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

[avi123]

My APAP always wants to go to the top set- pressure when it encounters obstrucive apneas, snore, hypopneas, flow limitations, etc. On the other hand, setting the lower pressure could act the same as doing it in a BiPAP. I wonder if it would be beneficial? If I raise the pressure to the max of 20 cm H2O it would go right there and stay hi most of the time. See it in the following graphs:



Those leaks are from me sticking my finger into the mask, above the cushion, to scratch my nose.


Statistics
Serial No.: 22111195209
Product: S9 AutoSet
8/29/2011 - 8/29/2011

Device Settings

Therapy Mode: AutoSet EPR: Off EPR Level: 2.0 cmH2O

Minimum Pressure: 11.0cmH2O
Maximum Pressure: 15.0cmH2O

Pressure - cmH2O
Median: 13.6 95th Percentile: 14.8 Maximum: 14.9

Leak - L/min
Median: 0.0 95th Percentile: 9.6 Maximum: 32.4

AHI & AI - Events/hr

Apnea index: 7.4 AHI: 8.8 Obstructive: 2.6
Central: 4.7 Unknown: 0.0 Hypopnea index: 1.4

In my case, after trying to titratrate myself over 8 months, by changing the pressure all the way from 6 cm, as advised in my PSG, from 8 months ago, all the way to 16 cm I could not find any correlation between the pressure and the AHI. That's another reason for me to post it in my signature line below.

[BlackSpinner]

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

which was 20, permanently blew out (for lack of a knowledge of better medical terminology) my left nasolacrimal duct,

But isn't it fun to imposter a phsician and give medical advice?

And who suggested that they crank their pressure to 20? Nobody suggested sky diving either and climbing mount Everest has also not been mentioned. Neither did anyone suggest performing surgery on oneself.

The only thing mentioned has been for them to raise their minimum pressure a bit and keep it there for a few days and watch their data.

Oh and no one here is impersonating a physician.

[snoozebabe]

Thanks for all your advice, comments and warning. All very enlightening.

Well, I wouldn't have suspected that my therapy wasn't working until I chanced upon a discussion of AHI numbers in this forum and discovered that mine is still above the recommended range. Otherwise, the CPAP is the best thing that could have happened to me. I no longer feel as sleepy as I used to, and no longer fight the urge to fall asleep at the wheel. I can stay up the entire afternoon without having to take naps. But I do get relapses here and there which I've brushed off as the result of staying up late.

But when I discovered the normal range of AHI, I was a bit concerned, even though not very, since like I said, my therapy seems to be working even if the AHI is high.

I understand that it could be more than just simply raising the lower limit pressure, and I have to examine the graphs from the software carefully. So I will proceed cautiously, and probably will only try increasing my lower limit once for a week. If it doesn't work, I will seek further medical advice.

Below is my SmartCode report, if anyone is interested.

[BlackSpinner]

Well look at your last night, your 95% is stuck right at your upper limit of 14. Your graphs will show you what was going on minute by minute.

[jnk]

If the diagnosis is obstructive sleep apnea, I am not aware of any need for caution when it comes to raising the minimum up to within a cm or two of what you need to prevent obstructive apneas, in harmony with everything Pugsy, BlackSpinner, Brenda, and others have said. The only reason to leave the minimum lower than that for an OSA patient is "comfort," as far as I know. And personally, I usually find 6 cm uncomfortable as too low of a pressure for breathing comfortably with a mask on. Your max may eventually need to be raised, or you may one day find you get better therapy running at a fixed pressure CPAP instead of APAP. Everyone is different.

I'm never really sure what avi123 is talking about. But, hey, that's just me.

The first time I made adjustments to the settings on my machine, I called my sleep doc to tell him what I was doing and why, for my benefit and his. But I realize that not everyone has a sleep doc who is willing to have that discussion over the phone or who is willing to give the OK for anything over the phone. In that case, a person has to do what a person has to do to get the best sleep possible. Getting good sleep is the important thing.

[snoozebabe]

Well look at your last night, your 95% is stuck right at your upper limit of 14. Your graphs will show you what was going on minute by minute.

I haven't got the software - yet. Can only rely on the SmartCode report which only shows bar graphs of the numbers in the table. Hopefully I can lay my hands on the software soon to get a clearer picture.

[snoozebabe]

If the diagnosis is obstructive sleep apnea, I am not aware of any need for caution when it comes to raising the minimum up to within a cm or two of what you need to prevent obstructive apneas, in harmony with everything Pugsy, BlackSpinner, Brenda, and others have said. The only reason to leave the minimum lower than that for an OSA patient is "comfort," as far as I know. And personally, I usually find 6 cm uncomfortable as too low of a pressure for breathing comfortably with a mask on. Your max may eventually need to be raised, or you may one day find you get better therapy running at a fixed pressure CPAP instead of APAP. Everyone is different.

I'm never really sure what avi123 is talking about. But, hey, that's just me.

The first time I made adjustments to the settings on my machine, I called my sleep doc to tell him what I was doing and why, for my benefit and his. But I realize that not everyone has a sleep doc who is willing to have that discussion over the phone or who is willing to give the OK for anything over the phone. In that case, a person has to do what a person has to do to get the best sleep possible. Getting good sleep is the important thing.

Ya, you are right. Not everyone has a doc who is that supportive and you're lucky to have one. I don't have any other medical condition as far as I know and my sleep study did not show any central apnea event. So I will adjust my pressures a little and see if it makes any difference. Thanks for your support.

