How do you lower HI?

Hi, last night I had the following sleep data:

AI: 0.7
HI: 5.5
Avg Press: 11.2
Leak: 0.02 L/s

*EDIT - I have my pressure settings on APAP to 7.8 to 17

My breathing was quite labored throughout the night, and so my chest was sore in the morning... I still felt quite tired during the day (although this state is my new "normal" - better than the walking zombie, but still tired).

Does anyone have any suggestions on how to lower my HI?

Jeremy

What are the pressure settings in your machine?

For a ResMed Auto, the numbers you posted aren't bad. (pretty good, actually)
ResMed counts Flow Limitations in their Hypopnea count, so, "conventional wisdom" suggests that mentally cutting that in half will give you a more realistic number.


Den

jeremytang wrote:Hi, last night I had the following sleep data:

AI: 0.7
HI: 5.5
Avg Press: 11.2
Leak: 0.02 L/s

My breathing was quite labored throughout the night, and so my chest was sore in the morning... I still felt quite tired during the day (although this state is my new "normal" - better than the walking zombie, but still tired).

Does anyone have any suggestions on how to lower my HI?

Jeremy

It is my opinion, in agreement with Den's, that your machine data looks good. That ain't bad HI at all for a ResMed, so there would be little reason to chase it lower in most cases. Here are some other questions to think about along with Den's question, though:

What was found during your sleep study as far as specific diagnosis and severity?
How many hours of sleep do you get every night, now that you never sleep without the machine?
How is your stress level?
What medications are you taking?
What health conditions are you suffering from?
When was your last complete physical?
Have you reported your continuing tiredness to your primary physician, and also to your sleep doc? Have you told them specifically about the labored breathing, chest soreness, and anything else that seems out of the norm?
Is it tiredness alone, or is there also sleepiness in the mornings and early afternoon?

Of course, you are not required in any way to answer ANY of the above questions here if you don't want to. Those are just ones that popped into my mind, since it seems to me that if you are getting those great numbers and are getting 7 to 8 hours a night with the machine, it might be that the tiredness could be more than a standard airway-obstruction issue, especially in view of the suddenness of the symptoms of OSA.

I'm not a doc, so I'm not trying to diagnose anything--just give you some food for thought as feedback from a fellow patient.

jeff

Thanks for your reply... I updated my pressure settings above. I've only collected data by using the clinical menu so far - a cable is in order, so my other days aren't as good as that day - when I have a bad day, my mask leak is usually 10x that (0.2 L/s). I find that tightening the mask doesn't always work well so I loosen it slightly. I've also moved the CPAP up which seems to make hose management worse, I'll probably put it back on the floor.

I had a sleep study done about 3 months ago, and unfortunately didn't take any paper home with me, but the equipment provider said that my AI was 2. She said that's basically success... but I sure didn't feel like it. She said wait 6 months and if I still feel tired then they'll do another sleep study, this time in a lab (my first one was just a take home kit which found I have an AI of 14).

I would consider myself relatively healthy, I am short, muscular build (pretty stocky), relatively low body fat. Exercise regularly. The last check revealed no problems with blood pressure, but maybe an affinity to fatty foods (triglicerides) which I have since cut down significantly.

The only other health condition of note that I can think of is my sinuses tend to be sensitive, and I find it difficult to breathe through my nose when I'm lying down. I can only breathe through one nostril at a time. I am 32.

I find I'm generally tired all morning and especially at 3:00... I work from home and have very low overall stress.

I've been on CPAP for the past 3.5 months, and started taking a sleep log for the past couple days after discovering this forum... anyway this is my entry for that day:

Up at 5:00 am, but went to sleep a little earlier than usual (around 11) A little frustrated and somewhat tired. Chest sore from labored breathing… I'm going to see the doctor today to see if I can get an ENT referral.
Slept mainly on side, and through my nose from what I could tell…. But it sure didn't feel like I was getting air to my lungs unless I breathed deeply through my mouth (this is when I was semi-awake). It's like breathing through my nostrils is like breathing through thin straws. Could it be that my diaphragm isn't working good enough to push air through my nose? Or my nasal passages are too thin? When I turn the CPAP off I realize how hard it actually is to breathe through my nose.
In all I feel a little tired, but better than yesterday. My slight alertness could be due to a morning adrenaline rush as I rush to fill this diary out. Didn't eat that much yesterday; had 2 very small meals. No workout this whole week so far. This is the "normal" I've been accustomed to except for that disaster week prior to the 2nd.
Supposed to be a snow storm coming in today starting at 7 am.

