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AHI 9.44 need help getting it down/new post
#1
AHI 9.44 need help getting it down/new post
i need help getting my ahi down, i set the pressure to 11.5/17- i changed the ramp to start at 7 from 5 in the middle of the night as going from 15 to 5 was to much.
i set flex to 2 as I'm still adjusting to cpap.
i have 3 weeks of cpap use.
the doc. had  the pressures of 5 to 15 to start and my ahi was in the high 20's with an 90% of 11.
i set it to 11/15 and got a ahi of 10.61
so i tried 11.5/17 last night and got a ahi of 9.44. with 90% @ 15.7
I think ill try 15/17 next?

[Image: sCOdup7l.png]
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#2
RE: AHI 9.44 need help getting it down/new post
I do think you need to increase the minimum pressure some more.  But whether jumping from a min pressure = 11.5 to a min pressure = 15 in one day is a good idea is another question.

If you are NOT having any problems with aerophagia and you don't have any real problems tolerating the pressure at 11.5, then maybe you can handle going from 11.5 to 15 in one night.

But if this were my data, I'd be a bit more cautious.

First thing I'd do is set the ramp as high as I could comfortably tolerate it.  Would starting the ramp at 9 cm feel ok? Would starting the ramp at 10 or 11 in the middle of the night feel ok?

Second thing I'd do is I would make sure the ramp is set to Smart ramp in the clinical settings.  Smart ramp doesn't necessarily do a linear increase from the time you turn the machine on. Instead, it uses a modified version of the Auto algorithm to respond to events during the ramp period.  It also looks for nice steady sleep breathing to kick in before the end of the ramp period, and it will increase the pressure (linearly) after it's pretty sure you are asleep. Finally, it will increase the pressure (linearly) just as the ramp period is set to expire.

Third, I'd increase the min pressure setting by 1cm at a time every few days until the AHI comes down to where you want it to be OR unless you start seeing more CAs than any other event.
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#3
RE: AHI 9.44 need help getting it down/new post
ditto of robysue, as I mentioned in your last thread on basically the same subject:

http://www.apneaboard.com/forums/Thread-...#pid214875

when we help you, it is great to know that there was a whole thread showing your past history.

QAL
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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#4
RE: AHI 9.44 need help getting it down/new post
its said not to make big changes to pressure but i only been using cpap for 3 weeks with it on for 
3 to 4 hours before i took it off do to mouth leaks.
the last 2 nights i been taping my mouth shut and now I'm getting over 6 hours of cpap use
before taking it off.
i only have around 9 days of using cpap over 4 hours.
my thinking is when you do a sleep study and they set your pressure they don't start you off low
and slowly up the pressure, they set it to the pressure that gets rid of apneas.
i did the sleep study and they did not put me on cpap so the doc, put a range of 5 to 15 on it.
5/15 setting i was getting ahi's in the high 20's. with spo2 drops of around 300.
the 11/15 setting my ahi was 10.6 and my spo2 drops = 36
the 11.5/17 my ahi was 9.44 and spo2 drops=19
I think i have the high setting right at 17, its showing my 90% pressure at 15.7
so going by my 90% pressure I'm guessing a starting pressure of 15/17
is it possible to have obstructed apneas that don't go away at any pressure?
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#5
RE: AHI 9.44 need help getting it down/new post
First thing is to keep your mask on. If you are laying down, the mask is on, no excuses. Get up for a while if you want to. Some need to use lower pressures at first. It is a hard at the beginning, but I think dragging it out doesn't make it easier.

I think you are getting the hang of looking at the results and seeing what needs changing
"I'm guessing a starting pressure of 15/17"
A min 15cm would be a good target. The dreamstation is a slow machine to react and needs to be closer to the 95% than the resmed.
I'd get the max out to 20, to be out of the way. Would be my only suggestion.
Are you sure the positional apnea is sorted? you aren't putting your chin to your chest and need a better pillow or a soft foam cervical collar.


It also helps to post the charts in the same thread, we can follow the history and what has been tried already.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#6
RE: AHI 9.44 need help getting it down/new post
I guess we hesitate to tell folk to make big jumps in pressure increases for a few reasons, but if you don't suffer from Aerophagia or Central Apnea and the higher pressure doesn't bother you, then try raising your pressure 1cm each day and watch your results.  Better than making a big jump in pressure in one day.

I also agree with raising the ramp.  You are using a Phillips Respironics machine which will take longer to react to apnea events, so the ramp should be set closer to the minimum pressure.
Sleep-well
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE.  ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA.  INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: AHI 9.44 need help getting it down/new post
precisely why the old thread should be read and available.  also the op eliminated the first few posts due to size and not being on imgur yet.

Sleeprider, ajack, and op all confirmed presence of CA in abundance both in the sleep report and the first few posts.  this is why we all suggested to go slow.  Here is SR's post:

http://www.apneaboard.com/forums/Thread-...#pid214723

Here are some of the original charts from chicken

[Image: HidBjHA.jpg]

[Image: CYvXwFW.jpg]

[Image: IHU1cYm.png]

[Image: M8Kwpqz.png]

maybe the problems resolved themselves.  who knows?

QAL
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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#8
RE: AHI 9.44 need help getting it down/new post
my CA's could be caused by my medication? 120 mg of morphine plus two 7.5/325 percocets a day.
i do not fit the average sleep apnea person as I'm 6 feet tall and 150 lbs neck size 18.
had fatigue all my life, remembering going to bed by 8 pm so i could make it thru school in the 7 grade.
had the surgery in my early 20's around 1996, and they drilled out my nose too, was told it fixed me after sleep study.
I'm told sleep apnea could be from my medication?
there are no restrictions in breathing thru my nose after they drilled it out, can't figure on why i need such high pressure?
starting at 11 seems high to me but when i wake up and its at 11 it seems a little restrictive.
i am starting to see big improvements in the spo2 drops from 300 to 40.
just need to get the ahi,'s down.
i sent the DME an email, i need a chin strap and/or a full face mask, my nose mask seems to leak at high pressure 
and i have mouth leaks plus it makes my nose itch. i have to crank it down to keep it from leaking.
Reno NV has sh**ty medical service no one has contacted me to see how my cpap is working.
took me 3 months to get the cpap.
ill keep up ing the pressure till the OA's and H's go away or CA's become an issue.
should i use the smart ramp?
i set my cpap to 15/20 with a ramp at 7 for 15 min. and flex-c to 2. 
i like the flex-c to bad its not on a timer to go off after I'm asleep.
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#9
RE: AHI 9.44 need help getting it down/new post
yes opiates will give CA. You would be better working with a pain clinic and other meds, even if you didn't have apnea. The opioid epidemic in the US is causing untold problems, from what I gather it's being used as a bandaid and masking medical problems that need sorting. The bottom line is if you are going to be on opiates and the dose is ever increasing as the body becomes desensitized and addicted. You will need an ASV.

There is no rhyme nor reason, some mild apnea needs 18cm, some severe apnea are fixed with 8cm
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#10
RE: AHI 9.44 need help getting it down/new post
Opiates are a well known cause of CA and the sedative effects also aggravate obstructive apnea. I think you have just told us the root cause of your problems. I agree with ajack, your medication is the problem here. I think continuing to adjust your machine is counter-productive without addressing the cause of the problem.

I wish you the best of luck in achieving good sleep and controlling your apnea, however in light of the fact the origin of this problem is prescription narcotics, I am out of my league, and have no further suggestions. Please talk to your doctors and advise them of this complication arising from the use of morphine and Percocete. You may need a new sleep study to titrate for ASV in the presence of opiate induced central apnea.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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