Any ideas on how to lower my AHI? (Pesky Hypopnea's)

[Catpap]

Hi all!

(Current AHI around 2-3)

After noting a lot of my OSA events were happening first thing when I went to sleep (when my machine was auto titrating from its min 4 to its average of about 14-15) I asked the technician this week to increase my start pressure to 7, which seems to have worked, but I'm still getting Hypopneas particularly at the later stage of my night sleep - from around 2-4 in the morning.

Just wondering if anyone else seems to have more Hypopnea events later on in their night sleep and if they have found any way of improving this?

Any thoughts/tips would be welcome - I'd just like to get my AHI as low as possible as fast as possible!

Thanks

[JimP]

Does it happen soon after returning to bed after a bathroom run?

If it does, my sleep doctor says that its normal. Problem he has had with sleep techs is that they try to eliminate every event where that causes some fairly high pressures that people have difficulty sustaining. Better to have a few events and not try to eliminate all of them if that provides for a better night sleep.

[LSAT]

Most of my events are hypopneas also.... I get mine early in the sleep cycle. I was told years ago that very shallow breathing can cause some. I never worry when I get occasional AHI of 2.0-3.0.

[Catpap]

Thanks for the reply's!

From the first night I used my CPAP I stopped having to wake up and go to the bathroom! Previously I was having to go pee about 4 - 5 times a night even with fluid restriction from about 6pm. Literally this all stopped on my first nights CPAP treatment and I now never have to get up to use the toilet.

I have been woken up with rainout - and yes they were happening when my pressure was lo, however over the last 2 night I can see that the higher start pressure does indeed help stop them at the beginning of the night (I was starting at 4 cmH2O before).

I just find that I seem to have them later on in my night of sleep and wondered if anyone else has this or if there was anything I could to help. I do agree LSAT that I guess its not too much of a concern as I am still feeling good in the day, I just want to optimize as much as I can as I need all the energy I can muster (Medical Exam finals in June).

[Pugsy]

With the slight increase in any obstructive apnea event (OAs or hyponeas) late in the sleep cycle in those wee hours of the morning my first suspect is REM stage sleep. It's fairly common for a person's OSA to be worse and/or need higher pressures during REM stage sleep.
The other suspect is sleeping on one's back.

The fix for either suspect is simply just a little more pressure (minimum pressure) to help hold the airway open better and thus prevent the airway collapse. When using apap mode...just a little more pressure to give the machine a better head start in dealing with the collapse.

REM sleep stages usually progress during the night. The first REM stage is usually around 90 minutes after sleep onset and as the night goes on REM comes on quicker and lasts longer so that the most REM stage sleep will happen in those wee hours of the morning.
See the hypnogram here (scroll down a little and on the right side)
http://en.wikipedia.org/wiki/Sleep

Sometimes the pressure needed for REM sleep varies widely when compared to what might be needed for other parts of the night...and sometimes not much of a difference. My OSA is 5 times worse in REM sleep than in non REM sleep and sometimes I would see huge pressure differences during probable REM sleep and sometimes not much change at all.
Having the minimum pressure more optimal is the key though. The machine works better on prevention instead of always being "fixing' things.

[Catpap]

With the slight increase in any obstructive apnea event (OAs or hyponeas) late in the sleep cycle in those wee hours of the morning my first suspect is REM stage sleep. It's fairly common for a person's OSA to be worse and/or need higher pressures during REM stage sleep.
The other suspect is sleeping on one's back.

The fix for either suspect is simply just a little more pressure (minimum pressure) to help hold the airway open better and thus prevent the airway collapse. When using apap mode...just a little more pressure to give the machine a better head start in dealing with the collapse.

REM sleep stages usually progress during the night. The first REM stage is usually around 90 minutes after sleep onset and as the night goes on REM comes on quicker and lasts longer so that the most REM stage sleep will happen in those wee hours of the morning.
See the hypnogram here (scroll down a little and on the right side)
http://en.wikipedia.org/wiki/Sleep

Sometimes the pressure needed for REM sleep varies widely when compared to what might be needed for other parts of the night...and sometimes not much of a difference. My OSA is 5 times worse in REM sleep than in non REM sleep and sometimes I would see huge pressure differences during probable REM sleep and sometimes not much change at all.
Having the minimum pressure more optimal is the key though. The machine works better on prevention instead of always being "fixing' things.

Thanks Pugsy that does seem to fit exactly what is happening, and you are VERY right about the machine trying to fix things - I see a pattern in more OSA events where the machine is trying to fix things (ramp up the pressure) I see that my auto machine seems to creep up high and fix all events, then begin lowering the pressure , then I have a few events, then it decides to increase pressure again - I seem to see patterns of events whenever the machine is "messing about" with my pressure i.e. more events if its decreasing, then more as it increases again to a higher pressure.

