AHI doubled when I switched to auto?

Hi Group!

I've been using the REMstar 460 for a few months set my sleep doc (based on my sleep study numbers). I start at 4 and ramp up to 9 over 25min. My AHI usually hovers around 3 (which is still high, but I just chalk it up to me being new and only using it a few months).

Anyway, I decided to buy the REMstar 560 which is basically the same but has the auto feature. I was excited because I assumed my AHI would go down. After setting it up and trying it, the first night I averaged 5 AHI. The next night I averaged 7 AHI.

I'm using the same mask, hose, etc. Just the upgraded model.

I switched back to the manual ramp 4-9 over 25 min last night and AHI numbers are back to normal.

Anyone had this experience or have suggestions? I know there's a lot of different factors, but all my settings are the same except for the "type" of therapy. Auto vs manual.

I figure I must be doing something wrong. Thanks for any advice!

it would all depend on the settings.

if you're used to a pressure of 9 and you left the 560 on the default 4-20, then you're going to have events as it gets up to around 9.

try setting the lower limit at 8 if you still have events at 8, after a few days, bump it up a half, and repeat.

What was your minimum pressure setting on the 560 in auto mode? If it was the default 4 cm and you need closer to 9 cm then the airway can collapse while going from 4 to 9 cm. It doesn't increase the pressure in the blink of an eye. Takes a bit of time to get there.
This is of course assuming the AHI is primarily obstructive in nature and not central in nature.
It would really help if we could see detailed daily report for one of the nights when AHI is higher.

Easy answer: Some people just don't fare well with auto-adjusting therapy and find that one straight pressure serves them better.

If I were you, I'd cut the ramp altogether (unless you just can't fall asleep at your prescribed pressure of 9). Otherwise, I'd cut the ramp time down to maybe 5 or 10 minutes. Realize that you're NOT getting therapy while the machine is in ramp mode (it's not preventing or treating any apnea during that time). If you have software (either Encore or Sleepyhead), look at your detailed data (not just the display on the machine, itself. The detailed data is very telling and will help you (and/or your doctor) tailor your therapy. You can even post a screenshot or two here so we can help you more.

Technically, any AHI under 5 is considered acceptable and therapeutic, but we all strive for the lowest AHI possible. Those of us who've been on the machine for a long time find that an AHI of even 3 can feel terrible when compared with our usual AHI of 1.

Good luck!

Assuming the others are correct about your auto settings being on default; another small observation:
Although many can successfully leave the upper limit at 20, there are a few of us who need to reduce the upper number to 2 or 3 centimeters
above our 95% pressure. Remember, only make small changes about a week apart, so you can keep track of what is doing what.

delfinparis wrote:Hi Group!

I've been using the REMstar 460 for a few months set my sleep doc (based on my sleep study numbers). I start at 4 and ramp up to 9 over 25min. My AHI usually hovers around 3 (which is still high, but I just chalk it up to me being new and only using it a few months).

Anyway, I decided to buy the REMstar 560 which is basically the same but has the auto feature. I was excited because I assumed my AHI would go down. After setting it up and trying it, the first night I averaged 5 AHI. The next night I averaged 7 AHI.

I'm using the same mask, hose, etc. Just the upgraded model.

I switched back to the manual ramp 4-9 over 25 min last night and AHI numbers are back to normal.

Anyone had this experience or have suggestions? I know there's a lot of different factors, but all my settings are the same except for the "type" of therapy. Auto vs manual.

I figure I must be doing something wrong. Thanks for any advice!

If your therapeutic setting is 9cmH20, then a setting of Auto 4cm - 9cm, yes your residual AHI is definitely going to go up. The Auto is meant to maintain the lowest possible pressure required at the time, as it is primarily meant for someone who can't adjust to their required pressure all night. It senses obstructions, increases the level accordingly. Then if you change positions and have less events, say on your side the pressure will dial back down to a lower pressure as it wasn't required as much. If you have REM related OSA, meaning get worse in REM, then it'll have to dial back up when you get to these periods. The ramp feature you were using of 25mins, is just there for the first 25mins to help acclimate to your optimal pressure, then for the remainder of the night you will always be on your optimal pressure. This is why your AHI is lower on CPAP, but higher on AutoPAP. AutoPAP requires obstructive events to change pressure settings.
If you have an optimal CPAP setting and you are comfortable with that pressure throughout the night, then CPAP is better to use as you'll never be below your optimal setting. Just because a therapy cost more, and on paper does more, it doesn't mean it's the best fit for every person.

-Example of why AutoPAPs exist. "Patient has mild OSA in Non-REM sleep and severe OSA in REM sleep. Therapy level of 5cmH20 alleviated events/snore for NREM, but patient required a pressure of 14cmH20 for increased OSA in REM sleep." The patient would be prescribed 14cmH20 on cPAP initially, but if the patient can't acclimate to using 14cm all the time, then an AutoPAP can be explored with a range of 5cmH20 to 14cmH20 for this made up patient.

