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AHI is all over the place. Any thoughts?
#1
AHI is all over the place. Any thoughts?
I was initially diagnosed with mild sleep apnea with an AHI of 19.1. For treatment, I was set at a fixed pressure of 8. While using that setting for 100 or so days, I averaged an AHI of 9.32. However, my AHI was never below 5 while under treatment at that pressure. I saw my doctor to discuss updating my treatment, but my DME never linked up my account, so we couldn't review and update my treatment. What was suggested was that I try different mask options to see if one works better. While testing out the new masks and waiting for my next follow-up, I am hoping that someone can provide some insight as to what I can do. 

With the Philips Respironics DreamWear Gel Pillows Mask, I was finally able to get some days where my AHI was lower than 5, but only slightly. I felt great during the initial month of treatment, but since then, I feel that my energy level is back to where it was prior to treatment. 

Please note that I was also given a full mask to try, but I felt too claustrophobic, and felt that I couldn't breathe. From time to time I use the chinstrap, but I'm not sure it does anything for me, and the best nights I have had have been without it. 

Many, many thanks in advance!


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#2
RE: AHI is all over the place. Any thoughts?
I would start by turning the Flex setting to off. Then watch a couple days to see if there is a difference. Hopefully, the CA readings would come down.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com
Dreaming


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php...ganization
Using Attachments to Post ScreenShots.
Mask Primer
Machine Choices



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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#3
RE: AHI is all over the place. Any thoughts?
Thanks, will give that a try!
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#4
RE: AHI is all over the place. Any thoughts?
I tried using my machine with flex turned off but I couldn't get used to the constant high pressure. I was getting a headache trying to exhale at a pressure setting of 7.5.

I realized that my flex setting was set to 2. I changed it to 1 and so far my AHI is around 5. Better than my highs before but I would surmise it's still not low enough.

Any another suggestions?
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#5
RE: AHI is all over the place. Any thoughts?
Not enough information. Would you prefer a guess or a suggestion based on the facts that your daily charts would provide?

the guess, set your pressure to 7. I would still strive to turn off flex, the pressure is lower.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#6
RE: AHI is all over the place. Any thoughts?
Hi Robmooe,

There is a wealth of collective wisdom here that is borne out of years of experience but they can't really help if you don't provide them with more data from your machine. Ergo, they need to see more of your charts. Also, refer to Bonjour's link on his signature on how to organize your charts.

Welcome to Apnea Board! You've come to the right place.
hearsay73
Hosehead padawan 
Repaying my sleep debt, 1 night at a time...
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#7
RE: AHI is all over the place. Any thoughts?
I'd say not enough pressure for proper treatment, You just gotta get used to exhaling against pressure, it took me a good 6 months to be able to tolerate anything above 5. Now after 3 years I can easily breathe against 12.

You do have a few options if 6 months isn't something you'd wanna wait for.

1. Get a bilevel
2. Get a proper mouthpiece that will enhance your low pressure therapy.

Whatever route you will go, with time you will be able to raise the pressure without any side effects like headaches.
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#8
RE: AHI is all over the place. Any thoughts?
Here are some additional screen shots from the last two days. on the 20th, I had flex turned back on. On the 21st, flex was turned off again, and my pressure was set to 7.


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#9
RE: AHI is all over the place. Any thoughts?
Note that flex off is managing your Centrals. Be aware that Centrals can vary all over the place for no apparent reason but they look good now.

Could you please post a copy of your diagnostic sleep study. The full copy, not just the summary. All to often the summary doesn't mention Centrals and it is good to know if they exist prior to CPAP.

Now to the obstructive Apnea.
PR machines are slow to respond to obstructive events. So we help them along with higher starting pressures. Start with increasing the min pressure by .5 and wait 2 or 3 days to get used to it before we try again to let your body get used to it.

Post results as you get them.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#10
RE: AHI is all over the place. Any thoughts?
robmooee,
Having used a Respironics machine now for almost 5 years, and playing around with the Flex setting, I know firsthand that using it (for some folk) will never yield great results.  
A setting of 3 is horrible (really disrupts breathing),  2 is ok, 1 or OFF works well for most.

There will always be a trade off between lowering the CA’s and/or trying to lower the Obstructives.  You also have some FL driving your pressure.  You will need to find that balance and what makes you feel best in the morning or gives you the best possible night sleep.

I suggested in my post #2 above to turn Flex off, which you tried and felt you couldn’t breathe out against the pressure.  Understandable!  When I first started, I couldn’t imagine how anyone could exhale at a pressure of 4.  This feeling will change as you get used to the pressure.

With the changes you made, CA’s went down and Obstructives, Hypopneas, Rera’s up a little.

Of course, it’s only been a couple nights.  You need to give it time.  

Good job on the charts, but going forward, please revise and drop and pie chart and calendar.
This way we can see the stats that are below that.  

Also, unless asked by someone, you can whittle the charts down to only showing the following graphs:  Events, Flow Rate, Pressure, Leaks. Include left sidebar, minus pie chart and calendar.
I suggest you keep Flex turned off.  

I know...we’re picky... Rolleyes
OpalRose
Apnea Board Administrator
www.ApneaBoard.com
Dreaming


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php...ganization
Using Attachments to Post ScreenShots.
Mask Primer
Machine Choices



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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