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How low can you go?
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chezdan9 Offline

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Posts: 22
Joined: Dec 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed h5i
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments: diagnosed AHI = 88

Sex: Male
Location: Massachusetts, USA

Post: #1
How low can you go?
After completing my first 12 weeks of CPAP therapy, I feel like I'm getting the hang of everything. I've learned little tricks, bought gizmos, and fiddled with the knobs sufficiently to get a good feel for the process.

My question is this: should I be chasing the ultimate "0"? If I adjust my nasal pillows so that it feels like my head is in a vice and my nose is sore in the morning and I wear my chinstrap, I can consistently hit AHI in the 0.5 - 1.0 range. If I make the appliance comfortable and don't wear my chinstrap I am usually in the 2.5 - 4.0 AHI range. I have trouble getting to sleep and maintaining sleep with the straps cranked down, but either way, I feel about the same when I wake up.

Should I keep it as low as possible, or just be comfortable as long as I'm under the 5.0 mark?
02-27-2014 03:32 PM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #2
RE: How low can you go?
Read this to help with fitting the mask properly.

http://maskarrayed.wordpress.com/swift-fx-fitting-guide/
(This post was last modified: 02-27-2014 03:43 PM by JohnNJ.)
02-27-2014 03:43 PM
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robysue Online
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Advisory Members

Posts: 1,217
Joined: Oct 2013

Machine: PR Dreamstation BiPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: PR Dreamstation humidfier
CPAP Pressure: min EPAP = 4; max IPAP = 9;
CPAP Software: SleepyHead EncoreBasic EncorePro

Other Comments: Papping since September 2010

Sex: Female
Location: Buffalo, NY

Post: #3
RE: How low can you go?
(02-27-2014 03:32 PM)chezdan9 Wrote:  My question is this: should I be chasing the ultimate "0"? If I adjust my nasal pillows so that it feels like my head is in a vice and my nose is sore in the morning and I wear my chinstrap, I can consistently hit AHI in the 0.5 - 1.0 range. If I make the appliance comfortable and don't wear my chinstrap I am usually in the 2.5 - 4.0 AHI range. I have trouble getting to sleep and maintaining sleep with the straps cranked down, but either way, I feel about the same when I wake up.
The name of the game is NOT Is your AHI = 0.0?

The point of CPAP is to get restorative, restful sleep that is largely uninterrupted by apneas and hypopneas. So the name of the game is How do you feel?? And is your AHI consistently below 5.0?

If you sleep better with the looser straps, but your AHI is in the 2.5 range, you're better off with the (slightly) higher AHI and more sleep than a perfect AHI, but bad sleep because the straps are so tight you can't get comfortable enough to get and stay asleep.

As for whether the chinstrap is worth it, that's really a question of looking at the leak line: If your leaks are acceptable without the chinstrap and your AHI stays below 5.0, then it's acceptable to skip the chinstrap in an effort to get more comfortable sleep. But if your leaks are often in the official Large Leak range without the chinstrap, then your machine may have trouble maintaining enough pressure for your therapy to be effective and your data to be accurate. And in that case, the chinstrap is, alas, mandatory. (Or as an alternative you con work on finding an alternate FFM that works for you.)

Quote:Should I keep it as low as possible, or just be comfortable as long as I'm under the 5.0 mark?
Ideally you need to aim for comfort with good (but not necessarily outstanding) numbers. But you need to track both AHI and leaks. If the leaks are too high, then the AHI data is not necessarily accurate.

But as a general rule, you want to do what is necessary for you to comfortably sleep with the machine all night, every night AND you want to feel well during the day.

An AHI = 0.0 that is achieved by making yourself miserable at night with straps that are too tight and a chinstrap that is not necessarily needed is a good way of making yourself feel miserable during the day because your sleep had problems other than untreated OSA.
02-27-2014 03:50 PM
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mjbearit Offline

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Posts: 605
Joined: May 2012

Machine: REMstar Auto AFlex DS550
Mask Type: Nasal pillows
Mask Make & Model: RESMed Swift FX
Humidifier: Heated humidifier - 2
CPAP Pressure: 12.5-20
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: So Cal

Post: #4
RE: How low can you go?
If your pillows are tight, you are doing it wrong! Dielaughing Okay, sometimes I crack me up! Seriously though, the pillows need to inflate to seal. I run an AHI between 1.0-1.2 and I don't worry about it. I don't even care about each day individually, I look at week, month, 6 month and that gives me an idea how I am doing. One day can be good or bad, but it is the cumulative effect that is going to make a difference in my life.
Even if I chased after "0.0" it would never happen for me. Even on days where I have 0 obstructive incidents, I still have CAs, and HAs. Overall though, keeping it in the range of 1.0, or thereabout, I am still well below the medical community's target of 5, and I feel pretty good!
Mike

As always, YMMV! You do not have to agree or disagree, I am not a professional so my mental meanderings are simply recollections of things from my own life.

PRS1 - Auto - A-Flex x2 - 12.50 - 20 - Humid x2 - Swift FX
02-27-2014 03:50 PM
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herbm Offline

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Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #5
RE: How low can you go?
No, you should not be harming your sleep in search of the AHI 0.0.

