AHI Puzzle: Your Opinions Please

[roztom]

HOpefully the numbers are readable. Please look at the AHI at various pressures. Notice as pressure increases OAI goes up and HI goes up and then drop down.

How would you suggest setting an APAP to handle this? 5 cm seems to be the only pressure that gives a good AHI but at a range of 5-6 cm it's hard to breathe.

Any ideas? Notice how the OAI/HI data flips at 9 cm.(BTW I was titrated at 9cm - interesting that my HI falls off there.)Tnx Tom


Press Hours OAI HI AHI SI
4.0 0.00 0.00 0.00 0.00 0.00
5.0 284.65 0.23 1.39 1.62 4.82
6.0 312.67 0.38 1.75 2.14 5.57
7.0 142.43 0.55 2.13 2.68 8.07
8.0 104.27 0.82 2.28 3.11 7.15
9.0 72.57 1.79 0.80 2.59 13.06
10.0 28.23 2.62 0.64 3.26 5.74
11.0 9.93 2.21 0.60 2.82 0.40
12.0 0.00 0.00 0.00 0.00 0.00
13.0 0.00 0.00 0.00 0.00 0.00

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, APAP

[BetterBreathinBob]

My Gosh, your numbers are all within the normal range of 0-5 AHI being normal. Are you trying to get to zero? Let's keep things in proper perspective. Are you sleeping well the entire night? Are you not tired in the afternoons anymore? Do you have an increased level of energy. Is your blood pressure improved? Ask yourself these questions to know if the therapy is working for you. We are humans, not machines. Try not to dwell too much on the numbers rather that your overall health has improved.


Good Luck
Bob

[roztom]

Good days and bad days.

When looking at the data - which is why I look at it I am trying to find an optimal setting for my APAP.

If you review the numbers you will see that the HI drops off at 9cm but the OSA goes up.

The combo results in a high AHI.

The fact that the best overall AHI is at 5cm where it is uncomfortable to breathe is ironic and possibly misleading.

How can HI go down and OSA go up at the same time? Assumiong the OSA numbers are really Central in nature then where would the best pressure be?

Just a question for the Collective Intelligence of this forum...

Tom

[Goofproof]

I would close the gap to 8 cm to 12 cm and recheck the data. A;so the mask does make a difference, I use two FF Masks, both work but the 431 results in a higher AHI. Jim

I'm up this month, still under 5, dad's living with me, and he died last night, I've been and will be under extra stress, that accounts for higher numbers.

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

[roztom]

Jim:

So sorry to hear about your loss.

I wish you and your family the best to get past this most difficult time.

Tom

[snoozie_suzy]

Jim

I am so sorry about your father, how painful. And what stress you must have been going through while you've been caring for him.

I wish you strength and comfort to get through this. Very sorry for your loss.

Suzy

[GoofyUT]

Jim-

I am so sorry to hear about the loss of your Dad. You are in our hearts and prayers.

Chuck

[NightHawkeye]

How would you suggest setting an APAP to handle this? 5 cm seems to be the only pressure that gives a good AHI but at a range of 5-6 cm it's hard to breathe.

Any ideas?

Yep. Assuming that you are using your machine in APAP mode, it doesn't do a very good job of controlling apneas and hypopneas below your titrated pressure. A lot of events get through before your APAP can raise pressure enough to prevent further apneas. You might have noticed prior posts where folks claim to do better with one brand of APAP vs another, or with straight CPAP. No doubt, you fall in the latter category.

As far as minimizing events, my guess is that you'd do a whole lot better on straight CPAP. Of course, only you know how well you sleep on CPAP vs APAP. Give it a try though. I'd do CPAP myself if it weren't for the gut-wrenching aerophagia. The solution for me seems to be to use fixed pressure BiPAP. I sleep better with it than I ever did with APAP. I've been using fixed pressure BiPAP long enough now to see clear trends toward lower AHI, and I really enjoy the improved sleep quality and time.

Of course, if all your data was collected in CPAP mode, then I haven't a clue. Good luck, Tom.

Regards,
Bill

[Sleepless on LI]

Goofproof,
I am so sorry to hear about your dad. Take comfort in knowing that your dad knew what a great son you were and how much you loved him. My sincere condolensces.


Tom,
May I make a suggestion? First off, your AHI's are not drastically different at any pressure, but I can understand why you'd want to bring it as low as possible, the goal most people in therapy strive towards. But as I was taught here, don't judge your AHI at any given pressure by one or two nights. The very minimum you should keep one pressure at would be one week, two even better, to get a real gauge of what your AHI is at that level. Your conditions can change from night to night, so your AHI will along with it. You can average it out if you keep the setting for at least a week and get a good handle on what your true AHI is at that setting.

