What is AHI? Mine was 49.7!

LSAT wrote:I am certainly no expert, but you said that your CPAP starts ramping at 5 and goes up to 9 and then later you say that your 95th percentile is 19.2......Something doesn't sound right.

19.2 was his leak rate.

You know, it is highly possible that your pressure was titrated wrong at your study. I was titrated at 16.0 cm and really only need 14.6 cm to maintain a consistent AI < 0.3. With the leaks under control, turn the ramp pressure up to 7 cm and see what happens. You may need a higher pressure.

Personally, I've never gotten a full face mask to seal properly, but that could just be my face shape. I use the Swift FX and absolutely LOVE it. I do have to wear a chinstrap (PAPcap) to keep my mouth closed, but it doesn't bother me at all.

Welcome, Fotoguy! The first thing you need to do is get a copy of your complete sleep study report(s). You need to learn what your AHI was during the diagnostic study, when you weren't wearing a mask. You need to learn the detailed results of the titration study, where they determined your pressure needs. How low were they able to get your AHI during that study? You also need to determine if there are any other sleep-related problems. That information should be in those reports.

I suggest that you try restricting yourself to side-only sleeping, to see if your AHI comes down. Search for "tennis balls" or "backpack" on the forum threads to find some ways of doing that. Many of us have positional apnea, where we have many more events when on our back. I do. This is usually because the tongue blocks the airway or because of chin position. The grouping together of the apneas (which are almost all obstructive) on the ResScan chart that you shared suggests that this may be a major factor for you. I saw that you posted in another thread about AHI and full-face masks. You may want to look at the link I provided there about my experience with high numbers of apneas using a full-face mask when sleeping on my back. In contrast, I only have one or two apneas when on my back while using nasal/nasal pillows masks, and often zero apneas.

Are you taking any medications/supplements? Steroids? Some meds interfere with breathing while asleep. Any known health problems?

Your apnea clusters may be associated with REM sleep too. As I understand it, when we've been sleep-deprived for a long time, we can go through "REM rebound," where we spend a lot of time in that sleep state for a while, as we are making up the sleep deficit. I have to say, though, that I have never seen so many apneas! If the machine was providing the correct amount of pressure to keep your airway open, this shouldn't be happening, so....it's entirely possible that your titrated pressure during the sleep study was not correct. In fact, it may be way off. How long (and how soundly) did you sleep during the titration study? Are you using EPR, which lowers the pressure with each exhale? If you're using EPR, you may want to try that set to Off. The EPR settings are 1, 2, 3 or Off. If your pressure is 9 and you have EPR set to 3, for example, then the pressure is only 6 during exhale (9 - 3 = 6). That's quite low.

[LATER EDIT: I see that you're using the S9 Elite, which can only deliver a set pressure. You mentioned a pressure of 9 earlier. If there's ANY way you can trade this machine for an S9 Autoset, it would be much easier to determine if your current pressure is correct, as that machine can vary your pressure, according to your needs. The Autoset is an APAP machine, so it can be set to a range of pressure. The Autoset can also be used as a CPAP machine, if it turns out that you do better with a set pressure.]

It looks like your leaks are under control, so that doesn't seem to be a problem at this point. You may notice your AHI goes down a bit as you become more acclimated to the machine. It does take time to adjust to this therapy. With such a high "treated" AHI, you may want to bring this to the attention of your sleep specialist if your AHI doesn't come down significantly. I suggest that you get your sleep study report(s) as soon as possible. That may hold some important clues.

Have faith that it'll all get worked out over time! We can help and support you along the way. Let us know what your sleep studies reveal and your current machine settings, and I'm sure we can offer some suggestions.

Just so you don't feel left out, your results are rather like mine. My AHI varies from the low 60s to a rare one under 30 - and yes I also get chest pains which are probably related to my high blood pressure.

I've been on my original prescription which was set 8 (the actual prescription was 8-10) for just over 2 months. Many mornings I also feel like crap - but it's a different sort of crap than before the hose - if that makes sense. I'm less "tired" but more "sleepy". I'm hoping to get an updated prescription soon - I went back for another study a couple of weeks ago and slept really well there - but the tech wasn't allowed to tell me how he did it - I have to wait for the doctor to review the results which took 4 months last time.

It's my hope that if I can get my apnea under control that will help with the blood pressure.

I've got an appointment with my family doctor Monday and hope to get more things figured out after that - and perhaps she can push to get my CPAP prescription updated sooner rather than later.

Good luck....

Andrew, we'd all be very interested to know what your recent sleep study revealed when you do get those results. I'm curious if they will find that your pressure needs are actually much higher than your current setting of 8. Titrations aren't always accurate. Be sure to get complete copies of your sleep studies. Look to see if central apneas may be a problem for you. A few are perfectly normal; large numbers of them are not. Consider the suggestions I made to fotoguy also.

Many of us have seen a reduction in blood pressure after our CPAP therapy is optimized. Your chest pains may be a different problem altogether, but many of us have had heart arrhythmias disappear with CPAP. Heart rhythm problems are quite common with sleep apnea patients, as it does affect the cardiovascular system (and many other body systems).

I hope that you will have the same good results that many of us have enjoyed. Sometimes it takes a while to figure out all the pieces of the puzzle. Please let us know how you're doing.

