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AHI Score Does Not Go Down on CPAP
#1
I am new to the Apnea Board, but not to Sleep Apnea. Until recently I was using a Respironics BiPap. The machine began to shut itself off and on all night long. Rather that repair the machine, my insurance company wanted a new sleep study. I had a new sleep study and a second night for titration. I was found to have an AHI of 12.5 and was prescribed a CPAP of 8. My insurance provided me with a ResMed S9 Autoset. I “allowed” myself to see the nightly AHI score by accessing the clinical set-up screen. My first night was 12.1. The second night I turned up the pressure to 12. My AHI score only improved to 10.2. I have a new full-face mask and from what I can tell, there are no leaks. Essentially there is no or only little improvement on CPAP. What is going on? Thanks for any assistance.
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#2
Hi Theo and welcome
Why have you been prescribed BIPAP and what the breakdown of AHI (AI, HI, CAI)
Just a thought ask the Doc to try the S9 in AutoSet mode range 8-15 see how it goes, If leaks under control than the S9 wouldn't go any higher than necessary and it can distinguish between obstructive and central apnea.
You can download ResScan software from here and it shows more info.
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#3
(04-05-2012, 06:32 PM)zonk Wrote: Hi Theo and welcome
Why have you been prescribed BIPAP and what the breakdown of AHI (AI, HI, CAI)
Just a thought ask the Doc to try the S9 in AutoSet mode range 8-15 see how it goes, If leaks under control than the S9 wouldn't go any higher than necessary and it can distinguish between obstructive and central apnea.
You can download ResScan software from here and it shows more info.

Thanks Zonk! I was on BiPAP for a few years. I am looking at the 2008 titration study (I don't have the sleep study) which indicated that I failed continuous positive airway pressure. "Successive bilevel airway pressure trial at 15/11. Bilevel pressure at 15/11 revealed an apnea hypopnea index dramatically reduced to 0.8. SA02 improved and snoring resolved." Thanks again Zonk
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#4
You could leave the pressure at 12 for a few nights, maybe a week. Let your body adjust. Then raise it another notch if needed. Rinse, repeat.

Or you could raise the top number to 15 (what the 2008 sleep test said) and the lower number to 10 or 11.

With either option, let your body adjust to it for several weeks. This will not only let the body get used to it, but will also start to show trends in the treatment results. One or two nights is not enough. Some nights, you may sleep rough. Other nights, you'll sleep good. So letting the data gather for a while then look at a bigger picture.

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#5
(04-05-2012, 06:05 PM)Theo Wrote: My insurance provided me with a ResMed S9 Autoset. I “allowed” myself to see the nightly AHI score by accessing the clinical set-up screen. My first night was 12.1. The second night I turned up the pressure to 12. My AHI score only improved to 10.2.

In my opinion, you are over reacting. I wouldn't recommend changing your pressure based on only one night's sleep.

Why don't you leave it set at your original prescription for a week or so and see how things look. If, for example, your high AHI is due to central apneas, raising the pressure may just cause your AHI to go up!

Let your body get acclimated to the new machine before you conclude it needs adjusting. Just my two cents worth.
Sleepster
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#6
(04-05-2012, 07:50 PM)Sleepster Wrote: In my opinion, you are over reacting. I wouldn't recommend changing your pressure based on only one night's sleep.

Why don't you leave it set at your original prescription for a week or so and see how things look. If, for example, your high AHI is due to central apneas, raising the pressure may just cause your AHI to go up!

Let your body get acclimated to the new machine before you conclude it needs adjusting. Just my two cents worth.

Sleepster is right, especially about the higher pressure possibly causing more central apneas. In my sleep study, I had 0 central apneas, but during my titration study I had 29 due to having pressure and having that pressure adjusted. Pressures over 10 cmH2O are known to cause more central/clear airway events. However, those events are preferable to obstructive/hypopnic events because they don't cause stresses on the body like the others do. (Unless you have a really high number of centrals, and/or a long duration of them accompanied by low oxygen saturation of your blood)

When I first went from a pressure of 9 cmH2O to 12 cmH20 (they set my first CPAP to the wrong pressure at the DME, and I had that pressure for two weeks until I got my Autoset), I had an increase in central/clear airway events, which caused my overall AHI to look high. However, the important part, the obstructive and hypopnea readings, were nice and low. As I got used to the higher pressure over a couple weeks, my overall AHI dropped into the 0.5 - 2.0 range because I stopped having as many central/clear airway events.

It is important to know what makes up your AHI and not to react and make changes based on just one or two nights of sleep at a new setting.

(technically, ResMed measures clear airway events and can't distinuguish them from central apneas because it doesn't read brain & other activity needed to fully determine they are central)

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#7
OK heres my 3 day AHI

Day 1 - 2.1
Day 2 - 16.4
Day 3 - 4.6

I havent changed anything, why? because this does happen, maybe I had a bad dream or a good one or as sometimes happens maybe I strangled myself with my hose. You have to learn to smile sometimes at the data and not to take it too seriously. A change in pressure should be watch for at least 2-4 weeks because your body has to adjust and that doesnt happen in a few days. It took me months to move from a 6 to a 10, also when I reached 10 I engaged the EPR. My advise and Im sure lots will echo this is wait and see what happens, take notes in a book and write down what happens over a few weeks or month then if no change it again and take notes. Another point is that sometimes you need to go down in pressure instead of up but make sure you makes notes to see because you will forget. Hope this helps

Welcome

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#8
(04-06-2012, 01:37 PM)Dreamcatcher Wrote: but make sure you makes notes to see because you will forget. Hope this helps

This. Write it down. Dates. Pressure change. Reasons why.

Later, you can take this to your doc.
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#9
(04-06-2012, 01:40 PM)PaulaO2 Wrote:
(04-06-2012, 01:37 PM)Dreamcatcher Wrote: but make sure you makes notes to see because you will forget. Hope this helps

This. Write it down. Dates. Pressure change. Reasons why.

Later, you can take this to your doc.



I tried Zonk's suggestion of using 8 and 12 in the Autoset mode. AHI scores have been consistently under 5. In reviewing the data on the SD card, I found that AHI’s are now mostly under 2, except for an occasional spike. I assume these spikes drive the mean score up.

I very much appreciate everyone’s input. Thank you all.
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#10
Glad it's working better for you, Theo.
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