Second, when I was doing some exploration last year, I kept my machine at the 4 cms. setting. In the beginning, I thought I was going to suffocate, but I got used to it. If you are getting your best results at 5 cms., and that means less side effects at lower pressures, give it a short while and I'll bet you won't feel like you're not getting enough air after awhile. A lot of people are on low pressures like that, too, and they breathe. Yes, everyone is different, but I'd be thrilled if I could keep my machine at 5 cms. and get a good reading. It would be worth giving it a little time to see if you could adjust to it.

One other thought. Someone on this site once told me to look at AHI's like money. The difference between a dollar twenty (AHI of 1.2) and two dollars and fifty cents (AHI of 2.5) isn't much. The difference between a dollar twenty (1.2) and twelves dollars (12) is a lot or enough. When you're looking at nightly data, you should try not to be concerned when you're dealing in small change. When the bucks add up, then you can question how to fix the problem.

If I were you, I'd be happy. There are many people on this site that would kill to have your numbers and be in your shoes. But you are the one who needs to be satisfied and I can understand where you're coming from in that regard.

[Guest]

When you're looking at nightly data, you should try not to be concerned when you're dealing in small change. When the bucks add up, then you can question how to fix the problem.

If I were you, I'd be happy. There are many people on this site that would kill to have your numbers and be in your shoes.

Ditto

[dsm]

Jim,

Just read of your Dad passing. Please accept my condolences & best wishes.
I hope life gets back to normalacy for you asap.

The stress issue is without doubt a big contributor to breathing complications and thus to AHI increases.

I have noticed that if there is any prolonged stress, my sinuses seem to play up & xPAP therapy benefits decline until the stress gets removed or reduced.

Goodluck

DSM

[Ric]

5 cm seems to be the only pressure that gives a good AHI but at a range of 5-6 cm it's hard to breathe.

Tom,

You are using an APAP. The paradigm for a CPAP doesn't fit an APAP, it requires a whole different way of interpreting the numbers. If you set the machine as a CPAP at 5, your AHI would be TERRIBLE !!!!!

I agree with your SS, you titrate to a 9 with these numbers.
(actually just barely over the line from 8.)


(MS Excel)

If you set the machine on 5 as a CPAP "because that's the best AHI reading", you will not be effectively dealing with 70% of the OA events. How much time you would ACTUALLY spend in apnea with a pressure setting of 5 is impossible to determine from this data, because in every event the pressure increased and the apneas were resolved (presumably). Therefore one can't even guess at what the numbers "would have been". But I agree with Bill, it would be lousy therapy. APAP is dynamic, when you experience an OA at 5 cm and it doesn't go away, the machine will bump the pressure up and stops the clock for the 5cm "bucket", and goes to the next "bucket", and the next... The AHI you see at 5 looks undeservedly GOOD, only because the higher pressures "kicked in". Don't be fooled.

Consider setting the lower limit at 6 or 6.5 or 7. (OF COURSE it's hard to breathe at the lower pressure settings, there's a lot of aerodynamic resistance in the tubes, HH, mask, etc.) In doing so, there will be zero minutes recorded at 5cm, does that mean your OI (and AHI) will get worse? No, of course not. In fact you will be preempting some events that will never happen, and so the cumulative minutes spent in OA will go DOWN, and your AHI will go DOWN.

With an APAP one cannot look at a single pressure and say "WOW, the best index is at 5, or 6, and therefore maybe I should bring the upper limit down to 6" (for example). That only means that obstructive events that require pressures greater than 6 to resolve will not get resolved. How many minutes will go by before you wake up and start breathing is impossible to calculate, but that is not the correct paradigm. You would be (almost) back to the pre- xPAP days, that can't be good.

That also touches on why APAP is superior to CPAP for some people: a CPAP is not ALLOWED to respond to events that would otherwise respond to higher pressure, even a slightly higher pressure.

I would venture that since you apparently have the upper limit set to 13, but record ZERO minutes at pressures of 12 or 13, you also have ZERO "Non Responsive Apnea/Hypopnea" minutes (on the EncorePro detailed report), true? Remember, that's why you invested in an APAP over the CPAP.

I would suggest upping the lower limit to around 6 or 7, and just leave the upper limit at 13 as you have it. That is wider than most would recommend, but since it never goes there I see no harm. I leave my upper limit at 16, and have only gone there twice, and those times I probably needed it. The upper limit has no meaning on most days.

-R