Do I need higher pressure if my AHI is still high?

[snoozebabe]

I have been using my CPAP for 5 months now and the AHI is averaging 10.5 / 11. This is still higher than the recommended range.

I have no problem with mask leaks. The leakage is 0%.

Does it mean I need to get my upper limit pressure adjusted even higher (currently at 14)?

[bdp522]

Do you have the software so you can see your charts? What is the machines pressure set to? If you use it in auto mode and the low pressure is too low, you will have events until the pressure gets up to where it will stent the airway open. You may just need to raise the lower setting. If you don't have issues with runaway pressure or chasing snores, there is no reason to limit the upper pressure. The machine shouldn't go higher than needed. It is the lower pressure setting that seems to cause the most trouble.

Brenda

[avi123]

Check this:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

Link:

http://www.respiratoryreviews.com/sep02 ... Index.html

“There is not much association between the AHI and anything else—sleepiness, muscle dysfunction,” or other markers for SDB, claimed Dr. Sullivan, who heads the Sleep Disorders Unit at the University of Sydney in Australia. The management of SDB should hinge on the history, examination, and clinical judgment," he asserted.

Not to cause other problems by raising the pressure it needs be done by someone who knows about it.

[BlackSpinner]

Check this:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

“There is not much association between the AHI and anything else—sleepiness, muscle dysfunction,” or other markers for SDB, claimed Dr. Sullivan, who heads the Sleep Disorders Unit at the University of Sydney in Australia. The management of SDB should hinge on the history, examination, and clinical judgment," he asserted.

Not to cause other problems by raising the pressure it needs be done by someone who knows about it.

Ignore the man behind the curtain.
From the same article:

The AHI can mislead physicians about the severity of SDB, Dr. Sullivan added. At certain points in the menstrual cycle, for example, women with SDB may respond to apnea with a large rise in blood pressure (BP) rather than in the AHI.

AHI values correlate with symptoms of SDB. “[The correlation] is mediocre perhaps, but it is not absent,” stated Dr. Rapoport, countering Dr. Sullivan’s earlier assertion. Because the AHI is imperfect, Dr. Rapoport views it as a marker for the apnea-hypopnea syndrome and not as a definitive metric. He has found the AHI most useful for detecting severe apnea-hypopnea syndrome.

10 is too high. You need to adjust your pressure - especially the lower end. Do one small adjustment a week and keep a close eye on your AHI

[snoozebabe]

Do you have the software so you can see your charts? What is the machines pressure set to? If you use it in auto mode and the low pressure is too low, you will have events until the pressure gets up to where it will stent the airway open. You may just need to raise the lower setting. If you don't have issues with runaway pressure or chasing snores, there is no reason to limit the upper pressure. The machine shouldn't go higher than needed. It is the lower pressure setting that seems to cause the most trouble.

Brenda

Hi Brenda, I don't have the software but I use the online SmartCode to generate the reports. The pressure for my machine is 6 to 14. Thanks for your advice!

[snoozebabe]

Check this:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

“There is not much association between the AHI and anything else—sleepiness, muscle dysfunction,” or other markers for SDB, claimed Dr. Sullivan, who heads the Sleep Disorders Unit at the University of Sydney in Australia. The management of SDB should hinge on the history, examination, and clinical judgment," he asserted.

Not to cause other problems by raising the pressure it needs be done by someone who knows about it.

Ignore the man behind the curtain.
From the same article:

The AHI can mislead physicians about the severity of SDB, Dr. Sullivan added. At certain points in the menstrual cycle, for example, women with SDB may respond to apnea with a large rise in blood pressure (BP) rather than in the AHI.

AHI values correlate with symptoms of SDB. “[The correlation] is mediocre perhaps, but it is not absent,” stated Dr. Rapoport, countering Dr. Sullivan’s earlier assertion. Because the AHI is imperfect, Dr. Rapoport views it as a marker for the apnea-hypopnea syndrome and not as a definitive metric. He has found the AHI most useful for detecting severe apnea-hypopnea syndrome.

