Questions about AHI

I've been a cpap user for a few years now and I've used the Transcend 365 as my main machine since I've started (now on my second machine).

When I did the at home sleep study, they said my AHI was 48 - so very severe. Since using the machine, I now average about 4.46. That said, it doesn't really seem to drop any more than that, and I don't really feel a difference in my daily fatigue, even though the AHI is considerably better with the machine than without.

For masks, I started with the Airtouch F20, however, the foam broke down on it super fast so I'd get leaks.

Recently, I switched to the F&P Evora, and it definitely seems to have a better seal, however, I wake up with a sore nose. Which is fine if it's working as it should.

The pressure on the machine is set to 0-20 and my average is just under 7. Because of the machine I use, I don't believe I can plug it into any software like Sleepyhead, but it has a small screen on it which provides me with basic data which can be broken down by day, week, 30 days, 90 days, etc.

I've seen folks say getting to an AHI of 1 or under can be life changing for some people in terms of how they feel, so I'm now in the pursuit of this and because I feel constantly fatigued, I feel I should aim for it.

I should also say that I did stop using the machine for a few months, and just picked it back up again, with the new mask. Should the AHI go down over time with consistent use?

Thanks for all your help and ideas. - WoolyJ

WoolyJ wrote: ↑

Thu Nov 03, 2022 12:43 pm

I've been a cpap user for a few years now and I've used the Transcend 365 as my main machine since I've started (now on my second machine).

welcome to the zoo. as you've gleaned, the machine is going to be a bit of a challenge as it won't work with tracking software favored by the forum. or really any that i know of.

The pressure on the machine is set to 0-20 and my average is just under 7. Because of the machine I use, I don't believe I can plug it into any software like Sleepyhead, but it has a small screen on it which provides me with basic data which can be broken down by day, week, 30 days, 90 days, etc.

are you sure it's set at 0 as the minimum and not 4 or 5 or such? also, do you have the ability to change the pressure on your machine?

what exactly does that data break down to? ahi is comprised of many events. it's the events that will help the folk here to help with any suggestions.

I've seen folks say getting to an AHI of 1 or under can be life changing for some people in terms of how they feel, so I'm now in the pursuit of this and because I feel constantly fatigued, I feel I should aim for it.

yes broadly speaking the lower the ahi, the better your therapy will be. mostly, it's good to get to an ahi of 2 or less. but that isn't the only thing that can affect your sleep.


i'll quiet down now and let my betters speak. i wish you good luck and hope that you stick with it.

welcome to the zoo. as you've gleaned, the machine is going to be a bit of a challenge as it won't work with tracking software favored by the forum. or really any that i know of.

Thank you for the warm welcome!

are you sure it's set at 0 as the minimum and not 4 or 5 or such? also, do you have the ability to change the pressure on your machine?

You're right! I took at second look and it looks like the minimum is 4 -- not 0. Mode is "auto adjust" pressure is: 4.0 to 20.0 with 6.0 in the middle of those two figures. Ramp is 4.0 cmH2O and 20 minutes. EZEX = 0. I don't have the ability to change those settings. They show in the settings, but it doesn't allow me to select them.

what exactly does that data break down to? ahi is comprised of many events. it's the events that will help the folk here to help with any suggestions.

This is a great question, and I don't really know. It just provides a few figures like AHI (4.23), Avg Leak (27.1 LPM), Avg Pressure (5.8 cmH2O) and Avg Hours (6.6). In terms of my Rx, I had 36 "apneas" and all 36 were obstructive.

WoolyJ wrote: ↑

Thu Nov 03, 2022 1:15 pm

welcome to the zoo. as you've gleaned, the machine is going to be a bit of a challenge as it won't work with tracking software favored by the forum. or really any that i know of.

Thank you for the warm welcome!

are you sure it's set at 0 as the minimum and not 4 or 5 or such? also, do you have the ability to change the pressure on your machine?

You're right! I took at second look and it looks like the minimum is 4 -- not 0. Mode is "auto adjust" pressure is: 4.0 to 20.0 with 6.0 in the middle of those two figures. Ramp is 4.0 cmH2O and 20 minutes. EZEX = 0. I don't have the ability to change those settings. They show in the settings, but it doesn't allow me to select them.

