Suggestions for lowering my AHI?

slepr · Post by **slepr** » Sat Mar 17, 2007 2:40 pm

Hi,

I've been on xPAP since the end of January, it is making a positive difference. A lot has to do with the great folks on this board sharing information.

I would like to get my AHI lower and would appreciate suggestions on how I might accomplish that. I see folks who are down below one! Well, even getting below 5 would be a gain for me. I was thinking of reducing the OAI at the expense of raising the HI (thinking HI was less problematic than the OAI health-wise). It is a bit daunting all the variables. My doctor was clueless about Sleep Apnea (but willing to learn). The sleep doctor who did my report just suggested the 'standard' fluff stuff that has been mentioned by others (get to be early, reduce leaks, blah blah blah).

Here are some of the details:

I was titrated at 7 cm H2O (my pre-xPAP AHI was around 20). During the sleep study my AHI was reduced to 7.
No indication of any centrals
My machine is set at 6->9.5. C-Flex at 2. I've not tried straight CPAP yet.
I'm a back sleeper, very little side/stomach.
Leaks under control. Got the Opus working well and really like it (Swift works for me too).

Thanks in advance for reading this note, and any suggestions.
Mike

Here are some graphs from the past week.

Linda3032 · Post by **Linda3032** » Sat Mar 17, 2007 2:57 pm

Hi, I will offer a few suggestions, but I'm sure the others can offer some better ones.

It looks to me like 9 is a good pressure for you. It seems all the numbers are lower at 9. So, you might try straight cpap at 9 for a week.

Also, have you played with c-flex? You might see how you do on 1 or even off -- if it's still comfortable for you without swallowing air.

Linda3032 · Post by **Linda3032** » Sat Mar 17, 2007 3:26 pm

Your Full Details of Encore Pro reports, the next to the last page "Summary of Daily Details" tells you exactly what apneas occurred at what pressures. Can you print and attach that here for everyone to see?

Also, how are your leaks?

slepr · Post by **slepr** » Sat Mar 17, 2007 5:08 pm

Here goes:

Thanks

Linda3032 · Post by **Linda3032** » Sat Mar 17, 2007 5:16 pm

Ya, that's what I'm talkin about.

I'm not good at reading charts, so I find this to be one of my most informative reports. I like it because with an Auto, it shows at what pressure the apneas occurred and how many.

Again, how are the leaks? Leaks could be messing up your numbers.

You can see that the higher your pressure, the more OA's you have. While the lower numbers have more HIs -- typical. So, I would guess it's better to have the HIs than the OAs. But let's hear from some of the forum experts.

slepr · Post by **slepr** » Sat Mar 17, 2007 5:23 pm

Linda,

>>You can see that the higher your pressure, the more OA's you have. While the lower numbers have more HIs -- typical. <<

OK, I didn't realize that was typical. Good information.

I also have the impression that it is better (and I mean a 'relative better') to have HI vs. OAI. Thinking that the HI is at least a partial flow of air.

Thanks again,

Mike

Linda3032 · Post by **Linda3032** » Sat Mar 17, 2007 5:30 pm

I think I mis-wrote. The typical part was only for the HIs -- I don't know about the OAs.

It does seem to me that you should have a sweet spot where both numbers are lower and I don't see it. That's why I asked you about leaks. But I really don't count myself as being very knowledgeable on reading and interpreting the numbers. I think it's a "guy" thing. ....

slepr · Post by **slepr** » Sat Mar 17, 2007 5:33 pm

OK, got it.

Leaks are under control so I feel pretty good there. Yep, I'm not sure either, it seems the OAI/HI diverge rather than come together at some pressure.

Thanks again.

DreamStalker · Post by **DreamStalker** » Sat Mar 17, 2007 5:51 pm

I agree with Linda based on the data you have so far (although only a weeks worth).

To read your AHI vs Pressure chart ... look for where the AHI curve forms a "U" shape and read the pressure where the bottom of the "U" is lowest ... that is about 9 cm.

