Please Help! AHI high after 30 days

hdclassic4466 · Post by **hdclassic4466** » Sat Apr 28, 2018 11:00 am

Hi, I'm a new user. 30 days use and I feel worse now than before I got my machine. So exhausted, feel like I'm in a fog, etc. Background, 43 year old male. Diagnosed in Dec. 2017 with OSA after a home sleep study. I believe my AHI was 21 from the sleep study. I am using a Respironics DreamStation, auto CPAP. Min pressure 4 and Max set at 20. Dreamwear nasal application headgear. I've downloaded my data to Sleepy Head and DreamMapper.....but not sure how to read it. I get avg. use of CPAP per night 7.3 hours and avg. leak rate of .23 so the mask isn't leaking. Just last night, I upped the minimum pressure to 7 but only slept with the CPAP about 3.9 hours cause was woken up by the dog and couldn't get back to sleep. Last night AHI was 12.37. I consulted my Dr. after a week of use because of high AHI's, felt horrible, etc. and they said give it time and did nothing. Now it's been 30 days and I'm about to put this thing on the shelf in the closet! I can tell I'm going to have to figure this out on my own (or with your help please). Any help or suggestions is appreciated. Thank You.

hdclassic4466 · Post by **hdclassic4466** » Sat Apr 28, 2018 11:56 am

Looking for suggestions, help before I put the machine in the closet. I'm a new user, 30 days in. My AHI score from sleep study was 21. I've attached what typical night looks like for me. I've avg. AHI for 30 days of 9.67. Avg. use hours is 7:33 hours. Leak Rate avg is .23 I have a Dreamstation Auto CPAP and Dreamware Headgear with nasal cushion. I feel worse than before I started cpap. Very Exhausted, tired and in a fog every day.

: Sleepyhead screen capture 1.PNG (120.68 KiB) Viewed 2796 times

: sleepy head data 2.PNG (108.42 KiB) Viewed 2796 times

DavidY · Post by **DavidY** » Sat Apr 28, 2018 5:57 pm

IMO, I would first change the pressure range from 4 to 20 to 7 to 12 cmH20 and see what the SH charts look like again after several days to a week.

Keep at it...I am 3 months into CPAP. Just starting to feel a lift of the fog that I have been in. From the beginning, my AHI has been less than 5 (OSA is treated If less than 5)...averaging between 2 and 3 at the beginning...now averaging under 2.

Dave

palerider · Post by **palerider** » Sat Apr 28, 2018 6:19 pm

DavidY wrote: ↑
Sat Apr 28, 2018 5:57 pm
IMO, I would first change the pressure range from 4 to 20 to 7 to 12

There's absolutely no reason to change the max pressure from 20.

Julie · Post by **Julie** » Sat Apr 28, 2018 6:24 pm

Agreed, but do raise the min. setting to e.g. 7 because it's too low to be effective (or anything else).

palerider · Post by **palerider** » Sat Apr 28, 2018 6:31 pm

Yes, a higher minimum will help, may need more than 7, but a little time will tell.

DavidY · Post by **DavidY** » Sat Apr 28, 2018 7:00 pm

Why leave the max at 20 when SH reported max of 10.x?

When I raised my max from 16 to 18, my centrals increased notably.

Dave

hdclassic4466 · Post by **hdclassic4466** » Sat Apr 28, 2018 7:51 pm

I appreciate the comments and will raise the minimum to 7 or 8 tonight and see how that does? Anybody see anything else I need to look out for in the data I posted? Thanks again.

Pugsy · Post by **Pugsy** » Sat Apr 28, 2018 8:34 pm

DavidY wrote: ↑
Sat Apr 28, 2018 7:00 pm
When I raised my max from 16 to 18, my centrals increased notably.

Don't assume that higher pressures will cause centrals in everyone.
I have seen pressures exceeding 20 cm routine and no increase in centrals. Not everyone will have centrals pop up because of cpap pressures and it doesn't have to be higher pressures but people seem to think that higher equals centrals and that doesn't necessarily mean it will or that it will for the majority of the people.

I have seen centrals happens for pressures as low as 6 cm just as often as at higher pressures. It's a relatively small percentage of cpap users who will have centrals develop because of cpap pressures...low or high.

Whether or not your centrals were a result of your pressures...doesn't matter because it's irrelevant to the next person.

The maximum pressure setting is a moot point if the machine never goes anywhere near the max.
Just because it can go somewhere doesn't mean it will and doesn't affect anything at all if it never goes there.
If the machine never goes over 10 cm...doesn't matter what the max is set at. Doesn't change the response or the results. If the machine could go to 100 it wouldn't hurt a thing to set it at 100...it still will only go where it feels the need and if it doesn't want to go above 10 then it still won't go above 10 and therapy is unchanged.

Limiting the max becomes useful when going higher causes problems...like aerophagia or centrals or arousals from changing pressures.
Otherwise there is no real need to limit the max if it isn't causing a problem.

DavidY · Post by **DavidY** » Sat Apr 28, 2018 8:53 pm

Pugsy wrote: ↑
Sat Apr 28, 2018 8:34 pm

DavidY wrote: ↑
Sat Apr 28, 2018 7:00 pm
When I raised my max from 16 to 18, my centrals increased notably.
Don't assume that higher pressures will cause centrals in everyone.
I have seen pressures exceeding 20 cm routine and no increase in centrals. Not everyone will have centrals pop up because of cpap pressures and it doesn't have to be higher pressures but people seem to think that higher equals centrals and that doesn't necessarily mean it will or that it will for the majority of the people.