Note: couldn't see doctor due to car in the shop!

jeremytang wrote:*EDIT - I have my pressure settings on APAP to 7.8 to 17

What is your EPR setting?
Is your average pressure usually up around 11, or was that just the one night?
Do you get 7 hours or more of sleep?

Den taught me that even if a person has an auto, it can still be good to find one pressure that works and run the machine in regular CPAP mode to see if sleep becomes more refreshing that way.

If your pressure averages above 10, you may want at least to try raising your minimum, if that doesn't cause any complications with swallowing air.

Seeing an ENT may be a good idea. Did that ever happen? You could, for example, have an allergy to mold or something, if symptoms got worse after moving to a new house and you are there all day.

Don't worry about breathing out of one nostril at a time. That is called the "nasal cycle." It may help to start the night sleeping on your side opposite of the obstructed nostril.

I have similarly labored breathing when my allergies act up or when something stressful causes my nasal passages to swell. When that happens, I have to raise the pressure on my machine to help me breathe through my nose. Most nights, 8 cmH2O is comfortable for me, but when my nose feels stopped up before bed, I have to raise my pressure to 10 cmH2O before I feel that I can breathe comfortably. (In my case, I am talking EPAP, because I am on bilevel, but that principle may also apply to CPAP/APAP.)

Have you tried nasal irrigation about an hour before bedtime? It can do wonders to 'take a little swim in the ocean' over your sink in the evenings. The squeeze bottle is better than the Neti Pot: http://www.neilmed.com/usa/sinusrinse_video.php

If that doesn't work, there are things that can be done by an ENT surgeon. The "nose" related surgeries can help PAP therapy be more comfortable and effective. The other surgeries (like tongue and palate/uvula), not so much. Those surgeries can make PAP therapy more difficult.

Be glad you got on PAP early in life. That should make the rest of your life go a lot better.

Hope you get that tiredness worked out. It can help the docs if you can differentiate your fatigue from sleepiness, depending.

That's all I got. Den, or others, may have more.

jeff

Again thanks for your reply.

I've been playing around with the EPR settings after noticing that my throat would lock up after exhaling. So on the Dec 2nd, I turned off EPR entirely and had the best, and deepest sleep so far - despite the fact my legs were moving around a lot and I felt partially sick.

The following day I made another change to CPAP constant pressure mode of 10.8. That gave me an average day (instead of the exceptional day I had the day before).

Since then, I haven't been able to replicate it. I'm waiting for my computer cable to analyze that particular day.

I also raised my minimum pressure last night to 8.8... had what I would characterize as an average day.

I'm working on the referral to an ENT right now - they need a doctors referral first, but I was trying to go Friday, but had car problems on the way there. I spent the day at the auto dealer instead.

I actually use the Sinupulse device to manage my sinus' but admittedly I'm rather inconsistent with it.

I'm definitely interested in getting something done about my nose area... and my dentist says when he looks down my throat that my airway is exceptionally small. I realize that most experiences with tonsils/uvula have been less ideal - but nonetheless it'd be nice to widen that airway somehow. My dentist also offers an appliance that holds the jaw in place at night (I do notice my lower jaw sinking does affect my breathing) so I plan on trying that.

Has anyone used a jaw device in conjunction with the PAP?

Jeremy

jeremytang wrote: . . . on the Dec 2nd, I turned off EPR entirely and had the best, and deepest sleep so far . . . The following day I made another change to CPAP . . .

The scientific consensus around here seems to be that once a person is in the ballpark with settings, a person should make one change at a time then wait a week or two to see what the average numbers are before deciding if it was a good move. That is because any of us can have a stretch of a few days when we have particularly bad numbers, or particularly good numbers, for reasons completely unrelated to the change but that occur then coincidentally. It is the average over many days that matters.

jeremytang wrote: . . . my legs were moving around a lot . . .

A lab-based sleep study would screen you for limb-movement problems during sleep. Something to think about.

jeremytang wrote: . . . my dentist says when he looks down my throat that my airway is exceptionally small. I realize that most experiences with tonsils/uvula have been less ideal - but nonetheless it'd be nice to widen that airway somehow. . . .

I agree that is a great theory. Oh, if it only worked that way in practice! The best thing for a small airway down the throat is air to splint it open. Period.

