I need help. :/

Although my apnea index has gotten way better it's still not where I need it to be. I felt pretty crappy today- mid-day which led me to go check my card and sure enough my ahi index was a little high.. I decided to go to auto and do 13.5 - 15 max. Right now it's been on straight c-pap 14 which has improved my ahi a lot. Some nights on straight 14 pressure I can have an ahi of 3 and change which is great for me, but much of the time it's staying around 6 and change. I was also wondering about system one resistance setting.. It's on zero, maybe it needs to be put on so that the air pressure will be coming back quick enough to stop my throat from closing? Any input would be appreciated.

cindjo717 wrote:I was also wondering about system one resistance setting.. It's on zero, maybe it needs to be put on so that the air pressure will be coming back quick enough to stop my throat from closing?

My understanding is that the PR System One Resistance setting is a comfort setting and that it has absolutely nothing to do with the Auto algorithm. And if I recall correctly, it does not change the rate the pressure is increased back to full pressure when you're using one of the Flex settings for exhalation relief. As near as I can recall, the resistance setting way the rounding between full pressure and exhalation relief pressure. And that rounding is supposed to be based on the physical characteristics of the Respironics mask being used. If I recall, the instructions seem to indicate that if a non-Respironics mask is used, the setting should be left at 0. But I suppose you could compare your mask to PR masks to find one that is "close" and then see what changing the setting actually does in terms of comfort.

Thanks Robysue. I will look into the masks and compare them. I am also wondering if my chart looks like it's an acceptable amount of apnea events or should I try for better? I don't know what to do at this point.

cindjo717 wrote:Thanks Robysue. I will look into the masks and compare them. I am also wondering if my chart looks like it's an acceptable amount of apnea events or should I try for better? I don't know what to do at this point.

Well on the day you posted the results you said you felt crappy AND the AHI was a bit above the "magic" (but arbitrary and somewhat meaningless) 5.0

Since you're not yet feeling decent in the daytime, then some tweaking to try to get that AHI down a bit more probably is in order---particularly since the main contributor to the AHI is still OA's. Since you're concerned about making sure "the air pressure will be coming back quick enough to stop [your] throat from closing" on your exhales, you might want to first experiment with turning down the Flex if it's currently on. Can you tolerate using a lower Flex or no Flex at all?

But rather than more extensive dial-winging just yet, I'd suggest doing a bit of data gathering since you say:

Right now it's been on straight c-pap 14 which has improved my ahi a lot. Some nights on straight 14 pressure I can have an ahi of 3 and change which is great for me, but much of the time it's staying around 6 and change.

So you need to tease out if you are doing anything different on the days that precede a night where the AHI is 3.something and you feel decent the next day versus the days that precede a night where the AHI is 6+ and you don't feel decent the next day.

So other than fiddling with the Flex settings, I'd be a bit reluctant to do more dial-winging for the sake of dial-winging without some additional data on what your days are like. Because a major piece of the "problem" (and hence the solution) could easily have something to do with what's going on in your days rather than the machine's settings.

Questions that might be illuminating:

• Is there any correlation between AHI and diet? In other words, does eating supper too late adversely affect things? Are you more sensitive than most to a glass or two of wine or a beer or two with dinner? When's the last caffeine consumed relative to bedtime? (And don't forget all the non-coffee sources of caffeine.)
• Any correlation between AHI and exercise? Does getting over tired during the day time lead to a worse than normal night? Does getting too little exercise seem to affect the AHI? Is the timing or type of exercise important?
• Is there any correlation between "bad night for sleeping in terms of restlessness" and "bad night for sleeping in terms of AHI"? Is there a pattern to when the events mainly occur? Do you have more events when you are dozing instead of nice and soundly asleep? And keep in mind that "restlessness" has many non-OSA causes including pain and stress. So track that too.
• Medication use---does taking OTC medicine affect the AHI in any way? What about prescription meds that are not maintenance meds that you take every day? And if you are on daily mediation, have you checked the known side effects recently? Any of them potential causes for more breathing problems at night?
• Go back to your sleep study report if possible: Do you know whether your OSA is substantially worse on your back? Is it substantially worse in REM? Is the answer to either question is yes, then it might be prudent to try a tight APAP pressure range with the MIN set at 14 and the max set somewhere around 15.5 or 16.
• And track anything else in your daily life that is somewhat variable regardless of how "unconnected to apnea" it appears to be.

After you have a week or two of data, patterns may emerge that will help point the way to what you need to do next to get that AHI down to the 3.something range you find acceptable.

***Go back to your sleep study report if possible: Do you know whether your OSA is substantially worse on your back? Is it substantially worse in REM? Is the answer to either question is yes, then it might be prudent to try a tight APAP pressure range with the MIN set at 14 and the max set somewhere around 15.5 or 16.***


^This is true for me, what you said above.^ I will try this tonight. Sleeping on my back and REM is worse for me. I will try 14 min. 15.5 max. and turn off the flex or turn it down. I have it at 2.