I have seen centrals happens for pressures as low as 6 cm just as often as at higher pressures. It's a relatively small percentage of cpap users who will have centrals develop because of cpap pressures...low or high.

Whether or not your centrals were a result of your pressures...doesn't matter because it's irrelevant to the next person.

The maximum pressure setting is a moot point if the machine never goes anywhere near the max.
Just because it can go somewhere doesn't mean it will and doesn't affect anything at all if it never goes there.
If the machine never goes over 10 cm...doesn't matter what the max is set at. Doesn't change the response or the results. If the machine could go to 100 it wouldn't hurt a thing to set it at 100...it still will only go where it feels the need and if it doesn't want to go above 10 then it still won't go above 10 and therapy is unchanged.

Limiting the max becomes useful when going higher causes problems...like aerophagia or centrals or arousals from changing pressures.
Otherwise there is no real need to limit the max if it isn't causing a problem.

OP is still tinkering. Personally, I would still drop the max down a bit to see if the centrals decrease accordingly.

Dave

Goofproof · Post by **Goofproof** » Sat Apr 28, 2018 9:07 pm

If XPAPs went to 40 cm we would still have doctors and people setting their machines to the MAX.

It makes no sense to allow your XPAP setting higher than needed by your worse apnea event, maybe 2 cm over MAX needed pressure. Use the software, set it in the range you need.

If you had speed control on your car turned on, would you set it to 120 MPH in the city? Some would! Jim

Pugsy · Post by **Pugsy** » Sat Apr 28, 2018 9:12 pm

I don't like making multiple changes unless urgently needed.
Those centrals could be awake/semi awake SWJ centrals and not real....they also could be post arousal SWJ centrals because the obstructive apneas aren't being well treated or prevented.

What I would do is increase the minimum and see if the OAs reduce...and see if the centrals mybe reduce because the chances of SWJ centrals reduce them.
There's actually more of a chance of those centrals being SWJ or post arousal centrals or even from the flex exhale relief than it is from the pressures being used.
The centrals are happening at pressures around 8.5 to 9.0...the machine isn't going higher anyway. Reducing the max isn't going to stop it from going to 9 and if the pressure of 9 is the trigger...going to have to be a lot lower max than 12.

Fix what is obviously needing to be fixed first and that's the OA situation and the minimum pressure and then see what's left that needs to be fixed.

Pugsy · Post by **Pugsy** » Sat Apr 28, 2018 9:14 pm

Question for the OP...

Are you waking often during the night and spending a lot of time awake with mask on?

Do you take any medications of any kind and if so, what?

Can you get me a screen shot of the overview usage graphs? Need to see usage for last 30 days especially hours of use.

TedVPAP · Post by **TedVPAP** » Sat Apr 28, 2018 9:34 pm

DavidY wrote: ↑
Sat Apr 28, 2018 8:53 pm

Pugsy wrote: ↑
Sat Apr 28, 2018 8:34 pm

DavidY wrote: ↑
Sat Apr 28, 2018 7:00 pm
When I raised my max from 16 to 18, my centrals increased notably.
Don't assume that higher pressures will cause centrals in everyone.
I have seen pressures exceeding 20 cm routine and no increase in centrals. Not everyone will have centrals pop up because of cpap pressures and it doesn't have to be higher pressures but people seem to think that higher equals centrals and that doesn't necessarily mean it will or that it will for the majority of the people.

I have seen centrals happens for pressures as low as 6 cm just as often as at higher pressures. It's a relatively small percentage of cpap users who will have centrals develop because of cpap pressures...low or high.

Whether or not your centrals were a result of your pressures...doesn't matter because it's irrelevant to the next person.

The maximum pressure setting is a moot point if the machine never goes anywhere near the max.
Just because it can go somewhere doesn't mean it will and doesn't affect anything at all if it never goes there.
If the machine never goes over 10 cm...doesn't matter what the max is set at. Doesn't change the response or the results. If the machine could go to 100 it wouldn't hurt a thing to set it at 100...it still will only go where it feels the need and if it doesn't want to go above 10 then it still won't go above 10 and therapy is unchanged.

Limiting the max becomes useful when going higher causes problems...like aerophagia or centrals or arousals from changing pressures.
Otherwise there is no real need to limit the max if it isn't causing a problem.
OP is still tinkering. Personally, I would still drop the max down a bit to see if the centrals decrease accordingly.

Dave

You are missing the point. Since the pressure does not seem to go above 12, it doesn't matter if the max is set to 20 or 15. Changing the upper limit as you suggest will make no difference to the OP since the upper limit is not being reached.

palerider · Post by **palerider** » Sun Apr 29, 2018 1:42 am

DavidY wrote: ↑
Sat Apr 28, 2018 8:53 pm
Pugsy wrote: ↑
Sat Apr 28, 2018 8:34 pm
Limiting the max becomes useful when going higher causes problems...like aerophagia or centrals or arousals from changing pressures.
Otherwise there is no real need to limit the max if it isn't causing a problem.
OP is still tinkering. Personally, I would still drop the max down a bit to see if the centrals decrease accordingly.

I always love how people with no experience, who're just starting out, barely figuring out their own shit, think they know better than people that have *years* of experience helping others.

Learn, don't argue.

There's *no* reason to lower the max, as you pointed out, the person's high pressure isn't even going close to it, but if you limit it now, they may need it later, and end up having more events than if you'd avoiding giving poor advice in the first place.

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Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days

Re: Please Help! AHI high after 30 days