why can't I get my HI down?

Hi, I really am having a problem with my HI readings. I have an AI most days within normal limits,or below 5 but the HI readings are always high,so that makes my AHI high.
This morning for example my AI was only 0.9 but my HI was 13.5,so that made my AHI 14.4!
I don't understand why my HI is always so high.My pressure is 9.
any suggestions?
Thanks so much.

I can't say exactly why, but my number of hypopneas was higher when I had more snores registering. I made adjustments to my pressure range (I use an auto machine) and was able to get the snores down in the low single digits and my AHI fell to below 2 and often below 1. I also have almost all hypopneas and very few, if any, apneas. You have a straight pressure of 9. I am not familiar enough with your machine to know what the increments are to adjust your pressure upwards very slowly and in tiny bits. Others who do will be along soon to let you know.

Was 9 your titrated pressure? If so, it may be a bit too low as they tend to prescribe a lower/safer number to start you out. If you could give us a bit more information on your diagnosis and numbers from your sleep study, it would help. Do you have the software for your machine to look at the data? The data would show leaks, snores, and provide the clues why your AHI is so high.

Keep us posted.... good luck!

sister wrote:Hi, I really am having a problem with my HI readings. I have an AI most days within normal limits,or below 5 but the HI readings are always high,so that makes my AHI high.
This morning for example my AI was only 0.9 but my HI was 13.5,so that made my AHI 14.4!
I don't understand why my HI is always so high.My pressure is 9.
any suggestions?
Thanks so much.

The S8 uses an older algorithm for scoring hypopneas. Some people have suggested that you can cut your HI in half and add that to your AI to get a more realistic picture of AHI, but that would depend TOTALLY on whether half of hypopneas you are having are recorded by the older algorithm and would not be recorded by the newer ones. Yours might all be recorded the same by both algorithms, or maybe the new algorithm would record none of them, or only 3/4 of them, etc. The point is, for any individual, we just don't know how many, if any, of your hypopneas to ignore.

Given all of that, I think you are going to have to go more on how you feel than what your machine is registering, at least until you can get a machine with a better algorithm. So how do you feel during the day?

sister wrote:Hi, I really am having a problem with my HI readings. I have an AI most days within normal limits,or below 5 but the HI readings are always high,so that makes my AHI high.
This morning for example my AI was only 0.9 but my HI was 13.5,so that made my AHI 14.4!
I don't understand why my HI is always so high.My pressure is 9.
any suggestions?
Thanks so much.

If your AI is below 1.O, you are likely getting decent treatment on an S8.

You use the HI number as trending information only--in other words you notice if it is going up or down, but you don't worry about exactly what the number is. So, as has been said, get your numbers as low as you can, then go by how you feel.

Be thankful that you have a machine that gives plenty of information on your breathing for trending purposes. Newer models too often give "0.0" for AHI, in my opinion.

hi, thanks so much for the responses! No, I don't have a data card or a data card reader,i do however have the software. I was wanting the card and reader at one time and almost bought it but now my doctor is thinking about having me do a months trial on an auto pap[rental] and if that improves my therapy I might be getting a new machine.So I decided to wait and see what he does first.
I was diagnosed with moderate sleep apnea with an AHI of 16.
Many times in the last 9 months I've been on c-pap I have gotten my AI down to o.o but the HI
remains high.
As for how I feel,I'll have to say I really can't be sure, I feel fine but I felt that way pretty much
before c-pap. I never knew I had apnea.I was diagnosed after surgery back in 2006 by the anesthesia
people. Really, I have always been a very active person and if I felt tired before c-pap I didn't have time to notice.
I think I read somewhere though that the resmed machines read out the HI's too high, I'm not sure.
GOD BLESS YOU!

If your doctor prescribes an auto machine, insist on an S9 instead of an S8. You'll be better off. Don't get the climateline hose, if it costs extra. Ditto slimline.

LoQ wrote:If your doctor prescribes an auto machine, insist on an S9 instead of an S8. You'll be better off. Don't get the climateline hose, if it costs extra. Ditto slimline.

