trying to get lower AHI

Hey guys. Been on CPAP therapy for over a month now... Gotten quite used to my Swift LT mask and find no problems wearing it. Been told that I no longer snore which is a really good thing. I check my S8 Elite II efficiency data daily for leak, AHI, HI, and AI, and log them in a spreadsheet (no card reader yet). I find that my AHI is consistently around 6.0 - 7.0 even though I have tried setting my pressure higher (right now it is at 8.0 but I have gone up to 12.0). I do find I have more energy during the day but still do not feel completed rested when waking up. Part of that might be I go to bed far too late than I should during the week, and usually only get 6 hrs on a weeknight. I usually sleep in on the weekends to make up for the loss, even though I know that is not supposed to help. Here are my current settings, hoping you guys might be able to provide some tips on how to improve my treatment:

Start CPAP: 4.0
CPAP: 8.0
Ramp: 20 mins (max 45)
EPR: Fulltime
EPR Level: 3.0
EPR Inhale: Med

wongnog wrote:Hey guys. Been on CPAP therapy for over a month now... Gotten quite used to my Swift LT mask and find no problems wearing it. Been told that I no longer snore which is a really good thing. I check my S8 Elite II efficiency data daily for leak, AHI, HI, and AI, and log them in a spreadsheet (no card reader yet). I find that my AHI is consistently around 6.0 - 7.0 even though I have tried setting my pressure higher (right now it is at 8.0 but I have gone up to 12.0). I do find I have more energy during the day but still do not feel completed rested when waking up. Part of that might be I go to bed far too late than I should during the week, and usually only get 6 hrs on a weeknight. I usually sleep in on the weekends to make up for the loss, even though I know that is not supposed to help. Here are my current settings, hoping you guys might be able to provide some tips on how to improve my treatment:

Start CPAP: 4.0
CPAP: 8.0
Ramp: 20 mins (max 45)
EPR: Fulltime
EPR Level: 3.0
EPR Inhale: Med

You don't mention ahi at 12? Or how much AHI is Ai vs Hi??

Or sleeping position? Or titrated pressure?

With EPR at 3 you need to raise pressure by 3. Or drop EPR to 2 and raise pressure by 2 - keep checking.

If you can go without or reduce the ramp will also help. If not try reduce the time or raising the pressure, even slowly.

or leak or if there were centrals during the titration or the original sleep study

I agree with what the others said. AND, try to get more sleep during the week. Even after several years on the hose, I need to get a weekly average of 7 1/2 hrs. per night. If I get more than a couple of nights around 6 or less, I'm dragging. Sure, many times we can't help it, but if it's at all feasible, get more sleep.

Den

Hey everyone thanks for the prompt replies. My leak rate is almost always 0.00 so I assume that's good! I didn't say AHI is 12.0, I said I tried CPAP at 12.0 but AHI did not improve from 6.0-7.0. My AI's are very low (usually < 2.0) and HI's between 4.0-5.0 or higher. I am mostly a back sleeper now that I'm on CPAP, but I do sleep on the side sometimes (the Swift LT is great for this). I just had my titration study last week but don't get to see the doc for the results until a couple more weeks. In the meantime I was hoping to try and improve my therapy by myself. Results from my original sleep study are (in brackets are comments from the report):

recording time = 6.2 hrs
sleep time = 5.5 hrs
sleep efficiency = 89.3% (normal)
total arousal index = 17.4 (increased)
awakenings index = 3.3 (normal)
slow-wave-sleep = 19.5% (increased)
REM sleep = 16.5% (reduced)
sleep onset latency = 6.9 min (normal)
Stage 2 latency = 18.5 min (normal)
REM sleep latency = 179 min (delayed)

total central apneas = 0
total obstructive apneas = 3
total hypopneas = 81
AHI = 15.3 (moderately elevated)
REM sleep AHI = 26.4 (moderately elevated)
supine position = 22.6%
supine AHI (adjusted RDI) = 21.7
non-supine AHI = 13.4
min 02 saturation = 85% (desaturation)
sleep time <90% O2 saturation = 0.6%
heart rate = 72-87 BPM (regular)

you are blind on all of this - no titration results in hand yet - no software

the LED can only provide limited information and even then, you need to use a setting for a week before you change it -

For feeling more rested: definitely more sleep.
For finding out your optimal pressure: at least a week a whatever pressure you're trying

And then:
Do you have any indications of nasal congestion? Those can be handled by:
Nasal irrigation
Changing the humidifier temprature. I love the warm humidity, but beyod a certain point, it causes congestion.

Two further point to consider:
GERD which may be a cause of nasal cogestion
Nasal allergies - adding a fine filter to your machine may help that.

O.

Okay so I finally got a titration study done and got the report back from the doc. He said at a pressure of 7 cm H2O my AHI was only 0.7! And at 8 cm H2O it was actually 0! It's really too bad my Resmed machine keeps "telling" me my AHI is really around 6.0. The doc explained that many machines including Resmed record normal disturbances in breathing that happen when you wake up or spontaneously during sleep as a hypopnea event. He said the titration study is more accurate because it only records events during sleeping hours, whereas the CPAP machines record events throughout the whole night.

I'm pretty happy with my mask too, it has solved all my snoring and dry mouth problems. I'm probably a mouth breather naturally, but these nasal pillow systems really make it hard to breath with your mouth. It's even hard to talk, it's like your lungs aren't getting any air in to speak or breath with your mouth. So it forces you to breath with your nose, which the doc says is what "normal" people do. My leak rates are almost always 0.0, and the titration study showed my oxygen saturation range was between 91-98% on CPAP.

I've taken the following steps to try and reduce my AHI further, but I just can't seem to consistently get my AHI below 6.0 on my machines:
[*] reduced ramp to 10 minutes
[*] increased starting pressure to 6.0 (going up to
[*] left EPR at 3, but it is now on "ramp only" because I find I don't need the ramp while I'm actually sleeping (only while I'm trying to sleep)

Any other suggestions would be greatly appreciated.