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1 year with CPAP, can't consistently stay under 5 AHI
#1
1 year with CPAP, can't consistently stay under 5 AHI
So, I've been using CPAP for 1 year now but can't consistently keep my AHI under 5.  I am hoping for some help from the forum.

My machine is the Philips Respironics DreamStation with the Fisher&Paykel Simplus full face mask.  My pressure settings are: minimum 10, max is 14.  I never use the ramp feature.  Auto mode.  Opti-Start is ON. FLEX is OFF.  Adaptive humidification at 5.  Tube temp at 1.

I believe I can only post one image, so I've compiled some of the relevant stats from my machine.  Please let me know if I need to include anything else.

Thanks in advance for your constructive feedback.  I'm tired of being tired all the time and really want to crack this nut!


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#2
RE: 1 year with CPAP, can't consistently stay under 5 AHI
If you want to post more images to the forum the best way is to use an image hosting site. Here is a step by step guide. Posting an Image in 5 Easy Steps

Dave
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#3
RE: 1 year with CPAP, can't consistently stay under 5 AHI
If you could repost a couple of your daily charts that might help, the one you posted is a little squashed.

Dave
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#4
RE: 1 year with CPAP, can't consistently stay under 5 AHI
The data so far says you need more pressure. I would think a AHI average of around 3 is a goal. You may not be able to do much with the CA after this amount of time. After we do the best we can with the machine and body/head position causes. You may decide that you want another machine to improve on what you finish up with. But it will be better than where you are now.

The dreamstation can be a slow machine to respond to events. I would start with a min 12 (90% pressure) and max 16 while you work out how to post the chart without the calendar and pie chart. The forum needs this data to give decent advice. You can try a flex of 1 to see of you find it easier, it may stir the CA a bit, but it may be worth it.
I would use http://imgur.com/ to post the charts
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#5
RE: 1 year with CPAP, can't consistently stay under 5 AHI
I see you had 12% Periodic Breathing last night. Is that common for you?
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5
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#6
RE: 1 year with CPAP, can't consistently stay under 5 AHI
It does seem like an increase of minimum pressure is warranted. You have a pretty consistent amount of obstructive events.  If this was my record, I would try a couple different things, one at a time.  It might take a while, because each change should be given 4 days to a week.

course A:  raising to min 11 cm max 15 (4 to 7 days), then raising to min 12 cm max 16 cm.  ajack already suggested this.
or
course B:  changing to a fixed pressure - at 12 cm.  It is my guess that this could reduce the CA score too.  (I would then check if adding flex of 1 or 2 made any change to my score)

[Image: lTfPtUX.png]

QAL

links to your past images:
http://imgur.com/9eKJgZ0
http://imgur.com/lTfPtUX
http://imgur.com/lKsN0wY
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#7
RE: 1 year with CPAP, can't consistently stay under 5 AHI
As Ajack suggested, you should minimize the calendar and remove the pie chart which makes more of the statistical data visible in your posts. To minimize the calendar just click on the black triangle to the left of the date.  (You can get it back again by clicking the same triangle.) To remove the pie chart, click on preferences in the file pull down menu, select the appearance tab, and uncheck the box for the pie chart.
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#8
RE: 1 year with CPAP, can't consistently stay under 5 AHI
Thank you for the advice so far and thank you Melman for telling me how to remove the calendar and pie chart.

I've attached my stats from last night.  I went ahead and reset my MIN to 12 and Max to 16.  Maybe I should start with 11 and 15 as someone else suggested for the first week.


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#9
RE: 1 year with CPAP, can't consistently stay under 5 AHI
That's a lot better, where the side bar and chart meet, if you move your mouse around there till you see the two arrows, if you the left click, you can squeeze the sidebar in size and make the charts bigger.

if you want to reduce the pressure you can or increase the flex to be more comfortable. The priority at this stage is to keep the mask on while getting into the treatment pressure range for the OA/H.
although a different brand, we are trying to duplicate page 33 and then see how the CA are going.
https://www.resmed.com/us/dam/documents/...lo_eng.pdf

If you were asleep most of the night, the treatment pressure is going to be closer to min 14-18 max at this stage. the dreamstation is slow to respond.

Positional therapy may help. Do you think you stick your chin to your chest or prop up your head on pillows? Some find a $10 soft foam cervical collar can help to keep the airway open. you need to make sure you're chin up and head back.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#10
RE: 1 year with CPAP, can't consistently stay under 5 AHI
Events are more obstructive than anything else suggesting either higher pressure or you might get considerable relief from positional therapy in the form of a soft cervical collar. We have seen a lot of people turn around CPAP therapy using the soft collar, and the cost is certainly low enough it is worth a try. Your median pressure is 13 and that would seem to be a reasonable minimum; however if the obstruction is caused by your head and neck being in poor alignment, the soft collar will surprise you.
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