Did you reset your machine for the full face mask, this will make a difference. this switch is in the clinical menu.
good luck
Chris

PS I am using the quatro ff with good results

Thank you to all for your very helpful information. Yes, the S9 was changed to full face mask. I always sleep on my side only. When I went to the hospital (about a month ago) my blood pressure was 246/132 and that was pretty much normal for me - always at least 200/120 (with BP meds). When I left the hospital I completely changed my diet. Very carefully watching the sodium. Now my BP runs about 130/80 all the time.

I've asked for the study results and was told they don't have them yet. I should be able to get them when I see the doc on 7/1. Having the ResScan software is very helpful and I can't imagine that they provide the machines without it. Before my heart attack I was taking Dilaudid and Hydrocodone for chronic neck pain. Since I left the hospital I have taken no pain meds (and don't see any difference). I take BP meds around noon and nothing else during the day.

When I see the doc on 7/1 I'll ask about the S9 Auto. Seems like that could help with my problem. I'm going to turn the pressure up to 11 tonight to see how that works. I just can't imagine why I have so many apneas while using the machine. Central apneas, sure. But obstructive apneas are supposed to be taken care of by the pressure.

AndrewB - in addition to CPAP, check your sodium intake. It made ALL the difference for me. I now won't eat anything with sodium/serving over 200mg. It's crazy how much sodium is in everything we eat. I used to like frozen fish. But the sodium could be 800 - 900mg. So now I go to the seafood counter and get fresh cod fillets (no sodium added and not farmed, so no hormones or antibiotics added). I've lost 30 pounds in the last month, probably mostly water weight from all the sodium I used to get.

Again, thanks all! This is an awesome forum!

fotoguy, I hope you'll share here what you learn. Wow, that was incredibly high blood pressure!!! Good thing you were able to bring that down!

I just read on another thread that your high AHI has only been since you've been using the full-face mask. Sorry that I didn't catch that earlier in this thread. I had assumed that you'd had that problem ever since starting CPAP. Are you having to tighten the straps on the full-face mask down very tight? I had to do that with the bottom straps of the Quattro to stop leaks, and that pulled my chin down, which increased my AHI quite a bit. You may want to experiment with the straps to see if you can wear the mask a bit looser. It's possible that your mask is the wrong size too. I ended up going back to nasal and nasal pillows masks, as I get outstanding results with those. My favorites are listed with my equipment below.

Good luck!

My first night with the full face mask, I had a lot of leaks. So I tightened the bottom straps the next night and had almost none. If it's any looser it will leak.

fotoguy wrote:My first night with the full face mask, I had a lot of leaks. So I tightened the bottom straps the next night and had almost none. If it's any looser it will leak.

Did you AHI change?

Yes. It went from 49.7 to 26.5. The apneas on the first night seem to have been related directly to the leaks.

fotoguy wrote:AndrewB - in addition to CPAP, check your sodium intake. It made ALL the difference for me. I now won't eat anything with sodium/serving over 200mg. It's crazy how much sodium is in everything we eat. I used to like frozen fish. But the sodium could be 800 - 900mg. So now I go to the seafood counter and get fresh cod fillets (no sodium added and not farmed, so no hormones or antibiotics added). I've lost 30 pounds in the last month, probably mostly water weight from all the sodium I used to get.

FotoGuy:

Yep - I've pretty much cut excess sodium out of my diet. It's amazing where it hides. I go grocery shopping with my wife now when I can and spend a lot of time reading labels. The place where I stop for my morning tea and bagel (Tim Hortons for any other Canadians out there) publishes a nutrition guide and I made changes based on that. Surprisingly, a lot of "light" foods are much higher in sodium.

We could almost be twins - although you'd be the much younger and perhaps better looking one . When I first started getting treatement for my blood pressure I would ask the nurse if they wanted to sit down first Unfortunately I haven't lost any weight as of yet. Part of my weight issue is that I tend to substitue food for sleep - when I'm starting to sag, I grab a bite of food. I'm hoping that will change when I'm better rested.

One thing I have found that really helps with losing weight is drinking lots of water. Weight loss is very hard, but it's all in developing the willpower to stay away from the bad foods. After my heart attack I gave up sodas, my one pleasure in life. Now I drink nothing but water. It's not enjoyable, but it's something that has to be done.

Fotoguy, IMHO, you are doing the right thing by trying a higher pressure (I am not a medical professional, though, so take anything I say as a suggestion only!). Give it a few days, and see if it brings down your AHI on average. The fact that your AI appears much higher than your HI tells me that you are indeed not at a high enough pressure. A higher pressure may help counteract some of the effects of using a FFM.

Andrew B, you might want to try a higher pressure as well. Don't go up more than 2 CM at a time, and give it a few days to see if there is an average improvement.

Fotoguy, I agree fully with those who say you need an autoadjusting CPAP, like the S9 Autoset. For someone like you you, who appears to have really severe sleep apnea, the autoadjusting machines make life that much better.

I wonder how much of an effect Sodium has on me. I don't watch it that carefully, except I don't salt food much when I am on a low carb diet. I have also not seen a correlation after having a particularly salty non low-carb day. I know caffiene and therobromine have little effect on me. I do have high BP, but nowhere close to what you have experienced. I am on a couple of fairly mild drugs for it. Maybe Ill try low sodium for a few days next week.

Last night I had everything set just as the doctor ordered and thought I was going to do pretty good. I checked this morning and my AHI was 60.1. It was all obstructive and Leaks was 0.0. I'm going to call Monday to see if I can get a ResMed S9 Autoset. And I will definitely up the pressure tonight. And thanks to all for your invaluable help!