Erratic AHIs

persistent · Post by **persistent** » Wed Sep 16, 2015 10:23 pm

New to this forum and like all the knowledge of collective minds and I am so impressed how some people try so hard to help another person who is struggling. To those people who give so much,thank you from the bottom of my heart. I have been using cpap for over ten years off and on with minimal results. I can relate to people who feel like they have lost a portion of their life due to being tired and sleepy all the time and just trying to recover from the fog in the morning. even though I have had minimal results with cpap I know what it is like to get a good nights sleep and it has only happened 2-3 times in the last 15 years. My AHI index is very erratic (.5-25) and I have searched in vain for the trigger that causes the high AHI. I hardly ever feel well rested. Any comments or ideas would be greatly appreciated. Like , what do I need for sleepytime , I have highspeed internet and remstar Auto Aflex with Mirage Quatro full face mask. Still optimistic.

MarylandCPAPer · Post by **MarylandCPAPer** » Wed Sep 16, 2015 11:45 pm

How old is your machine and mask? I got bad results when my machine aged (after 5 years) and eventually croaked. Also, I had large leaks that messed with my therapy (although it kept my AHI levels low) when I got a new machine and used a 1.5 year old mask that I thought fit fine. When I got a replacement of the same mask, the leaks became minimal.

Are you using any software, such as Sleepyhead, to monitor your CPAP treatment? Are you getting any warnings of large leaks? It would help if you fill in your Equpment Profile under User Control Panel. above, using TEXT and specify the exact model of CPAP machine you have. The model number of Remstar (Phillips Respironics) machines is usually on a sticker on the bottom of the machine and may be something like P550. Be sure to take out the water tub of the humidifier before you turn over the machine, if you have an attached humidifier. Depending on the age of your machine, your model may not show up in the drop down box in the Equipment Profile, but you can add it to the comments section. Are you also using an attached humidifier with the machine (which may say System One on the top, which goes with the Phillips Respironics machines). Are you using a constant pressure or a pressure range? If you add all that to your profile, it will show up with every post and help people here help you figure out how to improve your CPAP therapy.

JDS74 · Post by **JDS74** » Thu Sep 17, 2015 5:11 am

Without data, it will be difficult to see what is going on. I found that even tiny amounts of caffeine caused my AHI to double. Other food items do the same thing as well.

Since you have a PR machine, I would suggest that you get and use both SleepyHead and Encore to use a tools to try and determine what is going on. It is very important to know in detail what apneic events are causing your AHI to be so erratic. From there, you can do further investigation to see if it is stress, food, sleep hygiene, mask leaks, etc. that is the trigger.

Best wishes.

Pugsy · Post by **Pugsy** » Thu Sep 17, 2015 8:38 am

Exactly which model AFlex machine do you have? If you have a newer machine (2010 to present) probably one of the System One machines and Sleepyhead will work with them and you don't need anything special in terms of your computer to use it unless your computer doesn't have a slot for SD card in which case you just need a little adapter so you can use one of the USB ports.

If it is an older model ...M series or Legacy which is even older..you would need Encore software because Sleepyhead won't work with those older machines....and a special card reader is needed.

So does it have a regular SD card in the little slot or does it have the Encore Pro Smart Card which is about the size of a credit card?

I can help with Encore if that is what you end up having to use...and we can still find those special card readers.
Let's figure out exactly which model you have and then go from there.

persistent · Post by **persistent** » Thu Sep 17, 2015 10:42 am

MarylandCPAPer wrote:How old is your machine and mask? I got bad results when my machine aged (after 5 years) and eventually croaked. Also, I had large leaks that messed with my therapy (although it kept my AHI levels low) when I got a new machine and used a 1.5 year old mask that I thought fit fine. When I got a replacement of the same mask, the leaks became minimal.

Are you using any software, such as Sleepyhead, to monitor your CPAP treatment? Are you getting any warnings of large leaks? It would help if you fill in your Equpment Profile under User Control Panel. above, using TEXT and specify the exact model of CPAP machine you have. The model number of Remstar (Phillips Respironics) machines are usually on a sticker on the bottom of the machine and may be something like P550. Be sure to take out the water tub of the humidifier before you turn over the machine, if you have an attached humidifier. Depending on the age of your machine, your model may not show up in the drop down box in the Equipment Profile, but you can add it to the comments section. Are you also using an attached humidifier with the machine (which may say System One on the top, which goes with the Phillips Respironics machines). Are you using a constant pressure or a pressure range? If you add all that to your profile, it will show up with every post and help people here help you figure out how to improve your CPAP therapy.