10 is too high. You need to adjust your pressure - especially the lower end. Do one small adjustment a week and keep a close eye on your AHI

Thank you both for the helpful advice. Do you know whether it is possible for me to adjust the pressure myself on my machine?

[snoozebabe]

Check this:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

“There is not much association between the AHI and anything else—sleepiness, muscle dysfunction,” or other markers for SDB, claimed Dr. Sullivan, who heads the Sleep Disorders Unit at the University of Sydney in Australia. The management of SDB should hinge on the history, examination, and clinical judgment," he asserted.

Not to cause other problems by raising the pressure it needs be done by someone who knows about it.

Ignore the man behind the curtain.
From the same article:

The AHI can mislead physicians about the severity of SDB, Dr. Sullivan added. At certain points in the menstrual cycle, for example, women with SDB may respond to apnea with a large rise in blood pressure (BP) rather than in the AHI.

AHI values correlate with symptoms of SDB. “[The correlation] is mediocre perhaps, but it is not absent,” stated Dr. Rapoport, countering Dr. Sullivan’s earlier assertion. Because the AHI is imperfect, Dr. Rapoport views it as a marker for the apnea-hypopnea syndrome and not as a definitive metric. He has found the AHI most useful for detecting severe apnea-hypopnea syndrome.

10 is too high. You need to adjust your pressure - especially the lower end. Do one small adjustment a week and keep a close eye on your AHI

Thank you both for the helpful advice. Do you know whether it is possible for me to adjust the pressure myself on my machine?

It's ok - I found the link to the manuals that show me the steps to adjust my pressure setting. Thanks everyone!

[DaveLP]

I would get the software if you don't have it, and view the graphs to determine when events are occurring and what is happening. AHI is a combination of apnea and hypopnea. You need to see how much of each is being recorded. Apnea is an event where you may have a blocked airway or under 10% air flow. Hypopnea is a condition where air flow is 50% of normal or less.

Leaks and mouth breathing are two different things. EPI is a measure of those times when you exhale fully or partially through your mouth. Leaks are a measure of therapy pressure constantly leaving somewhere else, causing the machine to up the average pressure. All masks have a designed leak in the expiration port, some more than others. This prevents you from breathing out into the hose and re-breathing CO2. Mask leaks from poor seals will elevate this, but it won't be recorded as excessive leaks until it reaches 95%.

You can always go to the intellipap web site and input the last day code to see more detail. In my case, AI is low (under 1%)
but I have higher levels of hypopnea. My hypopnea counts increase with pressure while my apnea events stay the same. I get better numbers with limits on pressure increase. You might try adjusting the ranges but you need the software to see what your pressures are doing in reference to the events that are occurring.

The best measure of success is how you feel in the morning and whether you experience daytime sleepiness. Do you tend to nap watching afternoon TV or reading?

[Pugsy]

Blackspinner gave you spot on suggestion.
Start with minimum pressure adjustment. With 6 minimum the machine may simply not be able to get to the pressure some events may need quickly enough. It is a common happening when using APAPs with ranges.
Give it with a bit of a head start by increasing the minimum a bit.

[bdp522]

6 is low for the low pressure setting. I would raise the pressure one whole point at a time. Be sure to keep that pressure for at least a few days before changing it again. It could take that long for you to adjust to the change. Most find it best to set an auto machine 2 above and 2 below the titrated pressure. So if you were titrated at 12 the top limit would be 14 and the bottom limit would be 10. Small changes one at a time are best.

Brenda

[jnk]

I have been using my CPAP for 5 months now and the AHI is averaging 10.5 / 11. This is still higher than the recommended range.

I have no problem with mask leaks. The leakage is 0%.

Does it mean I need to get my upper limit pressure adjusted even higher (currently at 14)?

What are you diagnosed with, and what other medical conditions are you dealing with?

Self-tweaking may be fine if the only problem you are dealing with is plain obstructive sleep apnea. Self-tweaking may NOT be such a good idea if you are dealing with a form of central apnea, for example. People dealing with things beyond simple obstructive sleep apnea would especially do well to keep their doc and RT informed before considering any pressure adjustments.

