AH1 still higher then should be

[mystydragonfly]

Hi,

I've been using my CPAP off and on for a few years since I was diagnosed with moderate sleep apnea three years ago. I have recently been sleeping with it on for 6 to 7 hours a night, however my AH1 hardly ever goes below 5. Two nights ago it was around 7 and last night around 10. I do not have insurance. Can or do I need to adjust my macine? If so, how do I do it and to what level?

Thanks you all for your answers.

[BlackSpinner]

You can totally adjust your machine. The manuals are online. Programming the old VCRs was harder then this.

You can also check your data if you have a data capable machine to see where, when and what your actual events are using Sleepyhead software.

[Pugsy]

What is the AHI breakdown of that AHI that never wants to go below 5?
What are your pressure settings?

Can you post an image of last night's detailed report with AHI of 10?
Don't know how? Discussed in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779

Yes, you can adjust the machine but let's see exactly what is going on before adjusting anything.
If the AHI is composed of primarily Clear Airway events...changing the pressure (most often people want to increase it) is NOT the way to go.
Now if the AHI is primarily obstructive apneas or hyponeas...then normally a little increase in the minimum pressure is needed.
It's best to know exactly what you are fighting before you start throwing punches.

Here is a link that shows how to get to the clinical menu to change things in the PR S1 machine. It's easy to do.
http://www.apneaboard.com/pr-system-one ... structions
There's also a little video at the bottom that might help.
But again...don't go changing things without a plan.

[mystydragonfly]

Here is my Sleephead report from 12/8/13

[Pugsy]

What is your maximum pressure setting?
I see the minimum is 4 cm but can't tell for sure what the maximum is. Don't know if it isn't going any higher because it can't or just doesn't want to.
It appears to be 20 maximum. 4 to 20 is just the default settings. Did you have a sleep study where a titration with mask was done or are they using the machine to hopefully find the optimal pressure.

Anyhow...mainly hyponeas. I suspect that 4 cm minimum is simply not sufficient to stent the airway open and the machine can't get to where it needs to be in a timely manner.
If it were me and this were my report I would look at increasing the minimum pressure...probably to 6 cm and see what happens. I don't know about the maximum but the minimum is where I would start. The minimum is the most critical pressure settings in situations like this.

Your leak line is a bit ragged looking..having any trouble with leaks or waking often fiddling with the mask?
It doesn't really approach large leak territory though..until that 6:20 big leak.

I think that just an increase in the minimum is most likely all you need to do. If the maximum is 20...it sure isn't getting anywhere near it so I don't think it will matter what the maximum is.

[CRMW]

It appears that the machine is set from 4 to 20. isn't that the original setting for the machine? If these were my stats, I think i would set to 6 to 10 and see how that works.

[mystydragonfly]

Hi,

I changed the minimum pressure to 6 which didn't seem to help too much in reducing the AH1. I woke up in the middle of the night and the air movement seemed to be pretty strong, so I reduced the pressure again this time to 4.5. The AH1 is still higher than I think it should be. Does anyone have any further suggestions. Here is my report:

[robysue]

mystydragonfly,

Here's a marked up copy of your data:

Note the multiple number of clusters of Hypopneas that I've boxed in that are causing pressure increases. Indeed, almost all of your pressure increases are being caused by clusters of hypopneas that get started when the pressure is at 4 cm (your min setting). And after a pair of Hs occur close to each other, the PR machine increases the pressure by only 1 cm and then waits for a minute or so to see if the breathing stabilizes. But in your case, more Hs continue to happen and so there are several 1cm increases in pressure, all about 1 minute apart.

In other words, because the minimum pressure is set too low, the machine is taking too long to respond to the clusters of events. It simply takes too many Hs to get the pressure up where it needs to be to properly splint your airway. And once the pressure is high enough to splint your airway, the machine then works hard to see if it is possible to lower the pressure all the way back down to your minimum pressure setting of 4cm. Which starts the cycle over again.

That's why Pugsy suggested a modest increase in the minimum pressure setting. It may be your min pressure needs to be somewhere around 6 or 7 cm. But that's a pretty big jump to do at one time. And you said that when you tried setting min pressure = 6 that your "woke up in the middle of the night and the air movement seemed to be pretty strong". It may be that what you need to do is set the min pressure to 6 and use the ramp to start with a pressure of 4 at the beginning of the night. And if you wake up in the middle of the night, you can always just hit the ramp button to lower the pressure back down to 4cm. But you also need to leave the min pressure at 6cm for several days before you'll be able to tell whether a min pressure of 6 is enough to knock out those clusters of Hs that you are currently dealing with.

[mystydragonfly]

Thanks to all of you for your help. It is very much appreciated. I will try the ramp at 4 to fall asleep, (and during the night if I wake up) and leave the pressure at 6. I will let you know if it works. Again, many thanks. I count all of you among my blessings.

[mystydragonfly]

Hi,

I went ahead and adjusted my minimum pressure to 6, then to 6.50 (and used the ramp as needed on 4) as my AH1 is still on over 5. I am wondering if I need to increase my minimum pressure again to 7 (to see if my AH1 goes down) and keep the ramp at 4 as it is hard to get used to the air pressure? See my report from last night below. Thanks again for all of your help.

[robysue]

mystydragonfly,

Things that I've noticed about the last data you've posted:

1) The machine is not finding much of a reason to increase the pressure very often.

2) The overall wave form looks to me like you weren't sleeping or were just dozing lightly during this time frame. I'm basing that on comparing your wave form to mine, which is not always a good idea. But usually when people are soundly asleep, the size of the inhalations and exhalations decreases, often by quite a bit. Your wave flow only shows the kind of decrease in wave flow that indicates a transition to sleep in my data in two places: Between 22:35 and 22:45 and just after the break in the data and 00:15. The fact that you are doing some pretty big inhalations and exhalations all night long is also indicated in the summary data for the tidal volume numbers. Your median tidal volume number is more like the tidal volume of a person who is awake, but not not physically active. Sleep tidal volumes are usually less than what they are when you're awake. So a good question: How sound asleep were you during this four hour period? Were you sleeping very lightly (dozing) or were you sound asleep?

3) The cluster of H's between 23:45 and the wake at about 00:02 is significant and given the timing (about 90 minutes after you turned the machine on), it could be REM related---if you were soundly asleep before then. But if you were just dozing, well, then it might not be REM

4) The usage time is very, very limited. What did you do AFTER 2:15? Take the mask off and return to bed "just to get some sleep"?

My advice at this point is pretty simple: If the usage on this night is typical, the first thing you need to work on is getting the usage up---you really need to make sure you are using the PAP all night long, every single night. Don't get too worried about the data until you're sleeping with the machine. So what kinds of things are bugging you about sleeping with the machine? And why did you apparently take the mask off for good at 2:15 on this night? The reason I ask is that the first data you posted to this thread was for a full night and this one is not.


Now whether to increase the pressure or not really depends on whether it will help you use the machine all night long. You could bump the pressure up another 0.5 to 1.0 cm if the increase in pressure does NOT cause more discomfort.

[mystydragonfly]

Hi,

I have been using CPAP for at least 7 hours a night for the last 3 nights, but still have an AH1 that is above 5. I have had the minimum set at 7 and maximum at 20 for the last 3 nights. My last two night reports are listed below. I usually fall asleep within about 10 to 20 minutes after I first mask-up. I am up at least once a night to use the restroom, but have been leaving the mask on and then falling back asleep. Still feel incredibly tired. Should I just keep at it (leave min. pressure at 7 and use ramp at 4 as needed)for a couple more weeks and check in again at that time?
Thanks for your help.