Hi, I was too late to insist on a S9, by the time I finished talking to you guys the DME was here with a rental autopap for me to try for 30 days,said that was all they had at the present time.
It's an S8 but i slept with it last night and the pressure went up to 11.2 !!!! So that tells me that i have trying to get my numbers down for the last 9 months and was not getting enough pressure!
This morning my AHI was only 1.4, AI was 0.0 and my HI was 1.4 !!!!!!!!.
It seems to me that i need an autopap!
I think he said my pressure on the autopap was set from 5 to 15. I have never understood my therapy anyway,I have been so confused.
I was diagnosed with sleep apnea in 2006, tried for 15 months to use the c-pap,with all my allergies and every problem in the world,finally my dr. told me, you are just not a canidate for c-pap!
I had the surgery,[UPPP ] in 2007, thought I was o.k. until january of this year. I don't know that i was, because a post op sleep study was never done.
That was probably my fault that a study was not done though, dr. would ask me how i felt, i'd say 'fine'. But i was fine before being diagnosed with apnea! Never felt tired or anything!
I was told i had sleep apnea in recovery room after surgery!
I was diagnosed with mild sleep apnea and put on c-pap with a pressure of 10.
Now after all that i was titrated this year and diagnosed with moderate sleep apnea,put on c-pap with a pressure of 9.
Now, my question, why was i put on a lower pressure this time when my apnea was worse?
I have never understood at all!
GOD BLESS YOU.

The pressure setting has nothing to do with the severity of your apnea. It is whatever pressure is needed to keep YOUR airway open to deal with events. Everyone is different. It appears they were able to keep you airway open enough to deal with events with a pressure of 9 cm this time. It may not have changed at all. They may have said 10 cm the last time because it is pretty average and they may have felt it was better to go 1 cm higher for your ongoing therapy.

I have severe OSA and my titrated pressure was 10 cm, 8 years ago. I had another study 2 years ago and they said 9 cm but an in home auto trial around that same time, said I needed 11 cm.

I use my machine in auto mode with minimum pressure of 10.5 cm and a maximum pressure of 13 cm. I get AHI almost always below 2 so this works for me.

I'm glad APAP is working well for you. It doesn't always with UPPP patients:

"The use of APAP is not indicated in patients with previous uvulopalatopharyngoplasty (UPPP) when the APAP algorithm is based on snoring detection."--http://archest.fsm.it/pne/pdf/61/3/pne6 ... nfulla.pdf

"Patients who do not snore (either naturally or as a result of palate surgery) . . . are not currently candidates for APAP titration or treatment. (Standard) . . . Most studies evaluating APAP, regardless of the technology used, exclude such patients because the sensors and algorithms identifying respiratory events may not be sensitive or specific under these circumstances."-- http://www.aasmnet.org/Resources/Practi ... Update.pdf

jnk wrote:I'm glad APAP is working well for you. It doesn't always with UPPP patients:

"The use of APAP is not indicated in patients with previous uvulopalatopharyngoplasty (UPPP) when the APAP algorithm is based on snoring detection."--http://archest.fsm.it/pne/pdf/61/3/pne6 ... nfulla.pdf

"Patients who do not snore (either naturally or as a result of palate surgery) . . . are not currently candidates for APAP titration or treatment. (Standard) . . . Most studies evaluating APAP, regardless of the technology used, exclude such patients because the sensors and algorithms identifying respiratory events may not be sensitive or specific under these circumstances."-- http://www.aasmnet.org/Resources/Practi ... Update.pdf

well now, this is certainly a concern for me! I did not know that apap was not recommended after UPPP! I had no idea! So what do I do now? I mean this is the machine that my sleep dr. has recommended for me!
I am doing so well now after just a few nights but how do I know that this is good in terms of getting a new machine?
Now I am just a bit worried about changing from a c-pap to an autopap.

sister wrote: . . . this is certainly a concern . . . Now I am just a bit worried about changing from a c-pap to an autopap.

