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High AHI still when on CPAP
#1
High AHI still when on CPAP
Hello, I'm new to CPAP and doing a trial for a month with a Resmed airsense 10 with a F20 mask.  I did an in home sleep test and the results where obstructive apnea with 75 AHI and oxygen dropping to 54%.  Now that I have the machine It's ranged from 35-50 with the pressure set to 6cmH2O  then when I fall asleep 8-18cmH2O.  The pressure on the screen of the machine says close to 18cmH2O. The sleep tech adjusts it from their office.  I don't feel any different after a week of using it and the numbers seem high to me.  I think the central apnea showed around 0.4.  

Just looking for input on this.  I'm 39, a bit overweight, don't drink much or on other prescriptions.
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#2
RE: High AHI still when on CPAP
Welcome,

I'll suggest getting OSCAR the free report tool. We'll need to see the sleep session data to advise. It's very likely the settings have yet to be adjusted to your needs.

You'll need an SD card for your ResMed xPAP to save data for import into OSCAR.
Dave

OSCAR
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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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#3
RE: High AHI still when on CPAP
Welcome to AB and yes your numbers are high.
Please download OSCAR (top of this page) free and post your nightly charts. (F12 will organize them for you) Use the "REPLY" button and attach your screenshot.

We need to see your chart, not just your summary info to provide you with the best suggestions based on data.
I can see a settings adjustment including Ramp (turn off, at these pressures you shouldn't need it) changing your min and EPR settings and possibly adding another device. But A chart will allow us to be much more specific.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#4
RE: High AHI still when on CPAP
OK, I have OCSAR on my laptop at home so I will download the info tonight and post it.
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#5
RE: High AHI still when on CPAP
Great, we'll be glad to help at that time.
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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#6
RE: High AHI still when on CPAP
Sorry I took so long to post the screenshots.  They have changed the settings I've been told since it wasn't working well for me.  Eventually I will be having a in lab sleep test.  But they figure I need a Bipap.  Thanks for taking a look.

Once more


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#7
RE: High AHI still when on CPAP
Changing pressure will do nothing!  You look to have positional apnea. What that means is you are sleeping in a position that is cutting off your own airway. Again no changes in pressure will help, you have to find a way not to get in that position. 

Most positional apnea is “chin tucking” or in other words your chin is dropping down to your Sternum. If happens a lot sleeping on your back or on to high ph a pillow. Your is severe that you are going to need to wear a collar in bed. Many people here use it to greatly reduce their positional apnea. 

Please look at the link at the bottom of the post. It show charts (much like yours) with a before and after using a collar. 

Most Drs don’t even consider this. I don’t know why but we hear that on this site often. 

You really need to read about the link and search the site about people using a collar.
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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#8
RE: High AHI still when on CPAP
I had thought of that before but didn't know it was actually a thing.  My pillow is pretty thick so it makes sense.  I like to sleep on my side at times and it seems pretty level that way. When I had my sleep test they said my AHI was worse when I slept on my side if that means anything. Maybe tonight I will use a thin pillow just to see if there's any difference. Just out of curiosity.
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#9
RE: High AHI still when on CPAP
Certainly, be curious and go with the flatter pillow and see how you go, it may take some getting used to.

Early on in my CPAP journey I thought 2 pillows was better because it kept my chin opposed to the face mask and reduced leaks. How wrong I was.

In the beginning...my sleep doctor said he preferred his patients to try and sleep with their neck extended. Hmm easier said than done, especially when I like thick soft fluffy pillows. Those thick chunky hotel pillows make things worse, even on your side, they encourage poor sleep positions and got me into trouble.

The soft cervical collar (SCC) helps me achieve an extended neck position.
I now use a single flat pillow.
I place the pillow low down, underneath my shoulder blades, SCC in place, neck extended, and find my need for CPAP pressures has reduced markedly.

Sleeping on my side is more comfy, especially in the early hours of the morning, and that's when I have more events. So even on my side I can flex my neck forward into a fetal position and obstruct the airway, hence the need for the SCC. Just need to bunch up the pillow when side sleeping to keep my neck level.

Common theory about sleep apnea is the tongue falling backward to obstruct the airway. This is only part of the problem. I don't have access to the reference article at the moment but remember reading a study that looked at the pharynx while asleep using a pediatric 'scope (DISE) and found that the airways can even collapse side to side, while patients are sleeping on their side. So the anatomy is complex and individual, and part of your journey of discovery.

There is another post recently where Sleeprider made an interesting comment about SCCs: firstly, they keep you from chin tucking but also eventually help retrain you regarding your sleeping position. I am a slow learner but finding this to be true.

Eventually you will find what works for you, so keep at it!

As others will tell you, this is a journey, post your charts and you will find amazing help from this community.

Bests wishes.
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#10
RE: High AHI still when on CPAP
I hope last night was much better. If it was, we need to change pressures - you are running the highest pressure this machine can go and I'm sure we can improve and move the pressure down. With some changes you will feel much much better.
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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