Some with pain issues or drug interactions may not be able to get their home-machine-estimated AHI as low as others. That is due to those situations affecting the hypopnea estimates made by their home machine.

If you are dealing only with simple obstructive sleep apnea, I agree with the others that raising the minimum would likely be the thing to do in order to see if that helps the numbers, and more important, how you feel. Your doc may have no problem with your doing that. It is generally considered a courtesy to keep your medical professionals informed about changes to a medical therapy whenever possible, even when you know what you're doing. It keeps the "team" concept in play, if they happen to be team players.

Just sayin'.

[johntee]

Use caution though, if you are increasing pressures. I also (years ago) was "chasing the dragon" by gradually increasing pressures to chase away the remaining Apneas and Hypopneas. At a visit to the sleep clinic doctor (where I was being treated regularly for 1+ year because I wasn't feeling refreshed), she explained that too high of a pressure can actually cause Central Apneas (not good), which she thought was happening in my case; my recollection of her explanation was that apparently the brain is tricked into believing that enough airflow exists (because of the high machine pressure), so the brain decides it doesn't need to take a breath. Much different than your run-of-the-mill Obstructive Apneas, and from what I understand, more dangerous.

She reduced my pressures at that visit, and it actually improved the AHI. (I still didn't feel refreshed, and still don't, but that's another story, lol.)

Good luck!
John

[DoriC]

Check this:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?

Link:

http://www.respiratoryreviews.com/sep02 ... Index.html

“There is not much association between the AHI and anything else—sleepiness, muscle dysfunction,” or other markers for SDB, claimed Dr. Sullivan, who heads the Sleep Disorders Unit at the University of Sydney in Australia. The management of SDB should hinge on the history, examination, and clinical judgment," he asserted.

Not to cause other problems by raising the pressure it needs be done by someone who knows about it.

This article is dated Sept 2002 and we've come a long way since then so disregard it. An AHI<5 is considered good treatment.

[avi123]

Here is a post on this board from two weeks ago. See what can happen by raising CPAP pressure:

Air shoots out eye thru nasolacrimal duct when using cpap
by David II on Tue Aug 23, 2011 1:13 am

Hello. My name is Dave and I am brand new to this as I have just discovered cpaptalk.com this evening, so please be patient with a newbie I have severe obstructive sleep apnea and have for many years, and about 3 years ago went thru testing for this. In the testing process, the pressure they took me up to, which was 20, permanently blew out (for lack of a knowledge of better medical terminology) my left nasolacrimal duct, so that when I use a cpap machine anytime or even just hold my mouth and nose and pressurize, air will constantly squirt out of the corner of inner corner of my left eye. This made me so angry that I quit cpap treatment altogether. Well, it is 3 years later and I have calmed down and wish to do things right here and get on the machine, and my goal would be to stay on the machine until such time as I sufficiently lose enough weight that the doctor lets me off of it. Just FYI, I used a mask that covered both my mouth and nose because they could never get just a nasal mask or pillows to work due them not being able to get my mouth to shut when I slept no matter what they tried. I am writing this to see if anyone else has any experience with this problem and could offer any insight and/or possible solutions, and also to see if anyone has heard of a full face mask and if so would it potentially solve this problem. all help is appreciated. thanks, Dave


Well, who is the poster on this board who is ready to pay the consequences if his/her advice about raising CPAP pressure is not appropriate? Do posters on this board carry malpractice insurance as MDs do?

Re-edited.

[Pugsy]

Yes, people can have pressure induced centrals. It happens to a very small percentage of people.
If someone happened to have a lot of centrals in their sleep study an APAP with a wide range might not have been the best choice. If no history of centrals and an APAP with settings off 6 to 14 already has a wide range and the top is 15. No one has suggest increasing the max... only increasing the minimum to 7. Chances of that increase throwing a truck load of centrals is slim to none but chances of giving the machine a head start on preventing events is pretty darn good.

Snoozebabe it would be better if we could see one of your reports to see where the APAP wants to go.
If it stays at 14 for most of the night... maybe.. but most of the time it is the minimum number that is most critical.