If it is working for you, it is working. It is always worth a try, in my opinion, for anyone, UPPP or not.

I think the problem with some UPPP procedures and some auto-titrating machines is that the old versions of UPPP cut out a LOT of the palate in a way that the person would never snore again, and some auto algorithms rely heavily on snores to find the right pressure. But if your UPPP wasn't that radical and your machine is able to read the way you breathe well enough, then the auto may work amazingly well for you.

As long as you use the data to make sure your therapy is effective, you can always tweak for proper customization of minimum and maximum settings to meet your needs. In my opinion, the main thing with an auto is to get the minimum close to what you need anyway. That is true for UPPP patients or anyone else. I just wanted to give the heads-up because I think it is good to be aware of all the factors that could influence how therapy may go. You may particularly need to watch your numbers over time when using an auto.

But, again, bottom line is that if it is working for you, there is no need to worry. Instead, enjoy! And if the auto ever stops responding the way you want, autos can be run in CPAP mode anyway for night-to-night treatment. Many end up using their auto that way and only running it in auto mode occasionally to retitrate.

jnk wrote:

sister wrote: . . . this is certainly a concern . . . Now I am just a bit worried about changing from a c-pap to an autopap.

If it is working for you, it is working. It is always worth a try, in my opinion, for anyone, UPPP or not.

I think the problem with some UPPP procedures and some auto-titrating machines is that the old versions of UPPP cut out a LOT of the palate in a way that the person would never snore again, and some auto algorithms rely heavily on snores to find the right pressure. But if your UPPP wasn't that radical and your machine is able to read the way you breathe well enough, then the auto may work amazingly well for you.

As long as you use the data to make sure your therapy is effective, you can always tweak for proper customization of minimum and maximum settings to meet your needs. In my opinion, the main thing with an auto is to get the minimum close to what you need anyway. That is true for UPPP patients or anyone else. I just wanted to give the heads-up because I think it is good to be aware of all the factors that could influence how therapy may go. You may particularly need to watch

But, again, bottom line is that if it is working for you, there is no need to worry. Instead, enjoy! And if the auto ever stops responding the way you want, autos can be run in CPAP mode anyway for night-to-night treatment. Many end up using their auto that way and only running it in auto mode occasionally to retitrate.

Yes, It is working for the first time in 9 months on therapy, I have finally found something that works!!!!!
thanks so much for your help, i am going to go with' if it works,it works', and I am so happy!!!!!!!
My hi is still not good or my leaks , this morning leaks were0.66 and hi were 3.1 but AI was 0.0 !!!

sister wrote: . . . this morning leaks were0.66 and hi were 3.1 but AI was 0.0 !!!

First step may be for you to make sure your therapy isn't escaping out of your mouth when you use nasal pillows. (One possible solution is a full-face mask.) Once you get leak under control, then you can be more confident that your other numbers (HI and AI) are accurate.

jnk wrote:

sister wrote: . . . this morning leaks were0.66 and hi were 3.1 but AI was 0.0 !!!

First step may be for you to make sure your therapy isn't escaping out of your mouth when you use nasal pillows. (One possible solution is a full-face mask.) Once you get leak under control, then you can be more confident that your other numbers (HI and AI) are accurate.

Hey,
I can't wear a full face mask, I have tried many times, the bridge of my nose just won't take it. I am keeping a close watch on my data from the machine, and it is getting better!
I have had the autopap for 1 week now and here is the data,
AHI 2.6
AI- 0.0
HI-2.6
Leaks-0.68
Pressure-10.6
All this week I have worn the Swift FX and A chinstrap and tape
I really don't think my pressure was high enough at 9 on the c-pap as these are the best readings i've ever had! sometimes in the last week my pressure has gone up to 10.8 and 11.2 !

Thanks!!!!

When leak is above 0.4, the other numbers aren't considered reliable.

There are some full-face masks that don't touch the bridge of the nose, like the hybrid masks.