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AHI under 1
#21
My doctor has a similar approach he adheres to a Endocrinology, Diabetes & Metabolism society that says 5 is normal, anything below that is irrelevant unless your getting zero, which mean your machine isn't working right. Consequently, he is happy as long as my worst night is <6 Thinking-about

Nevertheless I have endeavored to do what I read in the forum, and find that perfect sweet spot on the machine.

The top end was easy to set. My 95% is 14.8 and I get mask blowout at 16, so 15.8 works great. The low end setting is a little harder to arrive at. I tried to focus on the length of my sleep cycle. I saw a correlation in the length of my sleep cycle (time between awakenings) and the low setting on the machine

At my current settings I get a monthly average AHI between around .8 to.9 but my variation between nights range from 0.0- 1.6.
and the length of time between awakening has doubled
Coffee

(04-18-2016, 03:22 PM)apnea711 Wrote: My sleep doctor had low expectations. He was ecstatic that I used my machine every night and told me any AHI below 5 was 'excellent'.

But I have higher expectations and aim to get below 1.

I thought it might be a good idea to start a thread on what people have done to lower their AHI.

Mine now varies from 1 to 3, with some nights below 1. My goal is all nights below 1.

So here is what I have done.

1. Lost weight. Not much, just the 10 lbs. of fat around my middle. I lost the weight by walking and cutting back on grains.

2. Raised the head of the bed. I have GERD, so it was recommended to raise the head of the bed at least 8 inches. I had the local foam shop make a wedge that is the width and length of my queen bed, with one end 8" and tapered down to zero at the other end. The wedge goes under the mattress. GERD got better, but so did AHI.

3. No eating 3 hours before bed. I am an early riser, so I am usually asleep at 9. This means no food after 6 pm. This was the hardest thing to do but it really helped my GERD, and also lowered my AHI.

What I tried that did not work was raising my pressure. It lowered my OA but increased my CA and pumped air in to my stomach. So I set it back to what it has always been, 6 & 14 on my Respironics Bipap Auto 760P. I use a Quattro Air full face mask.

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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#22
(04-24-2016, 02:12 PM)0rangebear Wrote: My doctor has a similar approach he adheres to a Endocrinology, Diabetes & Metabolism society that says 5 is normal, anything below that is irrelevant unless your getting zero, which mean your machine isn't working right. Consequently, he is happy as long as my worst night is <6 :thinking-about:

Nevertheless I have endeavored to do what I read in the forum, and find that perfect sweet spot on the machine.

The top end was easy to set. My 95% is 14.8 and I get mask blowout at 16, so 15.8 works great. The low end setting is a little harder to arrive at. I tried to focus on the length of my sleep cycle. I saw a correlation in the length of my sleep cycle (time between awakenings) and the low setting on the machine

At my current settings I get a monthly average AHI between around .8 to.9 but my variation between nights range from 0.0- 1.6.
and the length of time between awakening has doubled

Thanks, Orangebear. This is the kind of useful information I was hoping that others would post. I don't understand the thinking of doctors that there is no useful difference between an AHI of 5 and an AHI of 1. With the former, that's 40 events in a single night. With the latter, it is only 8.

I was surprised to see that adjustments in 1/10s made such a difference. I will try making smaller adjustments on my machine. Two nights ago, I upped my IPAP from 12 to 13 to cut down on OA, which it did, but it upped my CA much more.

You said you doubled your time between awakenings. From what to what?

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#23
(04-24-2016, 04:13 PM)apnea711 Wrote: You said you doubled your time between awakenings. From what to what?

see my post at
http://www.apneaboard.com/forums/Thread-...#pid159167

I talk about my sleep cycle improvements (time between awakenings)
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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#24
(04-24-2016, 12:45 PM)JSL747 Wrote:
(04-23-2016, 11:40 PM)Dafod Wrote: Other than the big number differences I have got used to not chasing AHI. When using my A10 my AHI was 0 to 1.8 while on the PRS1 it's normally 1.2-4. But I feel better with the PRS1. Like people have mentioned I cannot accounting for confounding variables such as sleep hygiene. Also, I don't think the various machines AHI are calibrated such that they are directly comparable within 0.1AHI (at least within 1 or 2AHI). I know they should be but I have a sneaking suspicion that there is variance. I guess think of them more akin to a car speedo which is only calibrated within +/-8.7miles/hr at 62mph in Australia (although can now only show faster than actual not slower).

