Can't seem to lower my AHI's

Hello,

I have been on cpap for 3 months now. I have a S8 resmed autoset vantage and a resmed quattro full face mask. I average 0.10 to 0.36 l/s on the mask and anywhere from 1.2 to 3.6 ai, My HI has been 5.7 to as high as 11.5, which has given me an ahi averaging 10 ahi. I have tried a hybrid mask, I couldn't keep the tubes in my nose, and When I did get them to stay they leaked ,I tightened them up so tight that it hurt, so I went back to my ff mask. My presure was RX'ed for 12 on cpap, they changed it to apap and the settings were left from 4-20. I have gone in the settings and basically now have it set from 12-20. My average pressure has been 17. So I am guessing the sleep doc mis diagnosed my settings.

What else can I do to get these ahi's below 5? Mask leaks have been minor, I have to crank the thing down to prevent leaks but for the most part, I still get leaks when turning my face to one side or the other. I am getting frustrated, I am feeling better i guess, But i want my numbers to drop. I was diagnosed with severe osa if that helps. I had 72 apneas an hour nd 1 0r 2 cenral apneas during the sleep study.

Any advice is appreciated

Go to straight pressure......something sufficient that will prevent most of the events before they occur (like maybe try 17). The machine has to have an event to increase pressure. Those events get counted in your AHI.
Pretty simple, really.

Den

you should track your AI's and HI's separately. AI is the only one that really matters, HI can fluctuate up/down depending on what AI does in relation to pressure. That machine will always score HI's higher than other machines.

They titrated you at 12 cm? and now you are at 17 cm and AHI still remains high?

Sounds to me like you may have went over the preverbal "hump" per say. If you are like many you have a sweet spot coming down after the first hump where it starts to climb again. Sure you can go higher and go over that 2nd hump and see the AHI dip again, but it usually doesn't result in the lowest available AHI.

I would bump up your Minimum pressure from 4.0 to like 6.5 or 8 at a minimum. 4.0 starting pressure is way too low for nearly everyone, won't even flush out the CO2 from your mask. Next, I would try limiting the Maximum pressure for one night to 9.0 cm. Just let it run up and bump into 9.0 and stay there. If it wakes you up gasping for air in the middle of the night, then you can abort that experiment and let it go on back up to 20.

I would also program in a 30-minute Settling timer value and use the Settling for that same night. Then compare that night's AHI to prior.

Don't know if you snore or not but that can also play into your machine running up with higher pressures, if that happens it can start firing off more of those CA's seen on your PSG. IF that is truly happening that AHI you are looking at may be CA's not obstructive (that machine cannot differentiate the difference).

The experiment above in staying at or below 9.0 cm may be able to determine if that AHI you are looking at is truly obstructive apnea or something else. You mention CA's were seen on your PSG, that higher residual AHI could be from centrals in which 17 cm pressure may only aggravate more. Compare your AHI from the experiment to what you had before and go from there. Hopefully your CA threshold is not lower than 9.0 cm.

hosehead5150 wrote:Hello,

I have been on cpap for 3 months now. I have a S8 resmed autoset vantage and a resmed quattro full face mask. I average 0.10 to 0.36 l/s on the mask and anywhere from 1.2 to 3.6 ai, My HI has been 5.7 to as high as 11.5, which has given me an ahi averaging 10 ahi. I have tried a hybrid mask, I couldn't keep the tubes in my nose, and When I did get them to stay they leaked ,I tightened them up so tight that it hurt, so I went back to my ff mask. My presure was RX'ed for 12 on cpap, they changed it to apap and the settings were left from 4-20. I have gone in the settings and basically now have it set from 12-20. My average pressure has been 17. So I am guessing the sleep doc mis diagnosed my settings.

What else can I do to get these ahi's below 5? Mask leaks have been minor, I have to crank the thing down to prevent leaks but for the most part, I still get leaks when turning my face to one side or the other. I am getting frustrated, I am feeling better i guess, But i want my numbers to drop. I was diagnosed with severe osa if that helps. I had 72 apneas an hour nd 1 0r 2 cenral apneas during the sleep study.

Any advice is appreciated

Snoredog,

The way I read his first post, it appears that he's tracking his AIs and HIs separately. The numbers he listed didn't sound like he was having an issue with Centrals (the AIs were considerably lower than the HIs). And, he's already got his pressure considerably above the "4" that he started out with.

Den

Wulfman... wrote:

hosehead5150 wrote:Hello,

I have been on cpap for 3 months now. I have a S8 resmed autoset vantage and a resmed quattro full face mask. I average 0.10 to 0.36 l/s on the mask and anywhere from 1.2 to 3.6 ai, My HI has been 5.7 to as high as 11.5, which has given me an ahi averaging 10 ahi. I have tried a hybrid mask, I couldn't keep the tubes in my nose, and When I did get them to stay they leaked ,I tightened them up so tight that it hurt, so I went back to my ff mask. My presure was RX'ed for 12 on cpap, they changed it to apap and the settings were left from 4-20. I have gone in the settings and basically now have it set from 12-20. My average pressure has been 17. So I am guessing the sleep doc mis diagnosed my settings.