It's fun to chase the 0 as long as you do nothing that will harm your sleep and nothing that will interfere ultimately with USING the machine.

It's a great game to keep ourselves interested, motivated, and committed but it isn't medically necessary and if we damage our GOOD sleep at AHI < 5 to get TERRIBLE sleep (or worse, quite using our machine) as AHI < 1.0 then this is counter productive.

Play they game of hunting AHI 0.0 if you wish, but remember IT IS A GAME.

(I play the AHI 0.0 Game -- it's fun.

Got to AHI 0.91 last night with several of the events being bogus, maybe all of them, but still haven't seen an ENTIRE NIGHT of 0.0.)

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
02-27-2014 03:54 PM
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JohnNJ Offline

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Posts: 103
Joined: Oct 2013

Machine: ResMed S9 AutoSet & ResMed Power Station II
Mask Type: Nasal pillows
Mask Make & Model: Respironics Wisp & ResMed Swift FX
Humidifier: ResMed H5i & ClimateLine (distilled / fresh daily)
CPAP Pressure: 9.4 - 10
CPAP Software: ResScan SleepyHead

Other Comments: First night - November 25, 2013

Sex: Male
Location: New Jersey, USA

Post: #6
RE: How low can you go?
I have hit 0.0 AHI 10 nights out of 87.

I am not convinced that the machine accurately interprets the episodes so I'm happy if I feel rested in the morning.
02-27-2014 04:15 PM
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zonk Offline

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Posts: 7,908
Joined: Feb 2012

Machine: A10 AutoSet
Mask Type: Nasal mask
Mask Make & Model: Activa LT
Humidifier: Integrated /ClimateLineAir
CPAP Pressure: 9/13
CPAP Software: ResScan

Other Comments: CPAP since Nov 2010

Sex: Male
Location: Australia

Post: #7
RE: How low can you go?
The ultimate aim is good night sleep not zero AHI but there is a correlation between optimal therapy and low AHI (not necessary zero)

Whats sort of leak numbers are we talking about (median, 95th percentile, maximum)
02-27-2014 04:46 PM
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Peter_C Offline

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Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #8
RE: How low can you go?
It's your life, and if you want to spend it chasing numbers, that's a choice I suppose. If you have OSA, and are put on a CPAP to help you to control it, the goal is simply to help you get better sleep, and keep your O2 stats on a more even keel. Some people can easily hit the magic AHI of 5 or less, and it's wonderful. I have recently gotten some lower numbers, but I am pleased if I break '10'.

Can you sleep through the night without your mask waking you? If you can't, even though your AHI is 5 or less, in my book that isn't as good as someone who does sleep through the night without being woken by mask issues, even if their AHI is 5 to 10.
Does this make sense?

*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
02-27-2014 09:01 PM
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PaulaO2 Offline
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Posts: 8,057
Joined: Feb 2012

Machine: S9 Autoset
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: H5i
CPAP Pressure: 14-20
CPAP Software: SleepyHead

Other Comments: Ehlers-Danlos Syndrome, Hypermobility Type; chronic sarcasm

Sex: Undisclosed
Location: western NC, USA

Post: #9
RE: How low can you go?
Yeah, what they said. The AHI is just part of the picture. How you feel is a bigger part.

If you had high blood pressure, your doctor would say "Take this medication and keep your blood pressure under 110 over 80". And that's your goal, to keep it under that. The doctor would not say "And keep your blood pressure as close to 100 over 72" because that's just silly. Sure, you can try and you can probably reach that goal but is it worth it? Probably not.

Keep the AHI under 5 and make sure you are getting good sleep. Get those two and you're good.

If you want to tweak with settings and the like to get it lower, go for it. But not if it means tightening the mask like that. That goes against the "getting good sleep" part.

PaulaO2
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www.ApneaBoard.com


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02-28-2014 01:27 AM
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chezdan9 Offline

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Posts: 22
Joined: Dec 2013

Machine: ResMed S9 Autoset
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift FX
Humidifier: ResMed h5i
CPAP Pressure: 12
CPAP Software: ResScan SleepyHead

Other Comments: diagnosed AHI = 88

Sex: Male
Location: Massachusetts, USA

Post: #10
RE: How low can you go?
All good stuff. Thanks folks!

Zonk: my 95% leak rate is around 5 - 10 if I crank the straps down, but more in the neighborhood of 15 - 20 if I loosen them and don't use the chinstrap.

Peter_C: I think you gave the golden nugget of advice - am I sleeping through the night? With the straps tight and a low AHI, I am not getting the same quality of sleep as if I loosen the straps and have a higher AHI. THAT ANSWERED MY QUESTION. I'm all about going to sleep quickly and staying asleep and NOT having a sore nose in the morning!! So, I will stop fretting about having an AHI around 5 and worry more about the quality of my sleep.

p.s. - I am completely ADDICTED to my S9. I guess that's why I'm obsessing about it. Smile
02-28-2014 11:16 AM
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