This is from a Post I found, but don't remember who wrote it or what thread I found it in.......SORRY, but it might help explain your AHI difference and why you prefer the PR

Difference In Algorithms:

"The PR machines in general are much slower to raise the pressure than the Resmed machines. And that is an issue for some people, but not for everyone.
On the other hand, the PR machines are also slower to lower the pressure after raising it, which is also useful in preventing more events.
What it boils down to is this: Every manufacturer of an APAP or an Auto bilevel has made their own decisions on both when and how the machine will respond by increasing or decreasing the pressure. You can see the implications of those decisions in the pressure curves of the various brands.
Unfortunately, there's not been much objective testing of those algorithms to determine which auto algorithms are actually "best" in terms of managing OSA in which patients. The only benchmark study comparing the auto algorithms from the various manufacturers that I've seen is this one from Sleep Review: http://www.sleepreviewmag.com/2009/09/a ... -pressure/
This article is somewhat old (2009) and the machines they tested are now 2 or 3 generations "old", but many of the decisions manufacturers made back before 2009 are still present in their current Auto algorithms"
"

It seems a bit odd that the manufacturers would be still using the "old" specs/algorithms , when health care has been telling patients to "replace the machine every 5 years" does anyone see a glitch here or am I over thinking this awkward scenario?? Thinking-about
I enjoy being with a group who like to share their "Hosehead" experiences, to remind me I am not alone.
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#25
what does one have to do with the other?

mechanical things wear out.
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#26
(04-25-2016, 12:26 AM)Luvmyzzz Wrote: It seems a bit odd that the manufacturers would be still using the "old" specs/algorithms , when health care has been telling patients to "replace the machine every 5 years" does anyone see a glitch here or am I over thinking this awkward scenario?? Thinking-about
Manufacturers put a lot of effort into developing the major parts of their algorithms a long time ago. They make modifications to the algorithms, with the biggest ones being detection of CAs, but the underlying "philosophy" that the company started designing their APAP algorithm with a decade or more ago still underlies the current algorithms in very important ways.

In particular, if you compare the pressure curves of Resmed S8, S9, and A10s there is not a lot of difference. If you compare the pressure curves of PR M-Series, System Ones, and DreamStations there is not a lot of difference. And the differences you see in both families are due to the introduction of CA detection: Once CAs can be detected, it changes the rules of how the APAPs react to OAs and CAs, and not much else.

But if you compare the pressure curve of a Resmed S9/A10 to the pressure curve of a PR System One/DreamStation, there are a lot of differences. And they're by and large the same differences that were present back in the days of the Resmed S8 and Resprionics M-Series. The S8 responded aggressively to clusters of apneas and flow limitations and the pressure curve had the same "crested wave" shape that the A10 has today. The M-Series ran the Search algorithm and responded more slowly to apneas and hypopneas, but perhaps more aggressively to snoring; and the M-Series pressure curve had the same saw-toothed shape that the DreamStation has today.

As for why new machines are recommended every five years: First of all, things do wear out eventually. And replacing the machine at that first five year cycle gives a way of providing a backup machine for a lot of us who can't really afford to buy a backup out-of-pocket. But also a lot of effort has been put into making CPAPs more comfortable than they used to be. Heated humidifiers were once a rarity; now all machines have a heated humidifier as a standard part of the package. Integrated heated hoses are more common now than they were even five years ago. Most of the time the new generation of CPAP is smaller, lighter, and quieter than the previous generation, and that's a big consideration for some folks. Slowly, manufacturers are increasing the amount of data that even the bricks provide. (I think the Airsense 10 CPAP brick reports at least summary leak and AHI data. Someone correct me if I'm wrong.) And the tools needed to read the data have changed: The M-Series and S8 used proprietary cards for data collection; the early S9s and System Ones only had SD cards; now wireless modem connections seem to be standard equipment along with the SD card. (Personally I dread the day when they quit putting SD cards into the machine because I think it will make it harder for us to get at all the data our machines gather.)
Questions about SleepyHead?
See my Guide to SleepyHead
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#27
(04-25-2016, 03:29 AM)robysue Wrote:
(04-25-2016, 12:26 AM)Luvmyzzz Wrote: It seems a bit odd that the manufacturers would be still using the "old" specs/algorithms , when health care has been telling patients to "replace the machine every 5 years" does anyone see a glitch here or am I over thinking this awkward scenario?? Thinking-about
Manufacturers put a lot of effort into developing the major parts of their algorithms a long time ago. They make modifications to the algorithms, with the biggest ones being detection of CAs, but the underlying "philosophy" that the company started designing their APAP algorithm with a decade or more ago still underlies the current algorithms in very important ways.

