Newbie still has AHI in the teens on CPAP

Hi,

I am just 6 nites into my CPAP and I looked at my AHI a few times. I recall 15, 17.5, 18 and 12.5. Those seem high, don't they? I have a ff mirage quattro mask I am messing with, I don't notice any big leaks, maybe a hiss or 2 every now. I ordered some padacheek stuff. Should I contact my doctor or wait to see if it goes down???

There a small chance there could be some underlying problems, but here's what I tell most newbies before they sink a lot of time and money on multiple sleep studies, neurological tests and subsequent panic mode decisions:
When I started CPAP a moderate amount of AHI and centrals started showing up and I was quite worried. Then I got a nasty chest cold and they went up some more. I got better and they dropped a bit. Then a month later, I had a bad leg injury and they went up as high as they ever had. I nearly panicked but finally decided to just hang tight and stick with what I always found to be my best pressure. Sure enough day by day my apneas and centrals started disappearing and now I'm always AHI < 2, that is, unless I have a really bad night cuz of stress, pain or whatever. My point is that sometimes it takes awhile for the brain to figure out what it needs to do to get better. It's not a machine or a computer where you fix the immediate problem and it's instantly better. It's a bio-organism and very good at what it does, however it's rarely instantaneous.

what's your settings and data from it?

When starting out things can be a bit weird for a while.

Xney wrote:what's your settings and data from it?

When starting out things can be a bit weird for a while.

I have C-flex set to 3, ramp is 45 minutes, no large leaks, pressure is 15, not sure of what other settings?

Where are you getting the AHI numbers from? Off the machine or using the software?
You have one of the new PR S1 Pro 60 series machines don't you? Did I send you the software that would work with that machine? I can't remember who I sent it to.. I saw your other thread about maybe having the Auto IQ.
If you have the software can you tell us the AHI breakdown...each category index...how much was clear airway index, how much was obstructive apnea index and how much was hyponea index.

If you are getting the numbers off the LCD screen those are running averages and a really bad night can mess up the averages and takes several really good nights to level things out.
For this reason we don't worry much about the LCD numbers and instead prefer to look at the nightly detailed reports.

So before panic sets in about the numbers...let's figure out what they are first. Maybe look at some reports to see what is going on...see if leak is affecting anything.

Your profile shows an old discontinued machine. I think you need to look in the equipment list for the grouping of machines that start with PR System One and there you will find your machine.
The humidifier is called the PR System One heated hose humidifier (or similar wording.)
I know you only see "Remstar" on your machine but Respironics calls all their machines Remstar something.
The PR part of PR System One is Phillips Respironics which you may see on your machine. System One is seen on the humidifier.
They don't make it easy.

If I didn't send you the software link, send me a private message and I will get it to you. Right now EncoreBasic is your best choice for software.

Robysue has a guide composed with pictures. See if this helps.
viewtopic.php?f=1&t=72302&p=665165#p665165

Thanks Pugsy, I am answering your questions below in blue. I also PMed you.

Pugsy wrote:Where are you getting the AHI numbers from? Off the machine or using the software? It is of the machine.
You have one of the new PR S1 Pro 60 series machines don't you? Did I send you the software that would work with that machine? I just sent you a PM. I can't remember who I sent it to.. I saw your other thread about maybe having the Auto IQ.
If you have the software can you tell us the AHI breakdown...each category index...how much was clear airway index, how much was obstructive apnea index and how much was hyponea index.

If you are getting the numbers off the LCD screen those are running averages and a really bad night can mess up the averages and takes several really good nights to level things out. I got the AHI off the LCD screen.
For this reason we don't worry much about the LCD numbers and instead prefer to look at the nightly detailed reports.

So before panic sets in about the numbers...let's figure out what they are first. Maybe look at some reports to see what is going on...see if leak is affecting anything.

Your profile shows an old discontinued machine. I think you need to look in the equipment list for the grouping of machines that start with PR System One and there you will find your machine. I found my machine on that page...thanks. REMstar Pro C-Flex+, the part number is DS460HS
The humidifier is called the PR System One heated hose humidifier (or similar wording.)
I know you only see "Remstar" on your machine but Respironics calls all their machines Remstar something.
The PR part of PR System One is Phillips Respironics which you may see on your machine. System One is seen on the humidifier.
They don't make it easy.

If I didn't send you the software link, send me a private message and I will get it to you. I just sent you a PM. Right now EncoreBasic is your best choice for software.

Robysue has a guide composed with pictures. See if this helps.
viewtopic.php?f=1&t=72302&p=665165#p665165

I replied to your PM.

Don't worry about the AHI that shows on the machine right now. The 7 day average is a running average and if you had a really bad night for a couple of nights it is going to take longer for any "good" nights to show up in the 7 day average spot.
You haven't had enough nights yet and it would be expected that the first few nights might be less than optimal because you might not have slept well with the mask and stuff. Also, if you had trouble getting to sleep and staying asleep the machine doesn't know if you are sleep or not and does sometimes flag events that it thinks you had and you were awake. Our awake breathing is really fairly erratic compared to asleep breathing and the machine sometimes makes a mistake. It is possible that some of that AHI you see on the machine are "awake" events.

