need suggestions to lower AHI

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 9:44 am

Hi everyone! I got Oscar downloaded and took screen shots of my reports. Does anyone have suggestions on how to lower AHI? Tweak settings?

I'm using: Resmed Bipap AirCurve 10 vauto and Resmed F20 full face mask. Attached are my screen shots of the data. The last 2.5ish hours I was awakes the numbers were likely skewed somewhat. I am a newbie and don't really know where to start in terms of tweaking any settings to improve the AHI. Thanks!

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 9:48 am

: Screen Shot 2021-06-13 at 11.38.15 AM.png (649.58 KiB) Viewed 693 times

Sorry, there is one more attachment for original post.

: Screen Shot 2021-06-13 at 11.38.15 AM.png (649.58 KiB) Viewed 693 times

Miss Emerita · Post by **Miss Emerita** » Sun Jun 13, 2021 9:59 am

A couple of questions. Have you talked with your doctor about your high AHI? Why did your doctor move you to a VAuto, and why is your pressure support at 6?

Could you repost your daily chart, showing the side panel, including the information at the top about your settings, and these graphs:

Events
Flow rate
Pressure (not mask pressure)
Leaks
Snores
Flow limitations.

No need to show other graphs at this time. Please squeeze these into one screenshot by grabbing the horizontal gray bars that separate the graphs and pushing them up a little.

Pugsy · Post by **Pugsy** » Sun Jun 13, 2021 10:06 am

Are you comfortable with changing the settings on your machine yourself?
Some significant changes are need to have any chance to help you reduce the AHI.

You have omitted needed information from your screen shot and included information that is not needed and made more work for yourself.
See this thread for the formatting we like to see.
viewtopic/t158560/How-to-post-images-for-review.html

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 10:31 am

Yes, I am comfortable changing settings. All I want is to get better. I think I provided the needed info this time. Thanks.

Resmed Aircurve 10 vauto with full face mask Resmed F20

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 10:33 am

Leak rate is no longer an issue with the Resmed full face F20 mask. I have allergies, nasal congestion, and very mild allergy induced asthma.

Pugsy · Post by **Pugsy** » Sun Jun 13, 2021 10:40 am

Change PS from 6 down to 4.

Change the minimum of 4 to 8 (for now anyway...I suspect you will need more but I think 4 to 8 is a chunk to adapt to as it is so lets start with modest increase).

Change the maximum to 25....the machine won't go there if it doesn't need to but you are maxing out for prolonged periods with the current maximum as it is. It wants to go higher....lets see just how high and what happens when it does.

This won't likely be a quick fix but just a start.
But gotta start somewhere.

PS of 4 is a more "normally" used setting ....PS of 6 can cause some hyperventilation feelings in some people and I don't like to see it unless there is real physical need for it in terms of lung volume issue. I think going to 4 will be more comfortable for you.

So we back up and start with more "normal" settings and see what happens.

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 11:09 am

With numbers like there, do you think I'd do better with a straight CPAP setting?

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 11:10 am

Pugsy wrote: ↑
Sun Jun 13, 2021 10:40 am
Change PS from 6 down to 4.

Change the minimum of 4 to 8 (for now anyway...I suspect you will need more but I think 4 to 8 is a chunk to adapt to as it is so lets start with modest increase).

Change the maximum to 25....the machine won't go there if it doesn't need to but you are maxing out for prolonged periods with the current maximum as it is. It wants to go higher....lets see just how high and what happens when it does.

This won't likely be a quick fix but just a start.
But gotta start somewhere.

PS of 4 is a more "normally" used setting ....PS of 6 can cause some hyperventilation feelings in some people and I don't like to see it unless there is real physical need for it in terms of lung volume issue. I think going to 4 will be more comfortable for you.

So we back up and start with more "normal" settings and see what happens.

With numbers like these, do you think I'd do better with CPAP instead of Bipap?

Pugsy · Post by **Pugsy** » Sun Jun 13, 2021 12:15 pm

1speechpick wrote: ↑
Sun Jun 13, 2021 11:09 am
With numbers like there, do you think I'd do better with a straight CPAP setting?

Actually I think bilevel is probably your best option for several reasons.
Number one...the bilevel you were given is really a cpap/apap on steroids...it really works/functions like cpap/apap but with more options available to you to help you out. It's the machine that I use myself simply because I like it better.