In particular, if you compare the pressure curves of Resmed S8, S9, and A10s there is not a lot of difference. If you compare the pressure curves of PR M-Series, System Ones, and DreamStations there is not a lot of difference. And the differences you see in both families are due to the introduction of CA detection: Once CAs can be detected, it changes the rules of how the APAPs react to OAs and CAs, and not much else.

But if you compare the pressure curve of a Resmed S9/A10 to the pressure curve of a PR System One/DreamStation, there are a lot of differences. And they're by and large the same differences that were present back in the days of the Resmed S8 and Resprionics M-Series. The S8 responded aggressively to clusters of apneas and flow limitations and the pressure curve had the same "crested wave" shape that the A10 has today. The M-Series ran the Search algorithm and responded more slowly to apneas and hypopneas, but perhaps more aggressively to snoring; and the M-Series pressure curve had the same saw-toothed shape that the DreamStation has today.

As for why new machines are recommended every five years: First of all, things do wear out eventually. And replacing the machine at that first five year cycle gives a way of providing a backup machine for a lot of us who can't really afford to buy a backup out-of-pocket. But also a lot of effort has been put into making CPAPs more comfortable than they used to be. Heated humidifiers were once a rarity; now all machines have a heated humidifier as a standard part of the package. Integrated heated hoses are more common now than they were even five years ago. Most of the time the new generation of CPAP is smaller, lighter, and quieter than the previous generation, and that's a big consideration for some folks. Slowly, manufacturers are increasing the amount of data that even the bricks provide. (I think the Airsense 10 CPAP brick reports at least summary leak and AHI data. Someone correct me if I'm wrong.) And the tools needed to read the data have changed: The M-Series and S8 used proprietary cards for data collection; the early S9s and System Ones only had SD cards; now wireless modem connections seem to be standard equipment along with the SD card. (Personally I dread the day when they quit putting SD cards into the machine because I think it will make it harder for us to get at all the data our machines gather.)
Thank you RobySue, your knowledge is an enlightenment, as I continue to learn from The Forum, I will always have appreciation for those who wish to share and help improve the mind set of people who don't understand the little box that guarantees the breath of life through the night !!Coffee
I enjoy being with a group who like to share their "Hosehead" experiences, to remind me I am not alone.
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#28
My AHI has been 0.00 most of the time with small spikes to as much as .46. I have lost 15 pounds of weight and I think the biggest reason it is low is I reduced my hormone testosterone from 1,600 to 400 total, because I read that high T can cause OSA to get worse. Because of the results I am going back to the sleep doctor to get retested, I don't think I need this machine anymore. When I originally took my sleep test I informed them I was on Testosterone but they never said that it could make it worse and never asked my Endo. to test my level before the sleep test was done. If any man is on TRT and going to get a sleep test keep this in mind.
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#29
After 9 months I had my first 0 AHI night last week. I'm typically under 2 every night.
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#30
(04-24-2016, 02:12 PM)0rangebear Wrote: My doctor has a similar approach he adheres to a Endocrinology, Diabetes & Metabolism society that says 5 is normal, anything below that is irrelevant unless your getting zero, which mean your machine isn't working right. Consequently, he is happy as long as my worst night is <6 Thinking-about

It is ridiculously ignorant for a doctor to make the blanket statement that any AHI=0 must be a machine malfunction. While it can be a malfunction that is not necessarily so. A little investigation and testing can determine the difference. I do feel that AHI=0 should not be the target for therapy but that does not mean that it is always bogus.

Best Regards,

PaytonA
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