Need help reducing HI

[lvehko]

I've been using a nasal mask (Activa) now for about two weeks, and I am still having problems with a high HI -- it's varied between a high of 10.10 and a low of 5.9. I've been logging all my numbers with all the variables, so I can try and keep track of what's working and what isn't, and it doesn't seem like anything is having any effect on HI.

My prescribed pressure is 8, and I have tried it at 7, 8, 9 and 10, and get about the same results at all those pressures -- my AHI average for the last two weeks with the nasal mask has been 8.98, AI average is 1.44, HI average is 7.53. How can I get these numbers down?

The night I had the lowest AHI, I had turned the EPS off, and that's the only variable that I can isolate for that night. Is it possible that the EPS is affecting my AHI? The only other variable is mouth taping, and that seems to have no effect one way or the other -- my leak numbers are about the same taped vs. not taped, and I use about the same amount of humidifier water either way, so I don't think I'm mouth leaking.

Also, oddly, I haven't been able to make any kind of equation yet between how I feel and my numbers the night before. I've felt great a day after having really bad numbers and vice-versa. It's a little maddening, frankly.

I'm using a straight CPAP machine, not an AutoPAP. Anyone got any advice for me?

Thanks -- Min

[Guest]

I would try setting the pressure to 7.4 or 7.6cm. Set the ramp pressure to 5cm with a 30 minute timer. Then Use the ramp to fall deeper into sleep before the higher pressure kicks in.

Then look at your AI and HI indices in the morning for improvement. Compare your AI avg. now to what you get with the change.

[Guest]

I've been using a nasal mask (Activa) now for about two weeks, and I am still having problems with a high HI -- it's varied between a high of 10.10 and a low of 5.9.

I think the high HI is because you may be mouth breathing and you are using a nasal mask. Have you tried a full face mask like the HC431, Hybrid etc?

[inacpapfog]

I see that you use mouthtape for leaks, do you also use a chin strap? My AHI was running 2.0 points higher with tape and chin strap when I was using Swift or Activa. Do you sleep on your back alot? Gravity can really pull the relaxed jaw backward and compound the OSA issue!

[lvehko]

Actually, I think I solved it -- last night I turned the EPS or EPR or whatever it is off, and had MUCH better results this a.m. Not sure why, but that seems to be the problem.

Thanks for the responses though!

Min

[dream_sleeper]

I had the exact same issue with EPR. Even though my pressure is set to 11, I was consistently showing an average of 10.2 the first week. One night my AHI shot up to 33 and I woke up feeling like crap.

Turned off EPR for two nights now and pressure is averaging 11.2, where it should be and I am feeling much better now.

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

[cpapjack]

I think the high HI is because you may be mouth breathing and you are using a nasal mask. Have you tried a full face mask like the HC431, Hybrid etc?

Hmm, not sure about that one. I taped last night and my HI actually was higher last night when I don't tape. When I don't tape, it's normally around 2.3 and when I taped last night, it was 4.1.

[Guest]

Actually, I think I solved it -- last night I turned the EPS or EPR or whatever it is off, and had MUCH better results this a.m. Not sure why, but that seems to be the problem.

Thanks for the responses though!

Min

I don't think your pressure is high enough to take advantage of the EPR feature.

[Guest]

I think the high HI is because you may be mouth breathing and you are using a nasal mask. Have you tried a full face mask like the HC431, Hybrid etc?

Hmm, not sure about that one. I taped last night and my HI actually was higher last night when I don't tape. When I don't tape, it's normally around 2.3 and when I taped last night, it was 4.1.

Taping the mouth is very different from using a mask like the Hybrid. With the Hybrid you have a dual airway therapy but taping the mouth doesn't give you that. Taping the mouth may actually increase the resistance because you are restricting exhalation.

[cpapjack]

Taping the mouth is very different from using a mask like the Hybrid. With the Hybrid you have a dual airway therapy but taping the mouth doesn't give you that. Taping the mouth may actually increase the resistance because you are restricting exhalation.

That's a good point, but I don't know if I believe that one. We tape so we don't open our mouths. So how would that be restricting exhalation, when we just be exhaling through our nose?

[Guest]

Taping the mouth is very different from using a mask like the Hybrid. With the Hybrid you have a dual airway therapy but taping the mouth doesn't give you that. Taping the mouth may actually increase the resistance because you are restricting exhalation.

That's a good point, but I don't know if I believe that one. We tape so we don't open our mouths. So how would that be restricting exhalation, when we just be exhaling through our nose?

The air exhalation out through the nose naturally diminishes when the body gets used to breathing through the mouth. So, if you are a natural mouth breather and you put tape or use a chin strap, you are restricting the other component of exhalation. After you do this for a while, the body does adapt and then the air exhalation through the nares increases.

[sleeplessinma]

The air exhalation out through the nose naturally diminishes when the body gets used to breathing through the mouth. So, if you are a natural mouth breather and you put tape or use a chin strap, you are restricting the other component of exhalation. After you do this for a while, the body does adapt and then the air exhalation through the nares increases.

Are you saying that when you start taping the mouth, for a short period of time, the HI goes up. Finally the body adjusts to the taped up mouth and there is an increase in air coming out of the nares? I think there is some validity to that. I wonder what the SatO2 levels will be during that adjustment period. If the air coming out of the nares is less during the adjustment period, then there will be higher CO2 retention in the body and that has to have irreversible long-term consequences on the person's health. Any thoughts?

[laurabel]

What is EPR??

[Guest]

What is EPR??

It is a feature like the Remstar C-Flex machines have but it doesn't appear to work as well since nearly everyone ends up turning it off.

It offers some relief on exhale by lowering the pressure on exhale. But your pressure has to be high enough to take advantage of it.

According to Resmed's own studies it doesn't work.

[frequenseeker]

Relief of pressure during exhale allows you to exhale more quantity = increased CO2 loss if you are a person who needs a higher level retained. This is a component of Complex Sleep Disordered Breathing. This is why BiPAP is not recommended for CSDB patients and if you are not feeling well with EPR or c-flex I wonder if you are getting the same effect.

After feeling really awful initially with cpap, then struggling with bipap/VPAP until I got my AHI down around 3 and achieved a tenous improvement, I felt much better after CSDB diagnosis being back on CPAP along with a mask (Swift) that had the vents plugged up and a different vent added about 12 inches down the hose. AHI now around 1.5.