Number two...
You are likely going to need pressures in the mid teens to hold your airway open and prevent the airway from collapsing.
Pressures in the mid teens can be extremely difficult for some people to exhale against and the bilevel machine has a wider range for exhale relief than the cpap/apap machines have.
While we might have been able to get the job done with the AutoSet for Her that you had....it wasn't a given and we didn't have data to even see what was happening. That AutoSet could only go to 20 cm and you might need more than 20 cm to hold your airway open.
The AutoSet exhale relief was limited to 3 cm...your bilevel machine isn't limited. Think of PS (pressure support) as EPR or exhale relief and the difference between inhale and exhale is what makes it more comfortable.
3 cm difference (max EPR) is good but sometimes for some people 4 or 5 cm difference is much better.
More comfortable and when we are more comfortable we tend to sleep better and sleeping better is one of our primary goals here.
Without sleep not much matters does it?

The auto adjusting algorithms pretty much work the same between the AutoSet and the VAuto. So it's not like there is a huge difference in that regards.
Now if we were talking about the other types of bilevels machines that are more high end and target specific issues beyond just plain obstructive sleep apnea we would have a different discussion.

I actually think it would be nice if everyone was given a bilevel machine that could auto adjust (like your VAuto) and then almost all the bases are covered that often pop up as some sort of problem.
I have used both models and while I can do good on the AutoSet with 3 cm exhale....I simply do better with 4 cm. I sleep better.
I have prolonged experience with both.
People might not need all the features bilevel offers but it doesn't hurt a thing to have something and not need it or use it.
It would suck if someone needed 4 cm exhale relief for them to be comfortable exhaling so they could more easily fall asleep and stay asleep and not have it available on the AutoSet. Is it a deal breaker for everyone? Of course not but it matters hugely if it matters to you.

And I don't know about you but the main person I want to make happy is myself.

Could we have dealt with your higher AHI with the AutoSet.....probably but we didn't get a chance to try and if you are one of the people needing more than 20 cm pressure....it wouldn't have ever worked out well for you because of that limitation alone.

Be happy with the VAuto....it's a great machine...there's a reason it is my primary machine and my AutoSet for Her is my back up machine. I would love to have another VAuto as backup but I don't ever need pressures over 20 cm and to be honest....the cost was a huge factor for me. I found a screaming hot deal (cheap) on a low hour AutoSet for Her and the VAuto deal was twice the price and at the time I was shopping for a back up machine....money was tight.

1speechpick · Post by **1speechpick** » Sun Jun 13, 2021 12:41 pm

Pugsy wrote: ↑
Sun Jun 13, 2021 12:15 pm

1speechpick wrote: ↑
Sun Jun 13, 2021 11:09 am
With numbers like there, do you think I'd do better with a straight CPAP setting?
Actually I think bilevel is probably your best option for several reasons.
Number one...the bilevel you were given is really a cpap/apap on steroids...it really works/functions like cpap/apap but with more options available to you to help you out. It's the machine that I use myself simply because I like it better.

Number two...
You are likely going to need pressures in the mid teens to hold your airway open and prevent the airway from collapsing.
Pressures in the mid teens can be extremely difficult for some people to exhale against and the bilevel machine has a wider range for exhale relief than the cpap/apap machines have.
While we might have been able to get the job done with the AutoSet for Her that you had....it wasn't a given and we didn't have data to even see what was happening. That AutoSet could only go to 20 cm and you might need more than 20 cm to hold your airway open.
The AutoSet exhale relief was limited to 3 cm...your bilevel machine isn't limited. Think of PS (pressure support) as EPR or exhale relief and the difference between inhale and exhale is what makes it more comfortable.
3 cm difference (max EPR) is good but sometimes for some people 4 or 5 cm difference is much better.
More comfortable and when we are more comfortable we tend to sleep better and sleeping better is one of our primary goals here.
Without sleep not much matters does it?

The auto adjusting algorithms pretty much work the same between the AutoSet and the VAuto. So it's not like there is a huge difference in that regards.
Now if we were talking about the other types of bilevels machines that are more high end and target specific issues beyond just plain obstructive sleep apnea we would have a different discussion.

I actually think it would be nice if everyone was given a bilevel machine that could auto adjust (like your VAuto) and then almost all the bases are covered that often pop up as some sort of problem.
I have used both models and while I can do good on the AutoSet with 3 cm exhale....I simply do better with 4 cm. I sleep better.
I have prolonged experience with both.
People might not need all the features bilevel offers but it doesn't hurt a thing to have something and not need it or use it.
It would suck if someone needed 4 cm exhale relief for them to be comfortable exhaling so they could more easily fall asleep and stay asleep and not have it available on the AutoSet. Is it a deal breaker for everyone? Of course not but it matters hugely if it matters to you. And I don't know about you but the main person I want to make happy is myself.