***For a patient with no issues using cPAP at the optimal setting [9cmH20 in OP's case] then CPAP is the best option.
***For a patient that doesn't mind cPAP at beginning of night, but can't use it all night due to not getting fully acclimated to their optimal setting. An AutoPAP may be considered to keep patient using PAP therapy after covering all the details with physician.

BleepingBeauty wrote:Easy answer: Some people just don't fare well with auto-adjusting therapy and find that one straight pressure serves them better.

If I were you, I'd cut the ramp altogether (unless you just can't fall asleep at your prescribed pressure of 9). Otherwise, I'd cut the ramp time down to maybe 5 or 10 minutes. Realize that you're NOT getting therapy while the machine is in ramp mode (it's not preventing or treating any apnea during that time). If you have software (either Encore or Sleepyhead), look at your detailed data (not just the display on the machine, itself. The detailed data is very telling and will help you (and/or your doctor) tailor your therapy. You can even post a screenshot or two here so we can help you more.

Technically, any AHI under 5 is considered acceptable and therapeutic, but we all strive for the lowest AHI possible. Those of us who've been on the machine for a long time find that an AHI of even 3 can feel terrible when compared with our usual AHI of 1.

Good luck!

An AHI of 5 or less is considered acceptable from a laboratory, home sleep testing stand point. The AASM recently had a webinar/journal and their stance is a residual AHI from data downloading a machine, then the acceptable range is <10/hr and should really only be addressed if residual AHI is >10/hr

munkyBeatz wrote:

BleepingBeauty wrote:Easy answer: Some people just don't fare well with auto-adjusting therapy and find that one straight pressure serves them better.

If I were you, I'd cut the ramp altogether (unless you just can't fall asleep at your prescribed pressure of 9). Otherwise, I'd cut the ramp time down to maybe 5 or 10 minutes. Realize that you're NOT getting therapy while the machine is in ramp mode (it's not preventing or treating any apnea during that time). If you have software (either Encore or Sleepyhead), look at your detailed data (not just the display on the machine, itself. The detailed data is very telling and will help you (and/or your doctor) tailor your therapy. You can even post a screenshot or two here so we can help you more.

Technically, any AHI under 5 is considered acceptable and therapeutic, but we all strive for the lowest AHI possible. Those of us who've been on the machine for a long time find that an AHI of even 3 can feel terrible when compared with our usual AHI of 1.

Good luck!

An AHI of 5 or less is considered acceptable from a laboratory, home sleep testing stand point. The AASM recently had a webinar/journal and their stance is a residual AHI from data downloading a machine, then the acceptable range is <10/hr and should really only be addressed if residual AHI is >10/hr

That may be true (I'm taking your word for it, as I've not heard that, myself). But I think the most important factor in determining whether or not to pay attention to the AHI is how you FEEL as a result of your therapy. If you feel terrible when the AHI is higher, then you should be tweaking your therapy.

Frankly, as a user, I don't give a fig whether any sleep professional thinks an AHI under 10 doesn't need attention; it's MY therapy and MY life I'm concerned about. I'll stick with the advice and knowledge from other users over that of a sleep professional any day of the week, especially if that sleep professional is not a user and is just regurgitating what they've been taught or told.

Just a quick thanks to everyone who have helped. Will review everything and report back!

munkyBeatz wrote:

BleepingBeauty wrote:Easy answer: Some people just don't fare well with auto-adjusting therapy and find that one straight pressure serves them better.

If I were you, I'd cut the ramp altogether (unless you just can't fall asleep at your prescribed pressure of 9). Otherwise, I'd cut the ramp time down to maybe 5 or 10 minutes. Realize that you're NOT getting therapy while the machine is in ramp mode (it's not preventing or treating any apnea during that time). If you have software (either Encore or Sleepyhead), look at your detailed data (not just the display on the machine, itself. The detailed data is very telling and will help you (and/or your doctor) tailor your therapy. You can even post a screenshot or two here so we can help you more.

Technically, any AHI under 5 is considered acceptable and therapeutic, but we all strive for the lowest AHI possible. Those of us who've been on the machine for a long time find that an AHI of even 3 can feel terrible when compared with our usual AHI of 1.

Good luck!

An AHI of 5 or less is considered acceptable from a laboratory, home sleep testing stand point. The AASM recently had a webinar/journal and their stance is a residual AHI from data downloading a machine, then the acceptable range is <10/hr and should really only be addressed if residual AHI is >10/hr

My head feels like its going to explode after a night when I exceed 4

greater than 10 ....yikes

Pugsy wrote:What was your minimum pressure setting on the 560 in auto mode? If it was the default 4 cm and you need closer to 9 cm then the airway can collapse while going from 4 to 9 cm. It doesn't increase the pressure in the blink of an eye. Takes a bit of time to get there.
This is of course assuming the AHI is primarily obstructive in nature and not central in nature.
It would really help if we could see detailed daily report for one of the nights when AHI is higher.

My min auto pressure is set to 4 and max at 20. It seemed to average around 6 (sleep study had me stabilized at 9). I only had 5 hours of sleep last night, so that may have affected sleep quality. I'm going to do a few more days on auto and track via SleepyHead. I'll post my stats and get feedback. Thanks!

