried taking a proactive approach to all this but I am beginning to get quite frustrated. I naively assumed if I used it every night I be much improved by now.

Hang in there man. Have you actually met with a real sleep specialist MD yet? If not, it might not be a bad idea - I can recommend one for you. I met with het yesterday and she suggested a slight pressure tweak. Bam! AHI is 4.0 this morning. Not too shabby.

Jamie

[rested gal]

If it were me...and I'm not a doctor or anything in the health care field... I'd try a simple experiment first:

I'd set the bipap to bilevel mode (which is apparently the mode they have you using anyway) and I'd change the IPAP and EPAP settings to IPAP 14, EPAP 10. I'd set BiFlex at 3. I'd use the Quattro FF mask.

I'd just about bet the AHI will come down drastically with a higher EPAP setting. EPAP is the most important setting to "get right" -- meaning EPAP being set high enough to prevent most apneas right from the get go.

You may not need another sleep study at all. Might just need a bit of pressure tweaking, as Jamie did.

My thoughts about EPAP setting on a bilevel machine (and min EPAP on the BiPAP Auto.)

November 2007 - EPAP is for more than just comfort exhaling.
viewtopic.php?p=227068#p227068

December 2007 - my understanding of how a bipap titration is done.
viewtopic.php?p=231786#p231786

May 2008 - discussion with RonS about importance of EPAP setting.
viewtopic.php?p=265020#p265020

September 2007 - discusson with JLFitzfamily about EPAP 4
viewtopic.php?p=211222#p211222

[araminta]

"As I am falling asleep I do sometimes notice puffs of air escaping from my mouth when I exhale , but my mouth is completely closed and it is puffing just through the lips."

Inspired by posters here, I trained myself to not "puff air."
I started to go to sleep with my tongue pressed against the back of my teeth and the roof of my mouth. And eventually, the "blow fish" thing stopped. it's kinda amazing that the power of suggestion actually worked.