OAI, HI, AHI, SI, FLI OR APNEA TIME - WHICH TO IMPROVE?

I now have almost 2 months of data at 6 different APAP settings, but the anomalies persist and I don't know what to do. Here is what I have.

Pressure 7-20 7-12 8.5-13 8.5-14 8.5-12 8.5-11
OAI 1.50 1.74 3.42 4.24 5.66 5.60
HI 3.55 2.81 2.80 3.12 2.42 2.84
AHI 5.05 4.56 6.22 7.36 8.08 8.44

SNORE I 48 12 4 3 4 2

FLI .5 .7 .7 .8 1.4 .7

APNEA
(SEC.) 180 200 388 448 616 562

DAYS 24 4 3 6 6 3

I know that some of the sample sizes are too small to be really meaningful, but the trends are still there to ponder.
1. AI and AHI look best at 7-12 or 20. 90% P was 9.6 and 10.5.
2. SI drops dramatically at 8.5+. Consistent result.
3. AHI goes up at 8.5+ and is highest at anything over 14.
4. As Low pressure is increased SI goes down, HI goes down, and AOI goes up.

What do you see that I am missing and what do I need to do to get it right me me? I have been on CPAP for years at 14 with no effect. Thanks to this forum I got an APAP-CFLEX, reader, and software to get it right. Unfortunately, I still don't really know what I am doing, what numbers are good, what numbers are bad, and which numbers are the ones that I REALLY MUST work to improve.

Pat

The numbers do look confusing.

How do you feel at the different settings? That perhaps is the best indicator.

If it were me: Since you have the software, you might want to set your machine to straight cpap. Start at 8 for a week. Then 9 for a week. Then 10, etc.

Keep a diary on how you feel vs the pressures of each week.

See if you get a better sense of how you are doing at each pressure and go from there.

[quote="CROWPAT"]I now have almost 2 months of data at 6 different APAP settings, but the anomalies persist and I don't know what to do. Here is what I have.

Pressure 7-20 7-12 8.5-13 8.5-14 8.5-12 8.5-11
OAI 1.50 1.74 3.42 4.24 5.66 5.60
HI 3.55 2.81 2.80 3.12 2.42 2.84
AHI 5.05 4.56 6.22 7.36 8.08 8.44

SNORE I 48 12 4 3 4 2

FLI .5 .7 .7 .8 1.4 .7

APNEA
(SEC.) 180 200 388 448 616 562

DAYS 24 4 3 6 6 3

I know that some of the sample sizes are too small to be really meaningful, but the trends are still there to ponder.
1. AI and AHI look best at 7-12 or 20. 90% P was 9.6 and 10.5.
2. SI drops dramatically at 8.5+. Consistent result.
3. AHI goes up at 8.5+ and is highest at anything over 14.
4. As Low pressure is increased SI goes down, HI goes down, and AOI goes up.

What do you see that I am missing and what do I need to do to get it right me me? I have been on CPAP for years at 14 with no effect. Thanks to this forum I got an APAP-CFLEX, reader, and software to get it right. Unfortunately, I still don't really know what I am doing, what numbers are good, what numbers are bad, and which numbers are the ones that I REALLY MUST work to improve.

Pat

Thanks for looking over what I presented. Here are some answers to your questions:

1. 90% Pressure over all conditions about 11, but varied from 9.43 to 12.73 depending on the pressure range used.
2. For 7-12 pressure the 90% was 10.46.
3. What is "UARS"?
4. C-Flex is set at 2. A setting of 1 makes it too hard for me to breath.

Are you saying that I should not worry about the snore index and focus entirely on getting the OAI, HI, and AHI numbers down such that the AHI stays under 5.0?

While waiting for more responses to my original post I went ahead and set my machine to 7-12 pressure. I will keep it there are a week and re-evaluate again.

Pat

Are you saying that I should not worry about the snore index and focus entirely on getting the OAI, HI, and AHI numbers down such that the AHI stays under 5.0?

yep that is what I'm saying. the only items that cause a drop to your oxygen levels are hypoapnea and apnea events, so those are the ones you should be concerned with.

