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Further reduce AHI and OA events?
#1
Further reduce AHI and OA events?
Hello, I've been on CPAP for about a week now. I was diagnosed with moderate obstructive sleep apnea with an AHI of 28 during the sleep study. So far I continue to sleep for 10-11 hours per night, still feel tired when waking, and often take a short nap midday. I have noticed, however, that I seem to have more energy when my AHI numbers are around 2.50. However, my numbers tend to hover around 3.50 or higher, with OA events typically being the highest. What are some ways I can get my numbers lower, particularly the OA events?

Some additional info:
  • I'm a mouth breather, so I use a full face mask. I had to switch from a Medium to Large, but otherwise find it comfortable.
  • My machine came set at 5-20. I haven't changed this yet. (The lower minimum doesn't bother me as I see it can with some people.) 
  • EPR was originally off, but I've experienced aerophagia so I've been tweaking that setting, first at 1 and last night at 2. This has improved but not eliminated those symptoms.
  • I'm a side sleeper.
Thanks for any advice!

               
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#2
RE: Further reduce AHI and OA events?
You have 2 different nights. Let’s take the 2 nd one first. You have zoomed in to the repeated obstructions. Those were caused by sleep position. Most likely you were tucking your chin again likely while sleeping on your back. These can NOT be helped with pressure. You have to find a way not to get in that sleeping position. If they continue you need to look at a collar (link about collars at the bottom of the post).

Now the other stuff you need to address. 1st you low number is way to low. To get rid of obstructions your machine has to rev up from 5 to a pressure high enough to treat the apnea. I would suggest setting it at 9 and it may need to go up from there. 2nd you have a ramp of 45 minutes. If possible turn it off if not cut it back as far as possible. You are getting NO therapy while it is on ramp. 4td flow limits (they are just smaller apnea) are high and to help with that raise the epr to 2.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Further reduce AHI and OA events?
Welcome to Apnea board and it looks like your Airsense 10 machine has improved your AHI a lot. When it comes to pressures there are folks here that have a lot more experience than myself. Looks like your ramp time is to long and should be only 5 minutes or don't use it at all. Also looks like your bottom pressure is low and 7 CMH2O would be better. From your charts you are chin tucking and can get clusters of OH & H apneas from this sleep position that can be remedied with a soft Cervical collar. I will leave a link on the collar.
A few changes should get you closer to 2.5 AHI or your comfort area.
http://www.apneaboard.com/wiki/index.php...cal_Collar
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#4
RE: Further reduce AHI and OA events?
Thank you both for the helpful advice! It's been a while since I've checked in, so here's my current situation:
  • I did try a few different types of soft cervical collars, but mostly found them uncomfortable and they had limited impact on OA events.
  • My AHI numbers have gone down a bit on average compared to my first month with the machine. My current average is a 3.16.
  • My pressure setting is now 12.0-20.0 with EPR of 3 and ramp time off.
However, despite what look to me like decent numbers and now 8 months of using the machine, I'm seeing very limited impact to my overall energy levels. I still regularly sleep 9-10 hours at night, don't feel particularly energetic when I wake up, and most days need around a 30 min nap midday.

I plan to schedule a follow-up appointment with my sleep doctor soon to discuss next steps and other potential factors (I aspect RLS/PLM), but was curious if anyone had any other observations looking at my charts from a couple recent nights. 

Thanks again for all the help and feedback!

         
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#5
RE: Further reduce AHI and OA events?
SarcasticDave94 will probably check in soon. But I bet he will advise two things:
1) Doc will say your AHI is under 5 so all is good. Don't let doc get away with being lazy.
2) Let doc know about your other symptoms -- not felling rested after 9-10 hours, low energy, need for naps. These things may be more likely to get docs attention. Keep a log / journal to use as proof.
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#6
RE: Further reduce AHI and OA events?
Yes I could try those, but I'll add 2 others, occasional mask leaks are likely disturbing sleep, and it's possible some Positional Apnea pattern is on the charts.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Further reduce AHI and OA events?
Hey there - I have a very similar set of numbers as you.  Decent AHI, but feel a lot better when it's under 3 (it ranges from 3.5-4).  Definitely positional sleep apnea and also collars don't really seem to help and are uncomfortable.  Did you discover anything new since your post?
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