Unless a doc comes up with a way to build you a whole new airway, settle for the nasal stuff and leave the other stuff alone. Trust me. Search UPPP in the forums and read it all before agreeing to anything more than turbinate/septum stuff. When it comes to the stuff below the nasal area, experience shows that if you widen one area, that just puts more negative pressure on another area and then IT closes. On the other hand, if you open up the nasal area, that lessens the negative pressure created by the diaphragm so that there is less tendency for the upper airway to close off. That's one running theory anyway, which seems to me to be well supported anecdotally. It is worth doing your own deep study of the longterm success rates before agreeing to any surgery. Ask what percentage of people are glad they had the surgery and consider it a success 10 years later.

jeremytang wrote: . . . Has anyone used a jaw device in conjunction with the PAP? . . .

I use a mandibular-advancement device (MAD) in conjunction with my PAP therapy, mostly to hold my jaw shut during therapy while using nasal pillows. I like having it in case electricity goes off so I can at least keep my jaw forward and sleep sitting up to stay alive a night or two. But I have no delusion that there is any longterm solution to my very small airway other than PAP therapy.

Hope that helps.

jeff

I agree that UPPP is not a surgery I'd ever choose. UP3 is not usually a long term solution, plus it can make later CPAP use problematic.

However, MMA/GA (maxillomandibular advancement along with genioglossus advancement) has a very high success rate for opening the airway... if one chooses one's surgeon carefully. If I were considering MMA/GA (I'm not, as I'm fine with "CPAP") I'd go to Dr. Kasey Li at Stanford in California.

An interesting question and answer (by Dr. Li) on another board:
http://www.sleepnet.com/askasleepdoc/sl ... ery51.html

http://en.allexperts.com/q/Sleep-Apnea- ... sey-LI.htm

Description of maxillomandibular surgery:
http://drkaseyli.com/maxillomandibular.shtml

List of peer review journal articles about maxillomandibular advancement:
http://drkaseyli.com/researchpub.shtml

rested gal wrote: . . . MMA/GA . . .

I always forget about that one, for some reason. It looks pretty major, but yeah, that one makes sense to me too.

Thanks, RG!

One sleep apnea surgeon, Dr. Park, recently impressed me with his statements on another board about how sleep apnea surgery is usually reserved for those having unsolvable troubles with the most successful, best option, PAP therapy:

http://www.sleepguide.com/forum/topics/ ... 1#comments

Had UPPP surgery along with septoplasty last year, in hopes that it would take care of my apnea. If I could go back, would never have done it. Brutally painful for a month, and still snoring like a buzzsaw after all was said and done. Try doing that when your throat is still like hamburger meat. Read up on the purpose your uvula serves.... it makes a difference not having it, not in a good way.

For now, it appears that CPAP is the most effective, non-invasive way to go. I'm back on the wagon, and in the beginning stages of making it work. Frustrating? Yep. Uncomfortable at times? Yep. Still tired? Yep. Adding years to my life? Absolutely. I'm seeing my AI and HI numbers come down, and looking forward to the day that the fog lifts. You will too!

When you get your software up and running, check the graph to see if you are having clusters of events. Clusters can certainly make you tired. A bump in pressure can break the clusters up.

T.

Another thing you may want to consider in terms of lowering your AHI is the position you sleep in. For example, there were hints in my sleep study I might do better sleeping on my side rather than stomach. I'm now playing around with that to see whether I can get my AHI into a lower range (My AHI is usually in the 6 to 7.5 range and I'm beginning to suspect on those days I get it below 5 I am sleeping on my side). However, I'm not sure simply telling myself to sleep on my side is going to work as the night progresses and while I have heard about some tricks to keep from sleeping on one's back (such as mounting tennis balls on your back) I'm not sure I want to do the same for my stomach.

Thanks everyone for the fantastic feedback.

About sleeping on your side. My wife was a back sleeper but had to start sleeping on her side due to pregnancy hurting her back. Anyway she uses a body pillow (which are surprisingly hard to find at least in my hometown). She uses a set of pillows behind her and she hugs the body pillow. The body pillow is used to support your upper arm. Seems to work for her, but there was an adjustment period (couple months).

I'm going to stick with my current settings for a week. I guess I'm too used to instant gratification/feedback in this digital world. I have to remember that the biological world works on a different clock.

Once I get my software I'll post the results