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[CPAP] Advice on lowering AHI score.
#1
Question 
Hi All,

I am looking for some advice on adjusting my CPAP settings to help improve my AHI score.  My sleep study results showed OSA with an AHI of 44.7.  I've been on a CPAP since December 12th and have shown improvement but my AHI score is hovering around 10. Currently my pressure settings are 9 - 20. I initially had a min pressure of 5 but couldn't breath so raised it to 8.  I just recently moved it up to 9.  I tried to linked images on Imgur for my last two nights but it says I need four post since I'm brand new. I've not had any problems using the CPAP machine and dropping from 44.7 to an average of 10 is definitely an improvement. I would like to at least get below 5 AHI. 

Let me know your thoughts and advice on settings and how I can post my images. 

Thanks,

James
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#2
Hi James,

To post your images, until you have 4 posts, just leave a space in the link from imgur. Example: http ...... h ttp

We can figure out the rest.
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#3
Here. 

https://imgur.com/a/62w6p
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#4
Thanks in advance for everyone's help.
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#5
Your apnea events show show mixed obstructive and central events, and they are mostly in a couple clusters during the night.  This might partially clear up with the use of a soft cervical collar or similar positional therapy, but complex apnea is kind of tricky to judge based on limited data of one night.  Have you ever tried the EPR (exhale pressure relief) feature?  If you did, were results worse?

[Image: iiRDIzN.png]
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#6
No, I have not tried EPR. I currently have it off.  I can turn it on and give it a try.
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#7
https://imgur.com/a/62w6p

Welcome

My original post was incorrect so I've edited it out. Sincere apology there. I misread the numbers.

Dave
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#8
sleeprider Wrote:This might partially clear up with the use of a soft cervical collar or similar positional therapy, but complex apnea is kind of tricky to judge based on limited data of one night. 

I'll look into getting a cervical collar too.  My wife does say my neck is always in weird positions. I'm willing to try anything.
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#9
Leaks are not a problem here. The graph above shows no large leaks, and a normal profile of designed venting. Philips Respironics machines display total leak above an estimated excess leak graph. As you can see, the designed venting stays near the bottom of the graph.

I suspect that if you use EPR it will significantly increase your central events. It would confirm a complex apnea problem if your were to try it and centrals were to increase. So that is up to you. EPR could be comfortable and not make much difference, but if you were to experience difficulty with it, you should turn it off.

If this is complex apnea, or positional apnea, the more conservative approach is to level out the pressure, and see if the soft cervical collar can help. Your obstructive events seem to be treated at a maximum pressure of 11.5. You have no flow limitation flagged, and very few snores, so it's possible most of the events are not obstructive at all. I think keeping minimum pressure at 9.0 and limiting maximum pressure at 11.5 might help to avoid the centrals we see in that first cluster. It might be interesting to zoom in closely so some of the events so we can see a 2-minute segment of the flow rate with events and see what is really happening, for example at 02:40 or 04:15. I don't want to pick apart the big cluster at 01:20 just yet because there is just too much going on.
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#10
Sleeprider Wrote:It might be interesting to zoom in closely so some of the events so we can see a 2-minute segment of the flow rate with events and see what is really happening, for example at 02:40 or 04:15. I don't want to pick apart the big cluster at 01:20 just yet because there is just too much going on.

Here are some screen shots zoomed into the cluster around 2:40.

https://imgur.com/a/CZL7z


James
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