I have updated my equipment profile and will be downloading sleepytime soon.

persistent · Post by **persistent** » Thu Sep 17, 2015 10:57 am

Pugsy wrote:Exactly which model AFlex machine do you have? If you have a newer machine (2010 to present) probably one of the System One machines and Sleepyhead will work with them and you don't need anything special in terms of your computer to use it unless your computer doesn't have a slot for SD card in which case you just need a little adapter so you can use one of the USB ports.

If it is an older model ...M series or Legacy which is even older..you would need Encore software because Sleepyhead won't work with those older machines....and a special card reader is needed.

So does it have a regular SD card in the little slot or does it have the Encore Pro Smart Card which is about the size of a credit card?

I can help with Encore if that is what you end up having to use...and we can still find those special card readers.
Let's figure out exactly which model you have and then go from there.

I have updated my equipment and I am pretty sure I have the SD card so I will check to see if I need an adapter for the usb port. You sound very knowledgeable and I acknowledge you for all you have done for people like me. My question to you is: do you beleive Exercise food and stress and coffee can be factors in making your AHIs go up?

Pugsy · Post by **Pugsy** » Thu Sep 17, 2015 11:35 am

persistent wrote:My question to you is: do you beleive Exercise food and stress and coffee can be factors in making your AHIs go up?

My personal opinion...no in general but it also depends on what the AHI is composed up.
Especially with your System One machine...I think that stress and coffee can directly impact sleep quality and give you poor sleep quality as in poor sleep in general with a lot of wake ups which might cause the machine to flag awake breathing irregularities by mistake. These machines don't know if we are awake or not...they just monitor the breathing. I know that when I have a bad night for some reason and sleep poorly with frequent wake ups that my AHI might be a bit higher and it's usually Clear Airway (centrals) that are higher and I attribute it to awake/semi awake breathing getting flagged by mistake.

If the AHI is primarily obstructive in nature I don't think that those things make a huge difference except for maybe if the stress is from illness like a cold or something that is affecting the airway itself.

Wulfman... · Post by **Wulfman...** » Thu Sep 17, 2015 6:04 pm

persistent wrote:
Pugsy wrote:Exactly which model AFlex machine do you have? If you have a newer machine (2010 to present) probably one of the System One machines and Sleepyhead will work with them and you don't need anything special in terms of your computer to use it unless your computer doesn't have a slot for SD card in which case you just need a little adapter so you can use one of the USB ports.

If it is an older model ...M series or Legacy which is even older..you would need Encore software because Sleepyhead won't work with those older machines....and a special card reader is needed.

So does it have a regular SD card in the little slot or does it have the Encore Pro Smart Card which is about the size of a credit card?

I can help with Encore if that is what you end up having to use...and we can still find those special card readers.
Let's figure out exactly which model you have and then go from there.
I have updated my equipment and I am pretty sure I have the SD card so I will check to see if I need an adapter for the usb port. You sound very knowledgeable and I acknowledge you for all you have done for people like me. My question to you is: do you beleive Exercise food and stress and coffee can be factors in making your AHIs go up?

Problem is, we don't know what your machine settings are.
If you're using an APAP (Auto) in a range of pressures, that could be a/the problem. We don't sleep the same night after night and your breathing may vary considerably.......and some nights your machine may raise pressures if you have Flow Limitations or Snores, and some nights if you don't have them, the A/H events may occur before there is a chance for the machine to get to the pressure needed to prevent them.

Or, if you're using a straight pressure, it may not be sufficient to prevent events on some nights.

Den

.

persistent · Post by **persistent** » Thu Sep 17, 2015 7:56 pm

JDS74 wrote:Without data, it will be difficult to see what is going on. I found that even tiny amounts of caffeine caused my AHI to double. Other food items do the same thing as well.

Since you have a PR machine, I would suggest that you get and use both SleepyHead and Encore to use a tools to try and determine what is going on. It is very important to know in detail what apneic events are causing your AHI to be so erratic. From there, you can do further investigation to see if it is stress, food, sleep hygiene, mask leaks, etc. that is the trigger.

Best wishes.