Snores can however cause spontaneous arousals which can impact the quality of your sleep. Most that are logged by the Remstar are inaudible by nature. Here is what those Remstar acronyms mean:

OAI or AI=Obstructive Apnea Indice (Apnea Index)
SI=Snore Indice (better sleep on the couch)
HI=HypoApnea Indice (50% reduction in airflow >10 seconds).
FLI=Flow Limitation Indice (anything less than what a hypoapnea is).

translated they are:
DEFINITIONS:
APNEA = cessation of airflow for 10 seconds or greater.
HYPOAPNEA =>50% decrease in airflow for 10 seconds or greater with a decrease in oxygen saturation of >3%.
APNEA/HYPOAPNEA INDEX (AHI) = apnea plus (+) hypoapnea/hour of sleep.
RESPIRATORY AROUSAL INDEX (RAI) = AHI +snoring related EEG arousals/hour of sleep.
AHI/RAI** Scale =<5 events /hour = (none); 5-15 events/hour = (mild); 15-30 events/hour = (moderate); >30 events/hour = (severe).
Respiratory related sleep fragmentation: Sleep arousals due to respiratory events or snoring.
Desaturation = Drop in O2 oximetry distribution saturation by 3% below average saturation.
SaO2 scale: >89%=(none); 85-89%=(mild);80-84%=(moderate); <80% (severe).
EPWORTH SLEEPINESS SCALE =<10=(does not indicate EDS (Excessive Daytime Somnolence));10-15=(indicates daytim somnolence-not excessive);>16 (indicates EDS).
RESPIRATORY EFFORT RELATED AROUSALS (RERAs)=Sleep Arousals due to respiratory events characterized by pressure flow limitations in the airflow indicator channel without significant O2 desaturations.
StageIII and StageIV are combined and referred to as Deep Sleep.
Sleep Efficiency = Normal is >80%

Got it: concentrate on changing pressures as needed to minimize AHI; disregard snore index but accept any lowering as good.

What is the significance of FLI? Is it something that I should be trying to control? What number is "acceptable"?

What number of seconds of apnea/night is acceptable? I know the goal is 0, but I have only seen that occur once over the last two months.

Pat

CROWPAT wrote:What do you see that I am missing and what do I need to do to get it right me me? I have been on CPAP for years at 14 with no effect. Thanks to this forum I got an APAP-CFLEX, reader, and software to get it right. Unfortunately, I still don't really know what I am doing, what numbers are good, what numbers are bad, and which numbers are the ones that I REALLY MUST work to improve.

Your data looks good, Pat. Obviously, you're not entirely pleased with it yet though, and it sounds like you're not entirely happy with how you feel now either.

Remember that xPAP just improves one aspect of your life and health. Nutrition, recreation, rest, and numerous other life events and activities affect your general health and well-being as well. I feel better on days when I take the dog for a long walk or mow the yard, for instance.

I've been accused here of being addicted to monitoring my xPAP treatment, so I feel qualified to comment on the fact that it is possible to make continual improvements in your treatment, but be aware that these may come slowly, and that you are the only one who can figure out what is right for you.

I do have one specific recommendation for you though:
Concentrate on minimizing time in apnea. For me, AI is, by far, the most important parameter. I found out that I feel better and have fewer oxygen desats on those nights when I spend very little time in apnea. I have noticed that I can have significant desats even if I only have one or two apnea events a night, and so my goal is none. (I even manage to achieve that every few nights now.) Constant pressure, mouth closure (poligrip strips), and side sleeping are things which I have found important for improving my sleep by minimizing time in apnea.

Regards,
Bill

Thanks, Bill, for the advice and encouragement. Once I moved back to 7-12 I felt like I had a good night's sleep last night. I will keep it there for a week and then download and see what happened. I really want to get it right before I leave for a week in South America on a hunting trip.

Pat