Thanks for the explanation about why I seem to have more events in those wee hours.

So how's this for a thought - put up my min pressure to say 14 or 15 (the pressure I seem to have very few events if any), then set the ramp feature to about 7. Then start therapy and immediately press the ramp button to drop pressure, then during the night the machine will not fall below 10, or whatever figure I end up with.

Does that sound a reasonable plan?

[Guest1]

Are you using Aflex/EPR? If no, then do it. I recommend this:
1) Set Aflex/EPR to 3.
2) Set start pressure to 8.
3) Keep top pressure range open (to 20).

See results for 10 days at these settings.

[Wulfman...]

Thanks Pugsy that does seem to fit exactly what is happening, and you are VERY right about the machine trying to fix things - I see a pattern in more OSA events where the machine is trying to fix things (ramp up the pressure) I see that my auto machine seems to creep up high and fix all events, then begin lowering the pressure , then I have a few events, then it decides to increase pressure again - I seem to see patterns of events whenever the machine is "messing about" with my pressure i.e. more events if its decreasing, then more as it increases again to a higher pressure.

Thanks for the explanation about why I seem to have more events in those wee hours.

So how's this for a thought - put up my min pressure to say 14 or 15 (the pressure I seem to have very few events if any), then set the ramp feature to about 7. Then start therapy and immediately press the ramp button to drop pressure, then during the night the machine will not fall below 10, or whatever figure I end up with.

Does that sound a reasonable plan?

You need to look at your reports and see at what pressure your events are occurring. If your pressure is too low, you need to increase the minimum to the point where most of them are eliminated.
Have you determined that you actually "need" Ramp? If you do, try to set the starting pressure as high as possible and for as short of a time as possible. If you don't need it, so much the better.


Den

.

[Drowsy Dancer]

I'd just like to get my AHI as low as possible as fast as possible!

Are you an experienced user or a new user? It takes a while for some people to get used to the machine.

Also, the AHI numbers don't tell the whole story. There's quality of sleep, and there's also diminishing returns. A change in AHI from 7 to 3 is going probably going to feel more significant to you than a change from 3 to 1, and a change from 1.0 to 0.5 might not make a big difference in how you feel.

Chasing the lowest possible AHI number might actually impair your overall sleep quality if it turns out you're sensitive to pressure changes (some are more than others).

[Pugsy]

Without seeing what the pressure line is doing it's hard to say how much more minimum you might want.
Can you get me an image of a typical night? The detailed daily report?
If you don't know how to post the image it's explained in this thread along with examples of what I like to see.
viewtopic/t103468/Need-help-with-screen-shots.html

Your AHI is low and probably mainly are having little clusters during REM. I don't think you need just a drastic jump in minimum pressure from 7 to the teens but I would have a better idea if I saw a report.

And even if you did need a lot more than 7 I would still advise going up slowly (like 1 cm every 3 or 4 nights) because you might find that you don't need as much as initially thought. I have seen it happen often...when the minimum is a little more optimal the machine doesn't always go so high or stay up there very long when it does go up.

[Catpap]

WOW! Just had to post as very excited !

So last night I set my machine to min pressure of 13 cmH2o, which was absolutely fine going off to sleep without using the ramp.

Woke up this morning checked via sleepyhead and my AHI was down to 0.90!

Now it may well be psychological but even before I checked my AHI I lay in bed for a couple of mins and thought I felt good / well refreshed from my sleep - I wonder if a change from an AHI of 3 to 0.9 is noticeable or not?

Anyway will post some shots later as running off to the allotment now to get some work done

Thanks all

[zoocrewphoto]

WOW! Just had to post as very excited !

So last night I set my machine to min pressure of 13 cmH2o, which was absolutely fine going off to sleep without using the ramp.

Woke up this morning checked via sleepyhead and my AHI was down to 0.90!

Now it may well be psychological but even before I checked my AHI I lay in bed for a couple of mins and thought I felt good / well refreshed from my sleep - I wonder if a change from an AHI of 3 to 0.9 is noticeable or not?

Anyway will post some shots later as running off to the allotment now to get some work done

Thanks all

A lot of people have mentioned that they still didn't feel good with an ahi of 3 or 4 even though the doctor was happy with a number under 5. But they did feel better getting it down to 2 or 1. So, you could be one of those people who really needs it low to feel the full effect.

I really don't know if I am one or not as I have only had 4 or 5 nights that went above 3 with cpap. So, I can't compare there (and don't want to). Either I slept all night with my machine or I didn't. That is really the only determining factor for me. My settings work great for me, so it is just time in bed, and mask on the whole time. Even a night with only 4 hour or 5 hours (but cpap the whole time) is a huge improvement over 8 hours without the machine. Huge difference in how I feel.