Thanks for your input esp. about how food and coffee effects your AHIs. I have had some mask blow by at night and will the machine count that as an AHI?

persistent · Post by **persistent** » Thu Sep 17, 2015 8:09 pm

Pugsy wrote:
persistent wrote:My question to you is: do you beleive Exercise food and stress and coffee can be factors in making your AHIs go up?
My personal opinion...no in general but it also depends on what the AHI is composed up.
Especially with your System One machine...I think that stress and coffee can directly impact sleep quality and give you poor sleep quality as in poor sleep in general with a lot of wake ups which might cause the machine to flag awake breathing irregularities by mistake. These machines don't know if we are awake or not...they just monitor the breathing. I know that when I have a bad night for some reason and sleep poorly with frequent wake ups that my AHI might be a bit higher and it's usually Clear Airway (centrals) that are higher and I attribute it to awake/semi awake breathing getting flagged by mistake.

If the AHI is primarily obstructive in nature I don't think that those things make a huge difference except for maybe if the stress is from illness like a cold or something that is affecting the airway itself.

Thank you for your input and with limited knowledge I agree with you. I do wake up alot and get mask blowby. Could the machine count mask blowby as an AHI? Is it possible the machine can't detect the difference of air leak and an actual AHI? Last night I adjusted my mask tension and i went 6hrs with hardly no leak whatsoever and a AHI index under 5.

Pugsy · Post by **Pugsy** » Thu Sep 17, 2015 8:21 pm

I am not sure what you mean by "mask blow by". Are you talking about rapid big massive leak that wakes you up and is resolved quickly with a quick refitting of the mask?
The machine won't confuse a big leak with a cessation of breathing or a reduction in air flow and give you some sort of AHI event flag.

Now a big enough and prolonged enough leak can impact the machine's ability to respond, sense and report apnea events. That's why we like to confirm that we don't spend half the night in really big leak and nice low AHI...we don't know if nothing happened or the machine just couldn't sense anything because of big leak.

So if you are just doing a quick refit of the mask and the brief leak that may cause...no, there won't be any apnea event reported at that time of the refitting. All that is seen on the reports is a brief spike in leak rate.

Now if the leak is big enough it might compromise the therapy in a manner that allows the airway to collapse and you might get an event flag for that event but it was the leak that allowed the airway to collapse and the collapse that earns the flag and not the leak.

Wulfman... · Post by **Wulfman...** » Thu Sep 17, 2015 8:38 pm

Now that you've filled in this information, it is my suspicion as to your problems.

Additional Comments: pressure range 6-15

Too wide of a pressure range, minimum pressure is probably too low and your "mask blowby" is probably when it's getting to the higher pressures and your headgear isn't adjusted to be capable of handling the pressures.

Look at your reports and see what pressures you REALLY need to treat your events. Probably need to raise your minimum a bunch and maybe lower your maximum a bit.

Den

.

persistent · Post by **persistent** » Thu Sep 17, 2015 8:44 pm

Wulfman... wrote:Now that you've filled in this information, it is my suspicion as to your problems.

Additional Comments: pressure range 6-15

Too wide of a pressure range, minimum pressure is probably too low and your "mask blowby" is probably when it's getting to the higher pressures and your headgear isn't adjusted to be capable of handling the pressures.

Look at your reports and see what pressures you REALLY need to treat your events. Probably need to raise your minimum a bunch and maybe lower your maximum a bit.

Den

.

thanks Den after I download sleepytime and start getting data I will have a better idea what is going on.

Wulfman... · Post by **Wulfman...** » Thu Sep 17, 2015 8:51 pm

The software is actually "Sleepyhead"........not "Sleepytime".

Den

.

yaconsult · Post by **yaconsult** » Thu Sep 17, 2015 10:39 pm

Have hope - therapy often needs optimizing. Once we see some data from your machine, people can recommend the best settings for you. It can make a world of difference. For example, what works best for me is to have my minimum pressure set to 13 with my max at 20, but I have a severe non-cpap AHI of 80. The data will let us see what is happening when you sleep. USB card readers are available cheaply on amazon if none of your computers has an SD memory card reader - many laptops do.

It's good that you asked for help here. The cpap should be making a big difference in your life. If not, then some changes need to be made in settings, masks, machines, etc. If it's some other factor, it's likely that people can help you figure out what that is too, like medication, sleep hygiene, etc.

Install SleeyHead and get an SD card reader if you need one. Being able to see what happened overnight, breath-by-breath, is fascinating!

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