What is AHI? Mine was 49.7!

fotoguy wrote: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!

I assume that you used the full-face mask again last night. I don't know why you'd be getting such dramatically different results with that mask (versus your other one), but it doesn't seem to be working out for you.

You may need to enlist your doctor's help to get the S9 Autoset. You can try asking the DME first, but if your doc can write you a prescription specifically for that machine it may be easier. The Autoset can be set to CPAP mode by the DME, which will fulfill your pressure requirement as written on your current prescription, but they make a little less profit on that machine, so they may tell you they can't switch machines. The insurance companies pay the DME the same amount for any CPAP or APAP, as they all use the same insurance billing code. Some DMEs are cooperative and helpful, but others are not.

I assume that you have insurance. If not, you'd probably pay less purchasing online. If you do have insurance, I suggest that you call them (or check their website) to see which local DMEs are within their network. That way, if your current DME won't give you the Autoset, you can shop around until you find one who will. Also, some insurance companies will reimburse you if you purchase online. Often, the reimbursement percentage rate is lower, but sometimes you still pay less out of pocket. You may want to see if that's an option and do the math.

It can be a hassle, but it's worth it! You're going to be living with this machine nightly for many years, so get the best you can. Please let us know how it works out for you.

Thanks again, DreamOn. I will definitely be calling Monday to get an Autoset. And I won't take no for an answer. I have good insurance that covers it all. I'm almost afraid to use this thing until I can talk to the doctor and get it straightened out. It is only the support of this forum and people like you who keep me going with it. Thanks!

fotoguy wrote:It is only the support of this forum and people like you who keep me going with it.

I am very grateful to have found this forum too! The help we've found here has been the only thing that's kept a lot of us compliant!

Everyone is different, so it can take a lot of trial-and-error to find masks that work well for you. I've tried on about 15 (in various sizes), and only 3 of those have worked well for me.

I may be mistaken (my memory isn't always sharp), but I seem to recall that you used nasal pillows before, and those weren't comfortable for you. You may want to try a nasal mask, like the ResMed Mirage Activa LT. Just be sure to get the correct size. The straps on that one can be worn quite loose, and it generally seals very well. If mouth-leaking is a problem for you with pillows/nasal masks, you could try a good chinstrap (such as the PAPCap chinstrap) and/or tape your mouth closed.

If you didn't like the nasal pillows mask because the air felt too "direct," there are other nasal pillows that may work better. You also adapt to that over time. At first, I used Ayr Saline Nasal Gel inside my nostrils, and that helped to keep them moisturized. I also used a tiny dab of Lansinoh lanolin cream (sold for nursing mothers) on the outside of my nares. That helped to keep the pillows in place. I've found that the air feels more "diffused" with the AEIOMed Headrest nasal pillows. It is a little noisy on inhale, but otherwise works very well for me. If you're a mouth-breather, the InnoMed/RespCare Hybrid works well for many. It has both nasal pillows and a cushion that fits over the mouth. I purchased mine at CPAPAuction and use it occasionally.

Just keep trying until you find something that works well! It's important to get the sleep apnea under control, so your body can get on with the business of healing. I hope that all goes well on Monday!

I first used a Fisher & Paykel Zest nasal mask. I just can't get enough air through only my nose. That's why I can't swim and even hate washing my head in the shower - very hard to breathe with my mouth closed. I have congestive heart failure, which may be why. I believe that my pressure just needs to go way up. I'll increase it by 2 tonight and see how that works. I'll get the machine situation straightened out Monday. Thanks again for all of your help!

I seem to be causing more confusion than helping! I have had so much information going into my brain this week that I'm feeling a little overloaded. And I just got a new machine and haven't been sleeping well these past few nights either. So I'm not functioning at my best, and probably shouldn't be typing this week. But I remember you saying that now.

One of the Hybrid masks may work well for you if you need to breathe through your mouth too. The ResMed Liberty Hybrid is available through many local DMEs, but the InnoMed/RespCare Hybrid often is not. I much prefer the InnoMed myself. Others find that the Liberty works well for them. It may be worth a try if you can't find another full-face mask that works for you.

I suspect that you're right about the pressure. At least you have a machine and software that can give you useful, detailed data. The congestive heart failure may complicate things, so do consult with your sleep doctor if you continue to have problems (especially since you mentioned having chest pain). Be sure to get those sleep study report(s) too.

You'll get it all figured out. I hope all goes smoothly on Monday.

I turned the pressure up to 10 last night and my AHI was 20.1. That's a bit of an improvement. I'll try 11 tonight.

That's good news!

Last night I turned the pressure up to 11 and my AHI went down to 13.4. That's a big improvement. So tonight I'll put it on 12 and see how it does.

Yes, that is a big improvement! Just keep an eye on Central AI, to make sure that doesn't increase a lot, as central apneas can sometimes be induced by increased pressure.

The odd thing is that you were getting pretty good results with the nasal mask (around 5 AHI, yes?). I'm not sure why you would be having such a drastic difference with the full-face mask and need that much more pressure, especially since you say you're always a side-sleeper. Perhaps your congestive heart failure has some bearing in all this. Is your machine-reported leak rate good? With the ResMed machines, the closer the leak rate is to zero, the better, and over 24 L/min (0.4 L/s) is not good.

My leak rate is excellent - 95th percentile is 0. Last night I had 0 central apneas, but thanks for the warning.

fotoguy wrote:My leak rate is excellent - 95th percentile is 0. Last night I had 0 central apneas, but thanks for the warning.

Fantastic! You can't get any better than those numbers!

I called the DME today and they said that to get the ResMed S9 Autoset there had to be an order from my doctor. I called the doctor's office and was told that the doctor didn't like to do auto machines because they can cause more problems than they solve (I'm thinking, "Yeah, right - for their wallets!") She said she'd ask him about turning up my pressure, though (which I've already been doing). Tonight I'm going to turn it up to 12. My numbers last night were better, but I had to take 3 naps today and just haven't felt good at all. I'm tired and have a headache. And after only about a week I'm already tired of wearing that mask every night. All I can say here is that I didn't sign up for this.

Last night I turned the pressure up to 12 and my AHI was 1.9! It's a shame that they would give me this machine and not want me to see the doctor for a whole month. If not for the great help I've received in this forum, my AHI would still be at 50-60 every night. I know the doctor's going to be mad that I turned it up myself, but too bad.

EDIT: Just talked to the lady at the doctor's office and she told me that at my sleep study my AHI was 127! No wonder I'm always so tired.

fotoguy wrote:Last night I turned the pressure up to 12 and my AHI was 1.9! It's a shame that they would give me this machine and not want me to see the doctor for a whole month. If not for the great help I've received in this forum, my AHI would still be at 50-60 every night. I know the doctor's going to be mad that I turned it up myself, but too bad.

Hi Fotoguy,

I read your thread with great interest and am thrilled that you finally got some good results! You shouldn't have to suffer like that!

Good for you for doing everything you can for your health and sticking to it. You're an inspiration to me.

It's odd though, that your doc dissed an auto pressure machine. From experience (personal and this list's) the automatic machines seem to be the bee's knees in terms of efficacy and compliance.

Gracey

PS hope you continue to great AHI marks

Thanks, Gracey. I really appreciate your kind words.