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[CPAP] AHI Increase
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sabergum Offline

New Members

Posts: 2
Joined: Apr 2013

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 4-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Norway

Post: #1
AHI Increase
I was diagnosed with an AHI of about 20 earlier this year, and started PAP treatment in February, with the S9 Autoset at 4-20 cmH2O. The first few days I felt a huge difference, and had nightly AHI readings of around 4-6 the first week, gradually rising to around 6-9.

I was to the hospital for a control in early April, and after consulting the stats from the S9 they decided to increase the minimum pressure to 5 cmH2O in an attempt to further reduce the AHI. I also got the H5i with Climateline when i complained about nasal congestion and dry mouth.

Immediately after this, my AHI increased dramatically. The first night (without using the humidifier) i had an AHI of 6. Next night (with humidifier) it increased to 13, and after that it seems to stay in the 15-20 range, with peaks at 24, which is higher than in my sleep study. I have tried not to use the humidifier for a week, without any effect. I have also tried to reduce the minimum pressure to 4 again, for two separate nights, and got AHIs lower than the average, but still high (17 and 9). I am somewhat reluctant of messing too much around with the settings without knowing for sure what I am doing.

Does anyone have any similar experiences or suggestions on what to do?

(The AHI numbers are from Sleepyhead, which tends to show higher AHI than on the S9, but the tendency is the same).
(This post was last modified: 04-28-2013 03:22 PM by sabergum.)
04-28-2013 03:13 PM
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zonk Online

Advisory Members

Posts: 6,778
Joined: Feb 2012

Machine: AirSense 10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated
CPAP Pressure: 10/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #2
RE: AHI Increase
Hi sabergum and welcome
First of all, everyone is different. Humidifier is for comfort but for me cannot use CPAP without humidifier so for someone like me, humidifier is a must. I use the climate line on auto at 27C most of the time, in auto you select temp to preference and protect against rainout
Dry mouth is not uncommon with full face mask as allows you to breathe thru mouth, more humidity might helps and Biotene mouthwash
Congestion also common side effect, speak to your doctor there,re some OTC and prescription medication and also saline nasal washes with Neilmed sinus rinse or similar product would helps and recommended for CPAP users

Have you tried nasal or nasal pillows mask? these types of masks can works better if you don,t need full face mask. Chinstrap can helps keep mouth closed and minimize mouth leaks and dry mouth effect from mouth breathing

Try to download ResScan for comparison but does not work with Mac computers

How many hours do you sleep and how often you get up during the night
Whats the breakdown of AHI including central apnea events
Whats pressure and leaks stats (median, 95%, maximum)
04-28-2013 03:57 PM
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vsheline Offline

Advisory Members

Posts: 1,037
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: Quatro FX or F10 w/ Liner. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 4-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #3
RE: AHI Increase
(04-28-2013 03:13 PM)sabergum Wrote:  I was diagnosed with an AHI of about 20 earlier this year, and started PAP treatment in February, with the S9 Autoset at 4-20 cmH2O. The first few days I felt a huge difference, and had nightly AHI readings of around 4-6 the first week, gradually rising to around 6-9.

I was to the hospital for a control in early April, and after consulting the stats from the S9 they decided to increase the minimum pressure to 5 cmH2O in an attempt to further reduce the AHI. I also got the H5i with Climateline when i complained about nasal congestion and dry mouth.

Immediately after this, my AHI increased dramatically. The first night (without using the humidifier) i had an AHI of 6. Next night (with humidifier) it increased to 13, and after that it seems to stay in the 15-20 range, with peaks at 24, which is higher than in my sleep study. I have tried not to use the humidifier for a week, without any effect. I have also tried to reduce the minimum pressure to 4 again, for two separate nights, and got AHIs lower than the average, but still high (17 and 9). I am somewhat reluctant of messing too much around with the settings without knowing for sure what I am doing.

Does anyone have any similar experiences or suggestions on what to do?

(The AHI numbers are from Sleepyhead, which tends to show higher AHI than on the S9, but the tendency is the same).


Hi sabergum, welcome to the forum!

I think you may be being fooled into thinking the changes in the machine's settings you are making are significantly affecting the AHI. Mask leak may be major contributor to AHI.

Even if we make no intentional changes, AHI can vary a great deal from one night to the next, so, unless you absolutely can't stand something, best to leave things alone for week or month to be able to see how things are going, and make changes in consultation with your health care providers (or at least this forum).

I suggest keeping a close eye on ResScan or SleepyHeand plots of events. How many are central apneas and how many are obstructive apneas, and how high is the pressure when the events occur? (Again, make no conclusions based on just a few nights of data; look for averages across weeks.) If your events are mostly obstructive, increasing the minimum pressure a little would be expected to decrease obstructive events very slightly, on average. If your events are mostly central (or clear airway) events, it may help to turn reduce or turn off EPR if you are using it. A small percentage of people find using EPR increases the number of central apneas.

In your case, I suggest trying to learn to use ResScan 4.2, since the doctors will be more familiar with it and will likely trust its reports more, when you email reports to doctor or print out and bring to office visits.

Take care,
--- Vaughn

Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
(This post was last modified: 04-28-2013 04:31 PM by vsheline.)
04-28-2013 04:19 PM
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Shastzi Offline

Advisory Members

Posts: 920
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #4
RE: AHI Increase
Welcome

Hi sabergum!

Ditto here.
Keep an eye on the AHI and also check the duration of the events each day. Are they getting longer, shorter or staying the same?
Note when these occur as well. Are they in clusters or scattered about randomly?
Hopefully your OA's will fade out. Leaving some hypopneas and some CA's
Note the flow rates & pressures during these times and look for corellations.
Use the zoom in function liberally.

(Most clinics dont teach you this stuff because *it takes time* )

Good luck and hang in there!!

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
04-29-2013 08:58 AM
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sabergum Offline

New Members

Posts: 2
Joined: Apr 2013

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 4-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Norway

Post: #5
RE: AHI Increase
Thank you for your replies. I have to say, I am impressed by the level of knowledge in here Smile

To answer your questions:

I usually sleep 7-8 hours every night, and usually don't go up at all. I do wake up from time to time, maybe 3-5 times every night, but I usually fell asleep again. Around 5 - 10 % of the events are CAs but these seem to occur at times I have been awake, so I guess they are false positives. Average pressure last week is 9.4, 95th percentile is 13.7 (since I started treatment I have average of 3.9 and 95% of 12.9). I have virtually no leaks, average 0.0 and 95% of 1.2.

The OAs occur in clusters, and I usually have 2-3 periods of 30-45 minutes with no events at all. It seems to be quite consistent that the clusters start while the pressure is around 10-12.
04-29-2013 03:48 PM
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