3 weeks on cpap - AHI control advice?

I'm at three weeks and I've been patiently watching my data to see if time would improve my AHI. I'm feeling well adjusted to the mask and the pressures... I think my machine is pretty darned smart. But my AHI isn't where it should be.

Last night was fairly typical so I'll share that along with a two week overview:



Overview



I can't believe that the DME and docs hand this expensive equipment over to people who are sleep deprived and then act as if their job is done. How many people are using cpap ineffectively - or quitting because it's not helping? Pretty sad.

Anyway - I'm literally tired of waiting for improvement heheh Can I lower this AHI?

Thanks good people.

Amy

Can I lower this AHI?

Turn your minimum pressure to 7 cm. 4 cm is too low.

Hmmm.... It's set at 5. What's up with that?

A couple things that I notice is that you have about of 3rd of the ahi being clear airway events. These can be causes by being restless and/or awake. Do you feel like you were tossing and turning? Did your sleep study mention clear airway events (centrals)? Some people have them on their own, and some people have them when the pressure is too high (for them). They do look like they are possibly clustered a little. Knowing why you are having those will help to determine how to fix them.

Another thing I see is that your pressure is set wide open at 5-20. The pressure graph is pretty small, so it is hard to see what it was doing. It does like it spent the second part of the night at a higher pressure, probably due to more REM sleep or maybe more supine sleeping, or a combo. If the pressure starts too low, it takes longer to get to where it needs to be, and thus some events can sneak by. Your pressure doesn't seem to go up all that high as it doesn't go above 9 much. You might try raising the minimum pressure from 5 to 5.5 or 6 and see if that helps it a bit.

I'll try 6 for a few nights and see how that goes.

The centrals worry me because my mom and her mom both had congestive heart problems and my mom has severe a-fib. But they had problems in their 70s and I'm 51 - so I'm hoping cpap might help me avoid that.

Can I lower this AHI?

7 cm pressure is the lowest I can go without a feeling that I am not getting enough air. Surprised that you tolerated 5, but everyone is different.

Your obstructive AHI for the night you posted was 4.1. That is a bit high for me and I feel my best when my AHI is less than 2.

So yes, for both reasons I would raise the pressure and observe the data and how I feel. Doing it one cm at a time is not a bad way to do it since you seem to tolerate that low pressure.

zoocrewphoto wrote: The pressure graph is pretty small, so it is hard to see what it was doing.

Yes. You should try to change the scale on the pressure graph.

Daydream Believer wrote:I'll try 6 for a few nights and see how that goes.

Good plan. Might need a little more...might not. You won't know till you try.

When evaluating pressure needs you have to remove the CA component index from the AHI....it doesn't respond to pressure directly.

All the other stuff on the events graph like snores, Flow limitations and the OAs & Hyponeas are things that we would normally use just a little more baseline (minimum) pressure to better hold the airway open in the first place.
Any one of these categories by itself isn't horribly horrible but put them all together and the end result is what I call "clutter". Sometimes the clutter comes with not such great sleep quality and when that happens I think it is worth a try to reduce the "clutter".

Sometimes the CAs are a result of not so great sleep quality...like multiple arousals which would lead to multiple sleep onset chances for sleep stage transition centrals..or maybe just tossing and turning centrals or semi awake centrals flagged by mistake. Even if the centrals are the real deal...2 per hour isn't going to get the doctors attention unless you have other significant issues.

BTW the machine reporting is showing 5 to 20 on the daily detailed graph...but the summary trends are showing the past 4 cm along with current 5 cm minimum. It's just hard to see the difference between the 4 cm and 5 cm hash mark on the pressure graph on the detailed report. No big deal.

So if it were my report I would use a little more minimum pressure to see if I could clean up the "clutter".
How much will it take? Don't know. Might be as little as 0.5 cm increase...or might take 2 cm or more. Since the pressure minimum is already really low...6 cm is a good new number to start with.

There's a chance that the CAs will reduce a bit if the potential arousal clutter gets reduced. Can't promise that it will but there's a chance.

I think it'll help. I need to check the ramp, too. I usually feel one good hard push of air then it backs way off.

Does anyone have thoughts on using the headgear hose loop that's on the top strap? I tried it a few nights and it did help with keeping the hose from getting in the way - but it also pulled the nasal pillows upward during the night. I wonder if I could rig it to stay in place better.

Right now I just have the hose hanging over my headboard. It's a tall wooden headboard and just the right height but if the hose is pulled during the night it makes a lot of noise. Maybe if I anchor it loosely it won't slide or pull at my mask.

The only cpap related things that wake me up are leaks and the hose.

First night at min. pressure 6 doesn't show a big change. i'm posting the full night with a zoom to a cluster of events to see if it gives any clues about what's going on...



Zoom on cluster:



I installed the Sleep as Android app on my phone a few days ago. Maybe my brain liked the added pressure cause it captured a sleep laugh





Amy

Amy, next time you post a pic, click the ^ on the calendar, that way more useful info will be shown on the screenshots.

wish mark would make that the default

Okay - without the calendar



Thanks!
Amy

Lower max pressure to 10
Turn off EPR
Ensure mouth leeks are low (I now use a chin strap)
Raise min pressure

My numbers were similar to yours and My AHI dropped from 6 to 2 in one night after making all of these adjustments

Day_Dreamer wrote:Lower max pressure to 10
Turn off EPR
Ensure mouth leeks are low (I now use a chin strap)
Raise min pressure

My numbers were similar to yours and My AHI dropped from 6 to 2 in one night after making all of these adjustments

your random generic advice is .... well.

OP has a remstar machine, they don't *have* EPR.

her leaks look good already.

Daydream Believer wrote:Okay - without the calendar



Thanks!
Amy

see how that gives more info over on the left? that can be informative to people looking to help