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AHI still too high
#1
AHI still too high
Greetings!

This is my first post here so I'll give a little background. Last year I was finally officially diagnosed with "Severe" Sleep Apnea at 62 AHI. The diagnosis described mostly OSA, with some central and mixed apneas. I was given a Philips DreamStation APAP, the DSX500 model. Because I'm a mouthbreather, I chose the ResMed F30 and it seems to mostly work well for me, only occasional leaks (sometimes I'll pull the magnets off in my sleep).

With APAP, my AHI varies between 4-12, usually being around 6-8. My doctor increased the pressure from the minimum of 4 (just to get me accustomed to using this thing) to 6. She commented that my AHI is still too high, but she didn't increase the pressure any more.

I'm also not entirely clear on the periodic breathing and whether I should be concerned about that. OSCAR says my median is 2.68, max is 9. There's more data in the screenshots.

Am I even using the right machine for my condition? What pressure should I use? Anything else you notice in my data that I need to address?


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#2
RE: AHI still too high
Welcome to the forum.

First, because it is obvious, you are tucking your chin which is causing Obstructive Apneas. See the clusters of OA events? That's the indicator. The fix is a Soft Cervical Collar, see the link in my signature. We also have called this positional Apnea though that term to a doctor means side, back, front. The 0.68 psi (20 cmw) your macine is capable of is nowhere near enough pressure to fix this. All you have to do is stop your chin from tucking into your chest. Do to the existing Flow Limits, Hypopneas, Snores, RERAs you should bump up the min pressure a little, so Min pressure = 7 looking to increase it to 8 but taking it slow, in steps. Here I want to see the impact of the collar before going to 8. This pressure increase is needed because you are using a PR machine and their algorithims are slow to respond so min pressure needs to where needed so it can automatically raise pressure to avoid a future event. Min pressure on a PR using Flex should never be lower than 6, that and o and 5 most adults just find as not enough pressure so again 6 min but we are going to 7 today.

To evaluate your PB we would need a 5-min zoomed view of the flow rate during the PB event. I don't believe your PB is of a concern as the durations are short. Resolving the events, which we are working on should manage that. Your CA events are not enough to worry about right now, we will address them later likely by reducing or eliminating your flex.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#3
RE: AHI still too high
Really simple problem to solve this and bonjour is right on top of it. First, let’s quit messing around with ineffective pressure and set the minimum to 8.0. That is going to be effective and reduce the disruptive pressure variation. The call fo a soft cervical collar is essential. It’s inexpensive and has solved this problem for hundreds of forum members. Be aware your doctor is completely unaware of this aid. Read the positional apnea wiki http://www.apneaboard.com/wiki/index.php...onal_Apnea then check out the soft cervical collar wiki in my signature.
Sleeprider
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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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#4
RE: AHI still too high
I've been using the cervical collar for about a week now. Results from OSCAR seem to be all over the place. Some nights it's under 5 AHI and things look pretty good, other nights the AHI graph shows it climbing up to 40 for part of the night.

One thing I'll note is that I toss and turn in my sleep, so if I start out side-sleeping on my pillow, I might switch to laying on my back still on the pillow, which is not something I would find comfortable if I were conscious. Sleeping with no pillow doesn't really work for me either, since at some point I'll be on my side and that puts my neck in a bad position too.


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#5
RE: AHI still too high
I to tried sleeping without a pillow, for about 2 weeks-I couldn't do it.

So, I made my own pillow out of 2 layers of 2 inch memory foam. I could sleep some, but no where near adequate. After another 2 weeks, I went back to the old pillow.

Throughout the years, I've tried different styles of pillows-which also didn't improve my sleep.

I'm don't know the reason why humans can't sleep without pillows.

GL

AB
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#6
RE: AHI still too high
What collar are you using? Results appear inconsistent so you may need a different fit or model. The clusters of apnea still point to a SCC as the best solution.
Sleeprider
Apnea Board Moderator
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____________________________________________
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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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#7
RE: AHI still too high
Agree with sleeprider, your collar is not fitting correctly. It’s clear from the continued clusters of events.

I’d also advise that you turn off the Flex setting. It’s disgracefully bad at what it’s supposed to do, not sure how Phillips got away with it. It produces negative results in many cases and is worth ruling out
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#8
RE: AHI still too high
Then I'm going to have to use 2 collars or somehow attach more foam to the collar, because I got the tallest (widest?) one I could find, but I'm a tall fella with a neck that could compete with the sauropod dinosaurs.

What is the flex setting? What does it do?
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#9
RE: AHI still too high
Years ago, I made my own collar out of layered 2" memory foam from a mattress topper. If you want to experiment before spending $$ for a commercial product, you might try this.

It should be ok to supplement an existing collar and it is significantly 'stiffer' than the typical foam, which might be desirable in your situation. A sharp knife can be used to round off or taper otherwise square edges.

If memory foam is used, don't place it next to the skin, it is closed cell so it might cause sweating if placed on the skin side of the collar.

Be safe.

AB
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#10
RE: AHI still too high
Maybe check out the Corflex Ultra collar in 4-1/2" height. The have many circumference sizes.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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