Your HI bottoms out around 9.2 cm and then starts to gradually rise again with increasing pressure. Your OAI however continues to rise with increasing pressure. Someone like Snoredog, RG, or SAG, or otehrs would need to check out your plot … but this may be indicating that you are sensitive to central apneas with increased pressure … but I’m not knowledgeable enough about this stuff as others are. Did your sleep study indicate CAs? You may also be a candidate for CPAP rather than APAP?

Anyway, I’m certain this thread will get a lot of activity over the next day or two.

Best of luck!

Rabid1 · Post by **Rabid1** » Sat Mar 17, 2007 6:13 pm

Based on your charts, I totally disagree with the above advice!

Your lowest AHI appears below your titrated pressure at 6 cm.

Your OA's rise sharply with increased pressure, which is something someone more informed that I may be able to explain. You are having no non-responsive (central) apneas, so that is not an obvious concern. At a pressure of 9 cm, however, you are getting close to 5 OA's, which is too many.

It could be there's something that's making your auto "chase" what it conceives to be an event. At any rate, if it were me, I'd try CPAP at 6 cm.

Rick

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CPAPopedia Keywords Contained In This Post (Click For Definition): AHI

rested gal · Post by **rested gal** » Sat Mar 17, 2007 6:18 pm

I guess everyone has his/her favorite graph or chart to look at. The only one I look at when I'm checking my results is the graph (not posted so far) called "Sleep Therapy Daily Details" in Encore Pro. I never even glance at the "Daily Events Per Hour" table.

I'm no doctor, but I think if it were me I'd set the autopap for a range of 8 - 15 for awhile to see how that goes.

I'd also try it for a few nights in cpap mode at 9.

Rabid1 · Post by **Rabid1** » Sat Mar 17, 2007 6:27 pm

rested gal wrote:I guess everyone has his/her favorite graph or chart to look at. The only one I look at when I'm checking my results is the graph (not posted so far) called "Sleep Therapy Daily Details" in Encore Pro. I never even glance at the "Daily Events Per Hour" table.

I'm no doctor, but I think if it were me I'd set the autopap for a range of 8 - 15 for awhile to see how that goes.

I'd also try it for a few nights in cpap mode at 9.

There's a first time for everything! I actually disagree with RG!!!!

9 is NOT, I repeat, NOT the sweet spot. Basically at that pressure, as opposed to 6, you're trading a little under 5 hypopneas for a little under 5 obstructive apneas. That's not a good trade IMHO.

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DreamStalker · Post by **DreamStalker** » Sat Mar 17, 2007 6:36 pm

I agree with RG ... try and post your detailed charts for more detailed info of what is happening during your sleep sessions.

Rabid1 · Post by **Rabid1** » Sat Mar 17, 2007 6:42 pm

DreamStalker wrote:I agree with RG ... try and post your detailed charts for more detailed info of what is happening during your sleep sessions.

Roberto,

What's your logic? Am I missing something?

NightHawkeye · Post by **NightHawkeye** » Sat Mar 17, 2007 7:48 pm

Rabid1 wrote: Am I missing something?

Actually, yes. The lower pressures show fewer apneas because slepr doesn't have constant apnea while sleeping. The APAP doesn't raise pressure until it senses a need for higher pressure. It isn't unusual for an APAP to dwell at a low pressure for hours at a time for some of us. That doesn't happen for everyone, of course, but I see it in my own data all the time, and I presume that's what is happening with slepr.

Based only on the data presented so far, the sweet spot for slepr is indeed around 9 cm and, based on existing data, it looks like he should be able to achieve an overall AHI under 5.0. But, if I were slepr I'd continue to collect data in APAP mode for a while yet. Might want to bring the low end up a little. Also, I'd be suspicious of the apneas showing up at the highest pressure. Those could be centrals. It might be that slepr will need to restrict the upper range to avoid them.

Just my gender biased $0.02 of chart interpretation.

Regards,
Bill