By the way, if you're the SleepyHead dev, great job! Awesome software. If you don't have a donate button in the software, add one!

palerider wrote:it would all depend on the settings.

if you're used to a pressure of 9 and you left the 560 on the default 4-20, then you're going to have events as it gets up to around 9.

try setting the lower limit at 8 if you still have events at 8, after a few days, bump it up a half, and repeat.

Yeah, I think I'll change back to auto and start at either 8 or 9 up to 20. Makes sense I'd have events up to the 8 or 9. Thanks!

BleepingBeauty wrote:Easy answer: Some people just don't fare well with auto-adjusting therapy and find that one straight pressure serves them better.

If I were you, I'd cut the ramp altogether (unless you just can't fall asleep at your prescribed pressure of 9). Otherwise, I'd cut the ramp time down to maybe 5 or 10 minutes. Realize that you're NOT getting therapy while the machine is in ramp mode (it's not preventing or treating any apnea during that time). If you have software (either Encore or Sleepyhead), look at your detailed data (not just the display on the machine, itself. The detailed data is very telling and will help you (and/or your doctor) tailor your therapy. You can even post a screenshot or two here so we can help you more.

Technically, any AHI under 5 is considered acceptable and therapeutic, but we all strive for the lowest AHI possible. Those of us who've been on the machine for a long time find that an AHI of even 3 can feel terrible when compared with our usual AHI of 1.

Good luck!

Thanks for the advice. I'm going to cut the ramp to either 5 or 10 min or just eliminate altogether and start at 8 or 9. I'll post my SleepyHead data after a week of more trials. Thanks!

munkyBeatz wrote:

delfinparis wrote:Hi Group!

I've been using the REMstar 460 for a few months set my sleep doc (based on my sleep study numbers). I start at 4 and ramp up to 9 over 25min. My AHI usually hovers around 3 (which is still high, but I just chalk it up to me being new and only using it a few months).

Anyway, I decided to buy the REMstar 560 which is basically the same but has the auto feature. I was excited because I assumed my AHI would go down. After setting it up and trying it, the first night I averaged 5 AHI. The next night I averaged 7 AHI.

I'm using the same mask, hose, etc. Just the upgraded model.

I switched back to the manual ramp 4-9 over 25 min last night and AHI numbers are back to normal.

Anyone had this experience or have suggestions? I know there's a lot of different factors, but all my settings are the same except for the "type" of therapy. Auto vs manual.

I figure I must be doing something wrong. Thanks for any advice!

If your therapeutic setting is 9cmH20, then a setting of Auto 4cm - 9cm, yes your residual AHI is definitely going to go up. The Auto is meant to maintain the lowest possible pressure required at the time, as it is primarily meant for someone who can't adjust to their required pressure all night. It senses obstructions, increases the level accordingly. Then if you change positions and have less events, say on your side the pressure will dial back down to a lower pressure as it wasn't required as much. If you have REM related OSA, meaning get worse in REM, then it'll have to dial back up when you get to these periods. The ramp feature you were using of 25mins, is just there for the first 25mins to help acclimate to your optimal pressure, then for the remainder of the night you will always be on your optimal pressure. This is why your AHI is lower on CPAP, but higher on AutoPAP. AutoPAP requires obstructive events to change pressure settings.
If you have an optimal CPAP setting and you are comfortable with that pressure throughout the night, then CPAP is better to use as you'll never be below your optimal setting. Just because a therapy cost more, and on paper does more, it doesn't mean it's the best fit for every person.

-Example of why AutoPAPs exist. "Patient has mild OSA in Non-REM sleep and severe OSA in REM sleep. Therapy level of 5cmH20 alleviated events/snore for NREM, but patient required a pressure of 14cmH20 for increased OSA in REM sleep." The patient would be prescribed 14cmH20 on cPAP initially, but if the patient can't acclimate to using 14cm all the time, then an AutoPAP can be explored with a range of 5cmH20 to 14cmH20 for this made up patient.

***For a patient with no issues using cPAP at the optimal setting [9cmH20 in OP's case] then CPAP is the best option.
***For a patient that doesn't mind cPAP at beginning of night, but can't use it all night due to not getting fully acclimated to their optimal setting. An AutoPAP may be considered to keep patient using PAP therapy after covering all the details with physician.

This is a great point. I've started turning on my side halfway through the night. I'm not getting big air leaks, but I'm sure it's affecting my numbers because my body position isn't consistent. I need to will myself to stay on my back. I've even figured out how to lay on my stomach and keep the mask on. Ha.

I currently have the auto from 4-20cm, but it's hovering around 6cm auto. I'm going to keep trying auto until I can verify that cpap works better. I should know in a week or so. Thanks!

so I get the bit on having a straight CPAP set for 9cm through the night...but on APAP, is there a reason to keep the low end at 9 instead of, say, 7? Less pressure as a baseline, only has a minimal jump to 9 if needed...and possibly the 95% will be under 9 anyhow?