What else can I do to get these ahi's below 5? Mask leaks have been minor, I have to crank the thing down to prevent leaks but for the most part, I still get leaks when turning my face to one side or the other. I am getting frustrated, I am feeling better i guess, But i want my numbers to drop. I was diagnosed with severe osa if that helps. I had 72 apneas an hour nd 1 0r 2 cenral apneas during the sleep study.

Any advice is appreciated

Snoredog,

The way I read his first post, it appears that he's tracking his AIs and HIs separately. The numbers he listed didn't sound like he was having an issue with Centrals (the AIs were considerably lower than the HIs). And, he's already got his pressure considerably above the "4" that he started out with.

Den

I'm a he to clarify lol. I'll try the 9cm and see what happens. at this point, I'll try anything. I do track ai and hi seperately, My AI is between 1.2 and 3.6, If the HI is below 10 I get the 1.2 ai and if th HI is above 10 I average in the 3.6 range.

Snoredog,

Since he/she apparently doesn't have the software to see where the events are occurring, wouldn't it be "easier" (more reliable) to do it by stepping up or down with single pressure a cm at a time? Yeah, I know it takes longer with single pressure as opposed to a range, but if you can't SEE where they're occurring.......at least the reported numbers would give a hint.

Den

Wulfman... wrote:Snoredog,

Since he/she apparently doesn't have the software to see where the events are occurring, wouldn't it be "easier" (more reliable) to do it by stepping up or down with single pressure a cm at a time? Yeah, I know it takes longer with single pressure as opposed to a range, but if you can't SEE where they're occurring.......at least the reported numbers would give a hint.

Den

Actually I do have the software, I just don't understand the results, For instance, The events detail, The apneas have numbers at the top, It shows a line going up with numbers starting at 11 all the way up to 27, they seem to bunch up at different times, some at 2200 hours, some at 0130, some at 0230 and some at 0600, it doesn't line up with the pressure changes, for example at at 0400 the pressure jumped from 15cm to 20 cm, there was no ai or hi at that time, at 0600 the pressure stayed at 15 but i had 3 apneas and some hypoapneas, i can't really make out how many though. I have no idea what the numbers mean on top of the apneas though. I can't find the answer in the clinician manual or from searching online. THe hypoapnea line stays between 0-5, the apneas are all over the place.

If i take the average line for pressure, The median is 15 cm, i analyze it like a stock performance, if the middle of the road line is 15 dollars, and it drops to 12 and goes as high as 20, you buy in at 15..

Anonymous wrote:I have no idea what the numbers mean on top of the apneas though.

The number is the duration of the apnea in seconds.

Perhaps if you post a screen shot of a typical night we can give you some more directed advice?!?

Cheers,

Bill

I think my experience is very close to yours. I started CPAP 2 months ago. First with S8 Elite CPAP set at 13.4 pressure as per my study. My AHI was always in the 12-20 range. Similar to you, my AI is usually between 2-4, HI makes up the rest.

My doctor switched me to the Vantage APAP w/setting 4-20. The AHIs are are bit narrower, but still 10-14 every night for the past 4 weeks. Maybe 3 times I have seen the AHI under 10. My 95th percentile pressure ranges from 12-16 depending on the night.

My first mask was a Quattro but it ripped the bridge of my nose, so with the APAP change I went to the Liberty. Much harder to keep leaks under control than the Quattro, but my leaks are in the under .20 sometimes under .10 with no correlation to AHI results.

So like you I am at a loss as to why my AHI don't get any lower.

My plan is to stick with the current APAP/Liberty for another month, send the datacard to the DME and have them produce a report for the Dr. for interpretation.

billbolton wrote:

Anonymous wrote:I have no idea what the numbers mean on top of the apneas though.

The number is the duration of the apnea in seconds.

Perhaps if you post a screen shot of a typical night we can give you some more directed advice?!?

Cheers,

Bill

Heres a pdf link of one of my reports if this helps. I can't figure out how to post a screenshot..
http://www.vhrocks.com/test.pdf

HoseHead when I tried to check out your .pdf it said it was non existent. Might want to recheck your link.

Christy

I checked it from another computer and it comes up for me..

strange for me the link opens and says

Account Error: Nonexistent

AdmiralCougar wrote:strange for me the link opens and says

Account Error: Nonexistent

Do you have Adobe Reader on your computer?
Also, try righ-clicking on the link and try to download it.

I was able to download it, but for me, I might as well be reading Greek.....trying to read ResMed's reports.

Den