Transcend 365 xPAPs apparently can only have their clinical settings reset via software from Somnetics.

Apneaboard indicates the software can be found at https://mytranscend.com/customer-care/user-guides/ and there's a (short) thread from July 2022 over there at http://www.apneaboard.com/forums/Thread ... nical-Menu with a post from one of the moderators with some instructions about how to get into the clinical section of the software.

Note: The software only runs on Windows machines.

WoolyJ wrote: ↑

Thu Nov 03, 2022 1:15 pm

They show in the settings, but it doesn't allow me to select them.

i've got one foot out the door.
https://www.google.com/search?q=somneti ... e&ie=UTF-8

see if you can find some help there. apparently somnetic software could shed some light on this?

good luck!

Thanks to you both! I was able to get into the software and have full adjustment control over the settings. The configuration allows me to adjust the pressure. Do I need to bump the minimum number up from 4? Let me know if you have any ideas for what I should experiment with.

Are you seeing anything that would give you more information about the breakdown of your AHI that Zonker mentioned? The basic components are:

Obstructive apneas: may be reduced with a higher minimum pressure.
Hypopneas: may be reduced with a higher minimum pressure and/or EZEX (a form of pressure relief).
Central apneas: higher pressures and EZEX may make these worse and won't make them better.

Even if your apnea events during your sleep test were all obstructive, it is possible some (or many) of your events now are central. That's because for some people, central apneas show up with PAP treatment, because it can wash out a bit of CO2, leading to a reduction in the "breathe now" impulse. Pauses between breaths that are 10 seconds or longer are scored as CAs.

So ideally you could find information on your machine about the breakdown. If it just isn't there, we can maybe suggest some experiments anyhow. But information would be better!

WoolyJ wrote: ↑

Thu Nov 03, 2022 2:21 pm

Thanks to you both!

i see that robysue1 has stepped in. i'll bow out as she is much better with such things than i.

continued good luck!

Miss Emerita wrote: ↑

Thu Nov 03, 2022 4:20 pm

Are you seeing anything that would give you more information about the breakdown of your AHI that Zonker mentioned? The basic components are:

Obstructive apneas: may be reduced with a higher minimum pressure.
Hypopneas: may be reduced with a higher minimum pressure and/or EZEX (a form of pressure relief).
Central apneas: higher pressures and EZEX may make these worse and won't make them better.

Even if your apnea events during your sleep test were all obstructive, it is possible some (or many) of your events now are central. That's because for some people, central apneas show up with PAP treatment, because it can wash out a bit of CO2, leading to a reduction in the "breathe now" impulse. Pauses between breaths that are 10 seconds or longer are scored as CAs.

So ideally you could find information on your machine about the breakdown. If it just isn't there, we can maybe suggest some experiments anyhow. But information would be better!

I made a massive mistake and somehow deleted the historical data from the machine, and the software, and so I lost it all unfortunately. If you can suggest some experiments, that would be extremely helpful. I will try them all and report back on how each one has gone.

Do you have even one night of the AHI breakdown?

AHI - on the machine - basically means the number of interruptions it identified in your breathing.
And while knowing that is necessary for optimizing therapy, the number does not necessarily mean the number of interruptions per hour when you're asleep.
Our breathing while awake, or while in transition for sleep to wake and vice versa can become ragged - and whatever happens during those periods is discounted in sleep studies that have to ability to distinguish these states from real sleep.
The machines are not very good at that distinction.
So, for some of us, a higher AHI could mean we were not sleeping well for reasons other than breathing problems. An AHI lower than 1 could simple mean: this was great, consistent sleep without any interruptions: not pain, not heat, not noise, not light -- etc. ... I never tested or polled it, but I wonder if it's correlated with age as well. As a general rule, sleep maintenance is better the younger people are.

When we have a breath flow graph, we can sometimes understand where registered events should be discounted for the above reasons.

Since you don't have that info, let's see how your feeling changes when you try to control other variables that may be disrupting your sleepIn addition to the above mentioned pain, heat, noise, light, and age here are some that may be "machine induced" so to speak:
.

