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AHI too high
#1
I have been using my CPAP machine for 3 years. Recently my AHI is too high. I am using the auto pap with a range from 5-10.5. In June my doctor had prescribed 5-9 but as my ahi was rising I increased the top pressure by .5 gradually as my ahi was too high. Attached are screen shots from last night. Any suggestions?

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#2
You should be adjusting the bottom pressure up to take care of the Obstructives, and at the same same watch that you don't raise your max pressure any more than necessary as that may cause more clear airway events.

If you are using ramp, you could turn it off. With such a low starting pressure, it won't help.

From your pressure graph, it looks like you would do better with a minimum pressure of 6 and eventually ending up around 7, and keep your max pressure where it is now unless you see on the graphs that it is topping out there for a good part of the night.




OpalRose
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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
thanks for your reply. I noticed you have ?Flex 2. My script was for C-flex 3 but the DME provider turned it off at one point, when fitting a new mask and I didn't realize it. This June when a different person came to change the script, she noticed it was off and asked if I wanted it back on. She set it back to C-flex 3 which I didn't like that night. In reading about the machine, I found that when using auto pap it should be set to A-Flex not C-Flex. Is this correct? I have reset to A-Flex 2 which seems to be ok. I do use the ramp feature when I wake during the night and the pressure is high so I can get back to sleep. If I reset the bottom number to 6, I probably would have trouble getting to sleep initially and back to sleep during the night.
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#4
It's ok, as long as the ramp helps and you are comfortable with it.

AFLEX is a comfort feature to help you breath out against the pressure. It doesn't really kick in with a start pressure much below 6.

As far as the flex setting goes, I have tried all three settings, and 2 seems most comfortable for me.
Everyone is different, so try the different settings and see what works best for you. I have also tried CFLEX in APAP mode, it is a slightly different feel. I believe AFLEX works better.

I had to go back and read your first post. You're not really new at this, so I assume you can make your own pressure adjustments if needed without depending on DME?

I would still move the minimum pressure a bit, and watch your data on Sleepyhead.

OpalRose
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How to Organize and Post ScreenShots

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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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#5
You could set your minimum therapeutic pressure to 6 and use ramp when you initially go to sleep as well as when you have awakened at night you should be OK .
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#6
I'm no expert, but the fact that his 95% pressure is the max allowed says to me he might need to up both his min and his max pressures. That machine is trying to go higher than it's being allowed.

Look at the 3rd screen cap, there are a whole bunch of OAs and the machine is maxed out.

Personally I'd try 7 min and 12 max and see how things go.

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#7
Did the doctor prescribe the pressure after a titration sleep study?

Looking at your charts, you are having clusters of Obstructive events while your machine is maxed out at 10.5cm. You need to raise the pressure to make sure you are not having Clusters of OA.

I would raise my pressure to a range of 8-12 and evaluate for 7 days. You can use A flex at any setting you find comfortable.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#8
thanks for all the reply's. Yes after my sleep study, I was placed on auto from 5-16. The pressure would rise so much, it would blow the mask right off my face. At my next appt, after reviewing my stats the dr. said that 95% of the time my pressure was 9 so she changed it to 5-9. Recently as my AHI was increasing and I don't see her until next June, I increased the top pressure to 10.5, gradually. Most of the time, it still is in the 9-10 range at 95%, and the AHI ranges from 5-8 which I still think is too high. The night I inserted was the worst I ever had. I will try increasing the bottom to 6 and report back. thanks.
   
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#9
Raising minimum to 6 will not help. Because aflex kicks in at 6 and makes your effective EPAP to 4. It will give you more OAs.

If you are using aflex in any setting (X11.x2,x3), you really need to push your min pressure to 8 to see an effect, in your case. With aflex on and machine pressure of 8, you are essentially running at IPAP of 8 and EPAP of 6.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#10
[quote='AshSF' pid='138815' dateline='1447704373']
Raising minimum to 6 will not help. Because aflex kicks in at 6 and makes your effective EPAP to 4. It will give you more OAs.

so should I turn off AFlex? and leave settings the same?

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