Reducing Hypopneas..How To?

Hello All,

I have been on CPAP for 3.5 months now at a 10psi straight CPAP. Since being on CPAP, I have had only 9 apneas total (not an average, but total of 9 events), so I am confident the therapy is working. My hypopneas however are higher. I average 10 over the entire night of 7 to 8 hours of sleep. This results in an AHI of 1 or so, but I am always looking to do better.

Any advice to lowering the hypopneas any more? Or should I leave well enough alone? Perfection can never be achieved I realize this. Is it worth running after even lower numbers than I already have or is it a waste of time and frustration?

Zeke351

I think those hypopneas are probably only a second or two in duration with an AHI of 1. I'll bet they are clustered either as you are falling asleep or near when you awaken, too. I find my hypopneas fluctuate nightly from a couple to a dozen, but my AHI is always below 2.5 so I don't fret over it.

Emilia wrote:I think those hypopneas are probably only a second or two in duration...

If they were only a second or two in duration, then the machine would not have scored them as hypopneas. Hypopneas, by any definition, are at least 10 seconds in length...

Zeke351 wrote:Any advice to lowering the hypopneas any more? Or should I leave well enough alone? Perfection can never be achieved I realize this. Is it worth running after even lower numbers than I already have or is it a waste of time and frustration?

Zeke,

How do you feel? If you feel great, then I wouldn't worry about an AHI of 1. But if you feel foggy and are having issues with being tired, then maybe you do want to do something about it. After 3-1/2 months, you should be past the sleep debt issue, and should be feeling pretty good by now.

It is hard to know exactly what the hypo events are without all the data that is available in a sleep study. For example, I typically have 2 or 3 OA events logged each night. I am convinced that is due to me holding my breath when I turn over from one side to the other, and then continue to hold my breath while I adjust my pillows. That takes about 10 or 11 seconds, and that is the length of the events that I see. It would be nice to know this for sure, but it isn't worth a $2800 sleep study for me to find out.

If you are more curious, then perhaps you should consider buying a recording oximeter. It would be really useful to know if you are seeing oxygen desaturations when these events happen. In my case, I had a pretty low O2 level during my sleep study, but I am pretty rock solid in the mid-90s when using CPAP. It was worth the cost of the oximeter to learn that fact, and to be able to spot check it every few months.

-john-

Ideally you need all your data, or at least how many hypopneas vs apneas you're getting a night. Hypopneas can be considered as partial apneas, lesser in time and the machine can respond if it's an auto to stop it becoming an apnea.

I tend usually to get more hypopneas than apneas because I have tweaked my machine over the past 8 months to improve my therapy.

To reduce apneas or hypopneas, if you have an auto machine you really need to know at what pressure on average your hypopneas or apneas occur at, so that way you increase your minimum pressure to just under that. This makes it quicker for the machine to respond, reduces the effective time you don't breath for and will turn apneas into hypopneas more or if you're lucky remove the hypopneas because it's effectively splinting open your throat more so you don't get into an event area of having it collapse.

I don't know the machine you have and whether it's a fixed pressure CPAP or an Auto switching pressure APAP. WIthout having detailed data like per second data so you can check what your pressure is at when you go into a hypopnea or apnea it's very difficult to tell and you're then really only guessing.

Thanks
Dave

Dave21,

Unfortunately my machine is not an auto, just straight CPAP at a constant 10psi. I have virtually 0 apneas and am only averaging a total of 10 to 12 hypopneas over an 8 hour sleep cycle.

Jweeks,

I am really unable to gauge my therapy by how I feel. I was told by my sleep doc that I was considered asymptomatic, I was not tired, run down, foggy or "out of it". My starting CPAP was originally tied to my heart walls thickening due to sleep apnea and the increase in BP. Now that all being said, I have noticed that I feel better overall after being on CPAP.

So now I am wondering if increasing my pressure by .5 (the smallest increment my machine will do) is worth a try to reduce the hypopneas.

Zeke351

Zeke, congrats on your therapy. There are many who would love to trade numbers with you. There is only one way to find out if you can decrease your hypos by increasing your pressure by .5 and thats to go ahead and try it. Good luck.

Zeke351 wrote:Hello All,

I have been on CPAP for 3.5 months now at a 10psi straight CPAP. Since being on CPAP, I have had only 9 apneas total (not an average, but total of 9 events), so I am confident the therapy is working. My hypopneas however are higher. I average 10 over the entire night of 7 to 8 hours of sleep. This results in an AHI of 1 or so, but I am always looking to do better.

Sounds like you're doing great, Zeke!

btw, CPAP pressure is stated in cm H2O, not "psi."
centimeters of water... the amount of pressure it takes to raise a column of water _x_ number of centimeters.

Zeke351 wrote:Any advice to lowering the hypopneas any more? Or should I leave well enough alone? Perfection can never be achieved I realize this. Is it worth running after even lower numbers than I already have or is it a waste of time and frustration?

Zeke351

I'd leave well enough alone since you're doing very, very, very well. On the other hand, it can be interesting to experiment a bit, so if I wanted to try another full cm or two of pressure (I wouldn't bother with fractional increments) just out of curiosity, I wouldn't hesitate to raise it.

But it wouldn't be because I was trying to get a lower AHI. An AHI of 1 or 1.something is already so low it might as well be considered zero. You're doing super good. Especially since you said this:

Zeke351 wrote:I have noticed that I feel better overall after being on CPAP.

Way to go!

Congrats on what sounds like very good results