AHI still needs work - update

After posting sleepyhead results on July 25, I have been slowly increasing both min (6) and max (12) pressures until I am currently at min 11 - max 16.

Increasing max and min pressures has brought my AHI pretty consistently under 5, with only a few instances higher. However, what I am not seeing is the wonderful low AHI results many of the members here enjoy.

I have had 3 days under 2 AHI, but in general my AHI seems to run +/-3.

On August 25 I had 6.2 AHI and last night 4.5

last night -

Aug 25 -

statistics

Things I have noticed/tried:

The system rarely goes to the highest pressure - at any setting.

When I increased the minimum pressure to 11, I couldn't hold the air in. The pressure opened my lips. So for the last 3 nights, I have taped them closed.
I have tried a cervical collar, but for some reason, that caused me to swallow tons of air.

I typically have an issue with insomnia, but lately, with a lot of work, it has been better.


At this point, I don't know what to do to improve my results and was wondering if anyone here has suggestions for improvement.

Any way you can get your hands on a ResMed AirSense 10 AutoSet for Her preferably and if not at least the AutoSet?

Your results aren't horrible by any means. Far from it in fact. We all have nights where things go to hell for unknown reasons.
A couple of weeks ago I had a night where the AHI was 10.3 and the night before and after it the AHI was less than 1.0. I am still scratching my head over that one.

How are you sleeping and feeling? If you couldn't see the numbers to cloud your perception of how you are sleeping and feeling...what might you say?

Thought about maybe trying another increase in the minimum (this is the most critical setting) by 0.5 cm?????

Thanks I'll try the min increase.

I am hoping, when I see the sleep doctor next month, he will prescribe the Air Sense for her. Until then I am stuck with the current rental. It's a free rental, so I guess I can't complain too much.

I could feel better. My energy has increased over the 2+ months on xPAP, so it's definitely positive, but I still feel a little bit punched in the morning.

My sleep isn't as solid as it was prior to XPAP. I wake up to sounds in the house now. Cats get restless a few minutes before the alarm. I wake up. Previously they did CPR on me and I slept through it. Last night was the first dream I remember since starting XPAP.

Here is last night's SleepHead. It is worse again. I am at a loss to understand why. I had a cluster of 8 or so at 4:30 and I spent a lot of the night swallowing air.

Clusters of anything (except maybe centrals) happen because the pressure needed to hold the airway open isn't optimal.
Either the machine can't get to where it needs to be quickly enough or it doesn't try because something is missing to trigger the algorithm for pressure increasing.

The 2 most common suspects for needing more pressure when obviously it has been working well right before the clusters..
REM stage sleep pressure needs
Supine sleeping pressure needs
maybe a combination of both.
With either it is quite common for our OSA to worsen and/or need more pressure to get the job done.
A look at your sleep study results should shed some light on if these 2 common culprits are the cause.

Mine happens to be REM sleep...Sleep study showed 12 AHI in Non REM but 53 AHI in REM....doesn't take a rocket scientist to see that if I have clusters happen the chances are really great that it likely is REM related. When I was using the Respironics apap I would often see the pressure go from 12 to 18 for the REM clusters and I had to help it out with using 10 cm REM....because 8 or 9 minimum was still giving me fairly dense clustering.
Supine sleeping hasn't ever been that big of a deal for me...tried some experiments and end result was that supine sleeping for me didn't make much difference in pressure needs...now some people it makes a huge difference. I know one person who needed 18 cm when on his back and only 8 or 9 when on his side.

Pretty simple really...fixing it not always so simple. More pressure can create aerophagia issues in some people...and for some even centrals (but that's really not as common as people might think).

Your issues with the aerophagia and the Respironics algorithm and your apparent pressure needs...along with what I have discovered about the ResMed apap algorithm....I really, really hope you can try a ResMed AutoSet of some sort. I think you are a prime candidate for someone who would do better with the ResMed algorithm.

One thing to try maybe....increase Flex to 3 in an effort to create more of a bilevel situation which is normally the next step when people have significant aerophagia issues and need more pressure.
It's not perfect but the reduction available at the setting of 3 is a little more than what you are getting at the setting of 1.
So it becomes a little bit more like a bilevel machine...not as much as you probably need but something to at least try.
Assuming that you are okay with the setting of 3...if you don't like it...don't try it.

Okay, thanks for your help. I really appreciate it. I will change to 3 tonight and see what happens.

Over many nights I have looked at the results and wondered why the machine was so slow to respond. I am very hopeful for the new machine. Just have to wait a few more weeks for that. Waiting sucks, but then we are getting major family visit(s) over the next while, so I'll otherwise occupied.