Could we have dealt with your higher AHI with the AutoSet.....probably but we didn't get a chance to try and if you are one of the people needing more than 20 cm pressure....it wouldn't have ever worked out well for you because of that limitation alone.

Be happy with the VAuto....it's a great machine...there's a reason it is my primary machine and my AutoSet for Her is my back up machine. I would love to have another VAuto as backup but I don't ever need pressures over 20 cm and to be honest....the cost was a huge factor for me. I found a screaming hot deal (cheap) on a low hour AutoSet for Her and the VAuto deal was twice the price and at the time I was shopping for a back up machine....money was tight.

Thanks so much!! All these details really help a newbie, like myself. My PS is set to level 5. Is level 4 PS more comfortable for most (even with very mild asthma)?

Pugsy · Post by **Pugsy** » Sun Jun 13, 2021 12:56 pm

1speechpick wrote: ↑
Sun Jun 13, 2021 12:41 pm
My PS is set to level 5. Is level 4 PS more comfortable for most (even with very mild asthma)?

According to the report above your PS is set to 6 and not 5.

You need more minimum EPAP (exhale pressure) and if we increase that minimum then your inhale pressure would be quite high with the PS of 6 and could potentially cause some unstable breathing issues. Not a for sure thing but a potential and definitely for sure simply uncomfortable from that aspect of things.

If you were to have an in lab titration sleep study....the chances that you would come out of it with PS of 4 (maybe 5) would be high because that is what works well for most people. Once we start going over 5 PS (unless there is a medical need) we can run into trouble with unstable breathing. I wanted to avoid that chance and give you settings that "most" people do well with and start from there.
Gotta start somewhere and it might as well be with "what most people do well with".

I have used PS of 6 myself to try it...I found it uncomfortable...didn't like it. Too big of a swing and made me feel like I was breathing too fast or hyperventilating.
Some people do well with it but not me.

1speechpick · Post by **1speechpick** » Mon Jun 14, 2021 7:42 am

Good morning! I had a titration study done last Friday. Preliminary results indicate Cpap and Auto Bipap did not control the apneas, and I still had desaturations. Apparently I needed an "ST Bipap machine", and will likely need night-time supplemental oxygen.

I have no idea what an "ST bipap machine" is and how that differs from AirCurve auto bipap. Any insight is greatly appreciated.

Pugsy · Post by **Pugsy** » Mon Jun 14, 2021 7:48 am

1speechpick wrote: ↑
Mon Jun 14, 2021 7:42 am
Good morning! I had a titration study done last Friday. Preliminary results indicate Cpap and Auto Bipap did not control the apneas, and I still had desaturations. Apparently I needed an "ST Bipap machine", and will likely need night-time supplemental oxygen.

I have no idea what an "ST bipap machine" is and how that differs from AirCurve auto bipap. Any insight is greatly appreciated.

ST models are bilevel machines that have a timed breath feature that will force you to breathe if you aren't breathing enough on your own.
They won't/can't auto adjust in response to variations in obstructive apneas.
It is a fixed pressure (bilevel) but with a feature that will regulate and force you to breathe...which is a feature the AirCurve 10 VAuto does NOT have.

ST....short for Sustained Timed and it relates to breaths. It is considered a non invasive ventilator since it actually will force you to breathe.

1speechpick · Post by **1speechpick** » Mon Jun 14, 2021 8:08 am

Pugsy wrote: ↑
Mon Jun 14, 2021 7:48 am

1speechpick wrote: ↑
Mon Jun 14, 2021 7:42 am
Good morning! I had a titration study done last Friday. Preliminary results indicate Cpap and Auto Bipap did not control the apneas, and I still had desaturations. Apparently I needed an "ST Bipap machine", and will likely need night-time supplemental oxygen.

I have no idea what an "ST bipap machine" is and how that differs from AirCurve auto bipap. Any insight is greatly appreciated.
ST models are bilevel machines that have a timed breath feature that will force you to breathe if you aren't breathing enough on your own.
They won't/can't auto adjust in response to variations in obstructive apneas.
It is a fixed pressure (bilevel) but with a feature that will regulate and force you to breathe...which is a feature the AirCurve 10 VAuto does NOT have.

ST....short for Sustained Timed and it relates to breaths. It is considered a non invasive ventilator since it actually will force you to breathe.

Thank you for the information!

Are there bipap machines that have the ST option and an auto option all in the same machines (obviously not able to use both modes at the same time).

need suggestions to lower AHI

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