[DoriC]

The Dr had set our auto to 8-18 to "let the machine find the correct pressure". After many weeks of struggle with runaway leaks vs pressure and then finally educating myself a bit here,I reset the pressure to 11-15(2+/2-) titration pressure with much better results. When we went for next (and last) followup with the sleep specialist, he read the reports and gave me nice pat on the back and a thumbs up! You're getting excellent and responsible advice here from some of the best who have helped many people including myself.

[jnk]

. . . I don't have any other medical condition as far as I know and my sleep study did not show any central apnea event. . . .

If it was me, then, I'd raise my minimum as high as was comfortable to me--to maybe 8, 10, or even 12 cm--given that report of that home-machine-estimated AHI at those pressures.

[avi123]

If the diagnosis is obstructive sleep apnea, I am not aware of any need for caution when it comes to raising the minimum up to within a cm or two of what you need to prevent obstructive apneas, in harmony with everything Pugsy, BlackSpinner, Brenda, and others have said. The only reason to leave the minimum lower than that for an OSA patient is "comfort," as far as I know. And personally, I usually find 6 cm uncomfortable as too low of a pressure for breathing comfortably with a mask on. Your max may eventually need to be raised, or you may one day find you get better therapy running at a fixed pressure CPAP instead of APAP. Everyone is different.

I'm never really sure what avi123 is talking about. But, hey, that's just me.

The first time I made adjustments to the settings on my machine, I called my sleep doc to tell him what I was doing and why, for my benefit and his. But I realize that not everyone has a sleep doc who is willing to have that discussion over the phone or who is willing to give the OK for anything over the phone. In that case, a person has to do what a person has to do to get the best sleep possible. Getting good sleep is the important thing.

Reply:

Since I been on this board I have never seen from any of the posters, including you, RG, Pugsy, BlackSpinner, Brenda, and others, who are often rendering medical advice about pressure changes, showing exactly what they did and how they carried out their own process of AHI reduction by changing the CPAP pressure. I am not talking about others doing it, PSGs, books, articles, stories, etc.


JUST SHOW ME, black (or color) on white, data from your CPAP, proving your own results on it that you have reduced your AHI for a week!!!

I have deleted the summary graphs of my past AHI vs Pressure, vs Leak, during the the last 8 months showing that in my case, there have not been any correlations between the AHI values vs pressures changes from 6 cm to 15 cm. I have not received any meaningful comment on it. I'll try to post again again when the right time arrives.

[scrapper]

Pugsy, Brenda, jnk, Black Spinner, DoriC and others speak from years of experience.....newer members can totally trust their opinions and well meaning suggestions for improving care. Their own personal data is unnecessary to prove expertise, and is totally uninteresting to most people. Most individuals only want to understand their own data--not someone elses.

[wolewyck]

This was mentioned briefly by another poster, but it's worth reiterating-- an AHI above 10 is too high. Something is not working for your setup, and you should definitely consult with your doctor about that.

One piece of information I haven't seen from you is what kind of residual events you are having-- are they obstructive in nature, or does your machine record them as (possible) central apnea events? Because it makes a big difference in how they would be treated. If obstructive apneas or hypopneas, then it is likely that your pressure settings are not quite right. But if your events seem to be central (neurological) in nature, then increasing your pressure settings is not likely to be effective and in fact may make things worse. Some people have central apnea events "naturally", and some, like me, get central events when put onto a CPAP or bilevel machine. In either of those circumstances, a doctor may prescribe a different type of machine-- ASV (adaptive servo-ventilation). These machines are more sophisticated (and more expensive) than CPAP, APAP, and bilevel machines. The ASV has been extremely effective for both me and for my dad.

[Pugsy]

JUST SHOW ME, black (or color) on white, data from your CPAP, proving your own results on it!!!

I don't have to prove a damn thing to you and I sure as hell am not going to try.
Doubt if it would make any difference. You would still pick it to pieces.
End of May 2009. Ozij..Den..and Rested Gal helped me do the very things I have told people I have done. Some of the reports are missing from photobucket but the bulk of it is still there. Search the forum if you wish. I really don't give a rat's behind.

[DoriC]

Avi, You're obviously needing help from the experts here based on your data but with your belligerent attitude (probably caused by improper cpap therapy),I don't think anyone will want to share their valuable brain power with you. That's really unfortunate because you're missing out on achieving successful therapy and I would guess that you're desperate to learn to do that or you wouldn't be here, but you're going about it in the wrong way. I don't remember anyone ever daring these veterans to show proof of their own success. They wouldn't be here giving of their time and vast knowledge if they weren't successful themselves and wanting to pay it forward. Where would they get their boundless energy? I am forever grateful to my friends on this forum for helping me to give my dear husband a better quality of life in so many ways. Tomorrow will be 3 years that we started therapy.

[avi123]

Avi, You're obviously needing help from the experts here based on your data but with your belligerent attitude (probably caused by improper cpap therapy),I don't think anyone will want to share their valuable brain power with you. That's really unfortunate because you're missing out on achieving successful therapy and I would guess that you're desperate to learn to do that or you wouldn't be here, but you're going about it in the wrong way. I don't remember anyone ever daring these veterans to show proof of their own success. They wouldn't be here giving of their time and vast knowledge if they weren't successful themselves and wanting to pay it forward. Where would they get their boundless energy? I am forever grateful to my friends on this forum for helping me to give my dear husband a better quality of life in so many ways. Tomorrow will be 3 years that we started therapy.

Doric, you're really sweet. Let me ask you this: would you blindly let me manage your and your husband's money if I told you that I have been a Certified Financial Planner (CFP) for the last 35 years and posted more than 6,500 posts on http://www.morningstar.com discuss forums, or would you do some investigation?