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AHI going higher
#1
It has been 3.5 months since I started my CPAP therapy. At first, my AHI numbers were always below 1, but now I am often seeing numbers in the range of 2 or 3. My best guess is that this may be a result of me getting more deeper sleep now, compared to the first few months of the therapy. While these numbers are still good, and are no reason for concern, I definitely don't want to see them going even higher.

Now I am at 8 cm H2O. When I started 3.5 months ago, the pressure was only 6, and my AHI was always below 1. I was gradually increasing it, allowing me to breathe easier, and still maintaining the same level of AHI. I have been at 8 cm H2O for about a month, and just recently started noticing AHI creeping up slowly. Last week's AHI averaged at 1.49, while last 30 days were at 1.90. Should I maybe go higher or lower with pressure, or leave it as is?

Here's the chart from last night:

[Image: IGsLKOD.png]

http://imgur.com/IGsLKOD
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#2
If the pressure is higher than you need, it may affect the levels of CO2 vs O2 and those are involved in triggering apnea.

Here's an experiment for you:
You might try backing off some for a week and see if the average AHI for that week is lower than the preceding week.

Check if the results are repeatable as follows:
Try it back at the higher level for a week, then again at the lower level for a week.

If you can demonstrate a difference in average AHI for the lower pressure weeks than the higher pressure weeks, you'll know which direction to take the pressure changes.
                                                                                                                                                                                  
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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#3
ppca,

The data that you posted shows almost half of the recorded events are CAs. More pressure is not going to bring the number of CAs down, and it could make the number of CAs get worse.

You write:
(05-06-2017, 11:40 AM)ppca Wrote: It has been 3.5 months since I started my CPAP therapy. At first, my AHI numbers were always below 1, but now I am often seeing numbers in the range of 2 or 3. My best guess is that this may be a result of me getting more deeper sleep now, compared to the first few months of the therapy. While these numbers are still good, and are no reason for concern, I definitely don't want to see them going even higher.
When your AHI < 1.0, what was the OAI? What was the HI? And what was the CAI?

On the night you posted data for, your AHI = 2.16, your OAI = 0.0, your HI = 1.24, and your CAI = 0.96.

There's not much room for improving the obstructive events since OAI + HI = 1.24, which is pretty darn low. So in my humble opinion, more pressure is not likely to make much of a difference in terms of the obstructive events, but it could trigger a few more CAs that you are currently seeing.

If this were my data, I'd focus a lot more on How Am I Feeling? than What is the AHI?.
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#4
With regards to CAs, this was not a typical night. Normally, the vast majority of events are hypopneas.

When I was first diagnosed, the doctor prescribed CPAP at 9 cm H2O. But that was 3 years ago. So when I finally decided to re-start my therapy (this time obviously persistent to stick with it), I started at 6, and gradually increased it to 8, closer to what the original 3-year old prescription was.

I should try, as per Beej's suggestion, drop it down a bit, maybe to 7.5 or 7 and see how that works. Ideally, an APAP machine would be better, but it's not an option for the time being, as I already paid for this this ResMed CPAP machine, and it only has 500 or 600 hours on it.
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#5
What I see in your results is a high level of flow limitation which correlated somewhat with the hypopnea. I don't think the CA is a particularly important issue, but I think we can kill two birds with one stone. Just reduce EPR to 1. This will result in 8/7 pressure which should alleviate the FL and some hypopnea, and the lower pressure difference usually has a positive effect on CA. We can improve the numers, but don't overlook Robysue's advise that how your feel is most important.
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#6
as a novice, I think you don't really need an auto, as a priority, you are titrating it well and you are running low pressure. I'd think about turning the EPR off and seeing if it helped the centrals, It may let you increase the max a bit more for the hyponemia ones.
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#7
Thank you, folks. I will drop EPR to 1 and see what happens.

As to how I'm feeling, frankly I don't see a huge improvement. After years without treatment, it may take time to start feeling better, at least that's what I'm hoping for. Secondly, I am guilty of often (not every time) pulling off my mask in the morning, for the final couple of hours of sleep. I know I should quit that habit, but it feels so good to be able to turn in bed freely. This is something I do now much less than in the beginning of the treatment, and hopefully I will eliminate it completely.
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#8
I use a pool noodle with a 12 inch long slit in it to put the hose, I cut out a section when the hose goes in and out. I stick this between the mattress and the headboard. the elastic properties of the pool noodle makes a good hose keeper. you can also buy hose keepers.
I found that all the PR pictures of cpap are wrong, the tube needs to go behind your head, some use a hook on the wall/bedhead and elastics or belt ID card retractors
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#9
I use the bed headboard to run the hose and bring it down, so it is above my head, with enough slack to allow turning on either side. It is as good as it can get, very similar to what those advertised hose hangers do. It still feels better without any hose at all, but I'm getting there. Already had quite a few nights, when I did not "cheat" by pulling the mask off.
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#10
when you wake up thinking you haven't got the mask on, but it is.... you know you are there
your senses wake up later than you do
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