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[CPAP] Unable to achieve lower than 15 AHI
#21
RE: Unable to achieve lower than 15 AHI
I think your pressure is good nearly all the time, but the most recent results show two instances of positional apnea that account for nearly all the AHI. I'm thinking a cervical collar may be in your future to train you to avoid these chin-tucks or whatever is closing the airway. Overall the night looks much better, and I think the lower Flex setting actually helped here.
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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#22
RE: Unable to achieve lower than 15 AHI
Previous AHI 1.14 followed by this one last night of AHI 1.27 which is a major move down from previous readings which led to the  original post.
It seems major issues were mask fit, chin tucking and deliberate back sleeping in attempt to prevent  mask movement.
All member inputs were very much appreciated.
Hoping to get back to nasal pillows for comfort but may have to stick  with Amara View.
Highly recommend an oximeter to support any home analysis.
They are a little finicky  particularly in getting the synch to Sleepyhead data but in my view  any concerning presentations not supported by an O2 drop are generally not valid  and caused by something relatively minor - in my case chin tucking, mask problems etc..
Not a complete answer of course  but certainly an excellent guide to what is really going on.
Would be very receptive to inputs on this from our more experienced members.
https://i.imgur.com/cNLF6bPl.png
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#23
RE: Unable to achieve lower than 15 AHI
I'm assuming the O2 reading drop when the machine was off is bogus so I'd say it looks very good.
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#24
RE: Unable to achieve lower than 15 AHI
Not sure.
I often cannot tolerate the FFM - often?...make that "I hate FFM" and rip it off after say three hours and get up for 10 minutes as I find that more conducive to getting back to sleep later than just staying in bed.
When I take off the mask I leave the oximeter running as they can be a pain to synch to the timeline.
The oximeter does not seem to like movement as it always goes nuts.
As I get the exact same oximeter response every time I just ignore the oximeter  readings during the break period.

Intend to ask my GP about that.
Whenever I have had an oximeter placed on my finger -- say in hospital - I was always prone in bed.
So maybe they all do that.
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#25
RE: Unable to achieve lower than 15 AHI
Sleeprider: I think you are spot on re the cervical collar as I definitely tuck my chin  and  the collar would prevent that.
I have seen a technician and he has set a week on his recommended settings to see what eventuates.
If a satisfactory baseline is not established a titration test on a supplied  auto machine will be scheduled for the next week.
Get this -- at no cost
Because I previously bought a CPAP machine there.
There are good honest people around.
My experience has taught me to avoid vertically integrated businesses - where the physician owns the lab , does the follow-ups in his rooms and sells you the equipment and then interprets the data.
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#26
RE: Unable to achieve lower than 15 AHI
I wouldn't worry about the o2 reading rough with movement. My cms50f throws spikes. If the cpap machine is counting correctly and you would need to zoom in to count. Your median BPM have come down a bit to 16 and is in the high end still, your insp/exp times and tidal volumes are still out. This is what I would be talking to the doctor about.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#27
RE: Unable to achieve lower than 15 AHI
Shin Ryoku: I apologise for taking so long to reply personally to your input.
That was an interesting article. I would very much like to get back to the Philips Nuance Nasal Pillows as that was definitely the most comfortable mask in my experience thus far.
However I need to stay with the plan and minimise changes until I see a positive trend.
As a mouth breather that means it might be advisable to continue with the Amara View, which is certainly one of the more easily tolerated full face masks, until the reason behind my presentation history becomes clearer.
If I can establish that I will definitely try to migrate back to nasal pillows.
My week's  trial with a technician is up Tuesday and a decision will be made then regarding a titration study on an auto machine.
Getting there.
Thank you for your input.
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#28
RE: Unable to achieve lower than 15 AHI
(12-16-2017, 04:41 AM)hwka Wrote: Not sure.
I often cannot tolerate the FFM - often?...make that "I hate FFM" and rip it off after say three hours and get up for 10 minutes as I find that more conducive to getting back to sleep later than just staying in bed.
When I take off the mask I leave the oximeter running as they can be a pain to synch to the timeline.
The oximeter does not seem to like movement as it always goes nuts.
As I get the exact same oximeter response every time I just ignore the oximeter  readings during the break period.

Intend to ask my GP about that.
Whenever I have had an oximeter placed on my finger -- say in hospital - I was always prone in bed.
So maybe they all do that.

Good morning hawk

Its really great to read your therapy is going in the right direction. If you hate the FFM, why not try others? A nasal pillow or a nasal mask perhaps?

My story is that my FFM leaked like crazy but I did the nasal pillows, collar and tongue trick for a period and it soon all dropped into place. Not immediately and not like magic but I persisted as I believe we all can retrain ourselves.........
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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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#29
RE: Unable to achieve lower than 15 AHI
Actually I changed my profile.
It previously listed a Philips Nuance Nasal Pillows as my mask of choice - and the Nuance most definitely still remains so.
But as I was not seeing the desired improvements I started to review other options.
Fact is I am a mouth breather - have tried the various exercises and they do work , but I always at some stage during the night regress back to some mouth breathing.
In fact I am of the opinion that a lot of the clusters my graphs present may not be a true representation and that a period of mouth breathing is confusing the software into recording CA's and OA's.
More experienced members might be shocked at such heresy , but there you go.
In support of my thinking - there is often (usually?) not the expected drop in SPO2 in the synched timeline.
I see that as completely contradictory.
Unless the cheap oximeter is not putting out reliable information.
But published tests have shown the cheap wrist oximeters perform very well against the expensive commercial brands.
If the response is what tests? - I do not have them to hand but a Google search would be productive.
For interest only - I have a Contec CMS-50F Version 3.5 (AUD$60). 
I enquired directly of Nonin as to their 3150 model which looks exactly the same - at the time it was AUD$985.
I am not suggesting they are equal.
As the TV star of that old time-waster "Dragnet" would say: "Just the facts,ma'am"




So , willing to try anything I pulled out the Amara View again.
Results have definitely improved.
Is it the mask or a transient thing?
Don't know - yet.
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#30
RE: Unable to achieve lower than 15 AHI
I drifted off a bit in the last reply...
There is a good article on ApneaBoard about achieving a proper mask fit - well worth reading.
All - all - my previous masks no matter what type were fitted far too tight.
On my return to using the Amara View I re-read that article.
Consequently when I fitted the mask as per that advice I held it very lightly to my face with my CPAP running at full pressure- no headgear at all just the mask - and that set the baseline as to the feel and pressure on my face.
I then assessed the very slight increase in pressure required to hold the mask in position as I moved my head side to side on the pillow. 
That set a new baseline.
I then attached the headgear and straps according to that new baseline feel.
Compared to my previous fitting it was ridiculously loose.
But it works - the air pressure fills the silicone seal to the contours of my face and is remarkably comfortable.
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