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AHI still high after 2 months of use
#1
AHI still high after 2 months of use
Hello everyone,

This is my first time posting here so if I leave out any important information please let me know. I was originally diagnosed with severe sleep apnea in June, with an AHI of 31.9 consisting solely of Hypopneas. I'll attach a copy of the sleep study in this post. I started CPAP therapy in the middle of July using a Resmed AirSense 10 AutoSet. I got an SD card for the machine several days after using it so I have OSCAR data for most of the time between starting the therapy and now. I currently use a Resmed Airfit F20 mask because the silicone masks seem to irritate my skin.

Looking at an overview of my OSCAR data, it's apparent that I go over 5 AHI pretty frequently. I tried to talk to the ENT who prescribed me the CPAP about this but he just told me to call the DME that supplied the CPAP and talk to them about it. When I did that they tried witching it to a fixed pressure of 12 to see if that helped. I didn't feel any better and my AHI still fluctuated so I switched back to APAP after about 10 days. I spoke to them again and they pretty much just told me everything looked normal and that my apnea was being treated. I've been using a cervical collar to see if some of the apneas were positional but it hasn't seemed to help much. Is there anything I can do to lower my AHI and stop it from getting so high? And now that it's been two months should I be expecting the number of CA's to go down? Any help would be greatly appreciated as I'm at a bit of a loss for what to do.

Also, I have pretty bad aerophagia so if anyone has some advice for dealing with that it would be super helpful.

           
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#2
RE: AHI still high after 2 months of use
After two months, you would expect centrals to have eased off if they are treatment emergent. There may be a little positional obstructive apnea, but I think you may need to increase your minimum pressure (which might allow you to bring the max pressure down too, and help with the aerophagia and perhaps with reducing the CAs. That said, if the CAs persist at this point, you many need something else. I'd be interested to know more about those "spontaneous arousals" - because that's a LOT of times to wake up even aside from the hypops. Doctors tend to assume that all hypops are obstructive, but they CAN be central too. The problem is because you didn't have any apneas, and the test didn't differentiate between central and obstructive hypops, then we don't know for certain if you ever had a real issue with Obstructive Sleep Apnea, or it was a mixed or central issue. Centrals can't be treated with CPAP, so if your issues are mainly central, then you would need to take that to your sleep doctor. You also have pretty continuous flow limitation, which normally the recommended option would be to turn EPR on... but that often worsens central events too, so it's often a case of testing to see what helps and what doesn't.

Hopefully some of the others can be along soon to give you some more detailed advice. Smile Welcome to the board.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#3
RE: AHI still high after 2 months of use
Please show 3 10-minute zoomed views of your Central Apneas so we can see the character of the.

Set your max pressure to 13, there is no magic between the two. The goal is to minimize pressure fluctuation to hopefully limit the centrals.
Your flow limits are high so set EPR=2 to help both those and the hypopneas. If your centrals are CO2 driven, one reason I want to see the zoomed charts, you CAI may go up. Either way we needto know how you react to this.

Try wrapping a dish or hand towel around the chin point of your collar to make it taller. See if that helps your positional apnea.

Post and comment on the results including charts
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#4
RE: AHI still high after 2 months of use
Okay thank you for the suggestions, I'll try out the pressure change and EPR settings tonight. Here are the zoomed in screenshots of some of the central apneas.

           
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#5
RE: AHI still high after 2 months of use
All three of those, it looks like you've taken a big breath immediately before the CA or you've had some breathing that looks like you had a brief wake - in which case, those would likely be "sleep-wake junk" - in other words, stir for some reason (roll over, a sound, whatever) even if you don't completely wake up, you take a deeper breath or get comfy again, and the CA is just because you don't actually need to breathe quite as soon. That'd be my reading of them, anyway. You don't have the waxing and waning between CAs which is a good sign, hopefully.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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