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AHI still 6~10 after 2 wks. Advice needed
#1
Question 
Sleep test indicated AHI 44. Some improvement during the day after 2 weeks treatment. But still feel sleepy sometimes in the morning or during the day. AHI fluctuated between 5.2 to 10. There are periodic breathing recorded in some of the days. Sometime more OAs and sometime HPAs. CAI improved after trying to sleep on the side.

Wisp nasal mask cardboard indicated I should use S/M nasal cup. L-size feels more comforable but have more leaks. I tried both but seems no indication on which is better. I am waiting for delivery of oximeter CMS50e to measure SpO2.

Should I set a higher min. pressure say 7-8? Any other adjustment to improve the results?

New to forum and appreciate very much on any advice. Thanks.

APAP:dreamstation
mask : wisp
pressure: min 5.5 max 20
flex : 2        
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#2
I'd definitely start moving your minimum higher. Try 0.5 cm at a time and let it alone for three days or so before raising it again. Or go faster if the pressure does not bother you. Then start working at getting your flex down, that often helps lower AHI. You have some larger leaks too. You need to get those under control for sleep and therapy quality.

You are still in very early days getting acclimatized to this. AHI fluctuations are normal. But yours is still too high. Work at it slowly, don't surprise your brain.
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#3
Thanks Chill.

I shall try and raise the pressure. Is periodic breathing something to worry about?

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#4
Starting by raising the min pressure will help a bit. You got a bit higher OA which is what CPAP is for. Make sure your mouth closed during sleeping or else you will get a higher AHI too. Better use the M nasal the L is leaking. Your DreamStation has a leak test setting after wearing the mask so try it out.
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#5
(09-03-2016, 02:07 AM)joema54 Wrote: Thanks Chill.

I shall try and raise the pressure. Is periodic breathing something to worry about?

Chill's suggestion should handle the Clear airways as well as the Obstructive events. The CA events are probably the result of the pressure differentials.

Rich
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#6
joema54
Welcome to the forum. You have found a great resource to help you understand and manage your own therapy.

Let's try and clear up some contradictions in the data set you posted
You profile says CPAP Pressure: 5-20
in your salutation it say 5.5-20
But on your stats it appears that you max is set @ 16 and your EPAP @ -1

Since your average pressure according to your posted stats is 10.13 and your 90% pressure in you stats is 15.2. I believe the best adjustment you can make is to set the low @ 8 (about 2 below your average) and set your high at 16.3 (1.0 above your 90% )

Please note the Journal of sleep medicines clinical guidelines for APAP titration when on constant pressure, does not recommend pressure above 15. Since your maximum pressure is above 15 you should be using some type of pressure relief (EPAP) for right now. (you may find when you have more data you don't need it) You may also want to discuss the possibility of Bi-level therapy with your sleep doc if you need pressure higher than 15

It would be good to leave the machine at the same settings for several days (some will say at least a week) before you have a good enough data set to do any additional data analysis and make changes to these settings.



.









2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
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#7
You can zoom in on the PB section and post that. However, I doubt it is anything to be concerned with. I also get that one in a while. A lot of us do. It is periodic, no doubt about that, but mine is far from Cheyne-Stokes which which is what could indicate a problem. Thas is usually associated with heart problems. If that is something you have, then keep an eye on it and consult a doctor if it starts happening more often and more than once a night.
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#8
You're new to therapy, which means the AHI may go down on its own.

My biggest concern is the leak rate graph. It shouldn't be rising and falling like that. I recommend a chin strap or a full face mask.

Your AHI is dominated by OA's and you're hitting your maximum pressure for 5% of the time. Those indicate that the upper end of your pressure range (currently 16 cm) might be too low. I also agree that the lower end could be raised. But before you do that there are a couple of quesions to answer.

Does the high pressure bother you? If not, you can consider raising it. Either now or later if you prefer to wait. I don't think there's any hurry because of what I said in my first paragraph.

Do you have trouble falling asleep? If not, you can consider raising the lower end of your pressure range as recommended by others. There's little harm that can come from doing this, especially if the pressure isn't interfering with your ability to fall asleep.

I'm more concerned about raising the upper end (the 16 cm) as that can raise your AHI by inducing CA's. I'm even more concerend about your leak rate. When you leak like that your machine can't maintain the pressure splint needed to keep your airway from collapsing, so you're essentially right where you'd be when you're without CPAP.
Sleepster
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#9
Hi joema54,
WELCOME! to the forum.!
I wish you good luck with your CPAP therapy and getting it fine-tuned to meet your needs.
Hang in there for more responses to your posts.
trish6hundred
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#10
Thanks for the great advices from the many fellow members. Really appreciated.

I raised the minimum pressure to 6.5 and used the medium size mask last night. It seems that leak was better controlled with leak rate for 95% went down to 11%. AHI was 6.13. Maxium pressure was only 10.2 with 90% at 9.2. Both CAI and OSA went down to 1.5. Just the hypopnea index went up t0 3.07. I shall use the same setting for a few more days and observe. Unfortunately I have to go for a business trip and can only resume treatment a few days later.

BTW, what is the significance of EPAP? How can we set or alter settings to manage this?
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