1. If your minimum pressure it too low the machine may be letting obstructive events happen, instead of preventing them. It then raises the pressure in response to what it reads, until it thinks: good, all is well, whereupon it could be dropping you right back to the level where obstructions are apt to happen. Solution: higher minimum pressure prevents those obstructions and incipient obstructions, and doesn't let the machine drop to where they are more likely to happen.
2. For some of us, the mere fact that pressure changes can disrupt our sleep and we simply sleep better when the pressure in fixed. Pressure changes in automatic machines are based on the analysis of your breath flow pattern - and can occur even when there are no apneas or hypopneas.
3. For some of us, the amount of humidity (too high? too low) supplied by the humidifier can make a difference in breathing quality
4. Ditto for temperature - if you have a heated hose.

Miss Emerita wrote: ↑

Thu Nov 03, 2022 11:12 pm

Do you have even one night of the AHI breakdown?

Yes, I have last night's data. This is with the adjustment of putting the minimum pressure up to 6 (from 4) and dropping the max to 15 (from 20). (Data in attachements)

ozij wrote: ↑

Thu Nov 03, 2022 11:27 pm

AHI - on the machine - basically means the number of interruptions it identified in your breathing.
And while knowing that is necessary for optimizing therapy, the number does not necessarily mean the number of interruptions per hour when you're asleep.
Our breathing while awake, or while in transition for sleep to wake and vice versa can become ragged - and whatever happens during those periods is discounted in sleep studies that have to ability to distinguish these states from real sleep.
The machines are not very good at that distinction.
So, for some of us, a higher AHI could mean we were not sleeping well for reasons other than breathing problems. An AHI lower than 1 could simple mean: this was great, consistent sleep without any interruptions: not pain, not heat, not noise, not light -- etc. ... I never tested or polled it, but I wonder if it's correlated with age as well. As a general rule, sleep maintenance is better the younger people are.

When we have a breath flow graph, we can sometimes understand where registered events should be discounted for the above reasons.

Since you don't have that info, let's see how your feeling changes when you try to control other variables that may be disrupting your sleepIn addition to the above mentioned pain, heat, noise, light, and age here are some that may be "machine induced" so to speak:
.

1. If your minimum pressure it too low the machine may be letting obstructive events happen, instead of preventing them. It then raises the pressure in response to what it reads, until it thinks: good, all is well, whereupon it could be dropping you right back to the level where obstructions are apt to happen. Solution: higher minimum pressure prevents those obstructions and incipient obstructions, and doesn't let the machine drop to where they are more likely to happen.
2. For some of us, the mere fact that pressure changes can disrupt our sleep and we simply sleep better when the pressure in fixed. Pressure changes in automatic machines are based on the analysis of your breath flow pattern - and can occur even when there are no apneas or hypopneas.
3. For some of us, the amount of humidity (too high? too low) supplied by the humidifier can make a difference in breathing quality
4. Ditto for temperature - if you have a heated hose.

This is so extremely helpful, thank you so very much! I'll do some experimenting here with your suggestions, and report back with some data.

Thanks for posting your one night of data; that's really helpful! Unfortunately the chart makes no distinction between central and obstructive apnea events, but that isn't so important for you, since most of your events are hypopneas. They, too, *might* be central instead of obstructive, but let's experiment using the hypothesis that they're obstructive.

This suggests to me that you might benefit from using EZEX. I'm not sure what the increments are for your machine, but start with the lowest and make sure that's comfortable for you. Give it a few days and see whether you note any trend up or down in your hypopneas (or apneas). We can go from there.

Also, it looks to me as though your events are somewhat clustered. You may be tucking your chin down toward your chest, which can narrow your airway a little. If you use a high pillow, or several pillows, try using one fairly low pillow. Some people get a huge benefit from wearing a soft cervical collar at night to keep their head in a good alignment. Something else you could consider.

WoolyJ wrote: ↑

Fri Nov 04, 2022 7:32 am

Miss Emerita wrote: ↑

Thu Nov 03, 2022 11:12 pm

Do you have even one night of the AHI breakdown?

Yes, I have last night's data. This is with the adjustment of putting the minimum pressure up to 6 (from 4) and dropping the max to 15 (from 20). (Data in attachements)

oh! i'm so happy that the software at least produces a chart. will have to tuck this away for future info.