Let's see what your reports look like and then we can better evaluate what is going on.
Someone will likely ask you to post one of your daily detailed reports. Instructions on how I do it are below.
Also go to my signature line (lower left of this post) and click on the link for the thread where I have some examples of the software reports. I have examples of Encore reports there...so you will see what yours will look like.

These are my standard instructions on how to post and image at the forum and how I posted the images in my software options thread.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
If you want to use Photobucket they provide a box with the various url addresses and you just choose the last one in the box.
Copy/paste that last line url address into the body of your post.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

jjlady wrote:I have C-flex set to 3, ramp is 45 minutes, no large leaks, pressure is 15, not sure of what other settings?

Hi,

It would be interesting to see a data plot from your memory card. For example, you can have a lot of events before you fall completely asleep, and since you are using the ramp, you don't get full treatment for almost the first hour that you use the machine. Maybe try it without the ramp feature. Another thing that tends to happen is that as you get used to CPAP, you sleep more soundly, meaning your airway is more relaxed, and that can cause you to need even more pressure than what you had during your sleep study.

This is all hard to tell without seeing the data, so that seems like your #2 priority. #1 priority is just getting another 10 days or so of machine usage under your belt. You body needs time to adapt, and it needs to get caught up on missed sleep.

-john-

I can't get used to the pressure (yet) without the ramp, I lowered it to 30 minutes last night. I will try to load the software tonight.

On your list of things to do.... when you have time could you please correct your equipment in your profile.
I know it is extremely confusing because what you see on your machine doesn't match up with the choices in the equipment list.

Your machine is in the grouping of words that starts with PR System One
the 60 series machines are included in that group.
model 460 is the Pro and 560 is the Auto cpap with heated hose.
The humidifier is also listed in the humidifier section with the grouping of words starting PR System one

The machine you have chosen now has been discontinued a long time, won't look like your machine and doesn't even offer any AHI data.
If you fix it now then it will avoid confusion later.

Don't worry about feeling the need for ramp right now. Most important thing is being able to get to sleep. If we see on the reports that the ramp is allowing some events to sneak by and maybe elevate that AHI...we can talk about it later.
What I do suspect is that probably some of your "events" being flagged are likely events flagged by the machine while you are awake. It doesn't know if you are asleep or not and it can be fooled. If that is what is happening we just ignore those until you are getting more time asleep and less time awake with the machine on.

So let's see what your reports show first..then talk about your options.
If you need the ramp..then you need the ramp. There are ways to limit any events sneaking past the defenses when ramp is being used and still maintain a nice comfort level. We can talk about those options if they are needed.
Main thing....get the sleep....get used to sleeping with the mask and machine first....worry about making it perfect later after you are adjusted better to all this. We don't have to make it perfect immediately. Heck, I still don't have it "perfect".
There is "acceptable" and there is "perfect"....sometimes striving for perfect causes more problems trying to get there than "acceptable" does.

I changed my machine on my profile, still not sure if I got it right?

jjlady wrote:I changed my machine on my profile, still not sure if I got it right?

Machine is correct.
Humidifier is still off.

Your humidifier should be

PR System One 60 series heated tube humidifier with heated tube

Looks like there are only 2 choices for the PR System one humidifiers.
Either the original model....PR System One Heated Humidifier
or the PR System One 60 Series Heated Tube Humidifier with heated tube.

I know that the 60 series machine can be used without the heated hose and but apparently these are the only two choices that are offered.
The choices we have in the equipment menu are all tied to products that cpap.com offers now or has in the past. So sometimes the choices aren't exactly what we might be using.
So if someone happens to be using the 60 series machine without the heated hose...there is no choice for that.
Only the 60 series humidifier will work with the 60 series blower though...so best choice would still be the heated tube choice.

Pugsy, "There is "acceptable" and there is "perfect"....sometimes striving for perfect causes more problems trying to get there than "acceptable" does."

Ain't that the truth!

Starlette

I got a fit life full face mask today and am going to try it tonight, so I am going to wait until tommorrow night to upload some data. I want to compare the 2 masks. I liked the fit at the DME but am afraid it might be hot.

Pugsy wrote:I replied to your PM.

Don't worry about the AHI that shows on the machine right now. The 7 day average is a running average and if you had a really bad night for a couple of nights it is going to take longer for any "good" nights to show up in the 7 day average spot.

I've seen this mentioned several times. Does this machine really not give a one night result for that night? I use a Resmed S9 autoset, and it tells me the current ahi for all usage since the previous noon (or what it thinks is noon, since I changed the time on mine). I can look at my ahi when i get up to use the bathroom, and later when I get up for the day. It says the hours I used the machine, a green happy face for the mask fit, and my ahi. Right now, since it is officially a new day and yet unsused, it has 0.0, green happy face, and -- for ahi.

What good is a 7 day average on the screen? I could see going to an additional page to see more long term normals, or looking at that in a report. But for the first thing to see on screen? A useless average of the last 7 days? It seems like it does more to confuse people than to offer useful data.