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How to improve Hypopnea Index?
#1
Any idea how to improve my HI? Please see the attached file.


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#2
looks to me like you need a higher min pressure.
You can ignore the stuff early in the evening.
You have a bunch of hypos in the 12:30 +/- timeframe.
The whole time you have flow limitation -- which is indicative on not enough pressure.
Are 4 to 10 still your settings?
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#3
(05-13-2016, 02:40 PM)justMongo Wrote: looks to me like you need a higher min pressure.
You can ignore the stuff early in the evening.
You have a bunch of hypos in the 12:30 +/- timeframe.
The whole time you have flow limitation -- which is indicative on not enough pressure.
Are 4 to 10 still your settings?

I had a new sleep Study done last week. According to the report my new setting should be 5-15. This posted result is after the setting was updated to 5-15.
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#4
From what the DME told me about the AirSense 10, it starts at the lowest pressure in your range (after the ramp, if that's being used). Then it stays at that pressure until you have an event, then bumps by 1 until the next event, etc. If that's true, it makes me think your starting point should be raised.
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#5
(05-13-2016, 03:01 PM)thasan26 Wrote: I had a new sleep Study done last week. According to the report my new setting should be 5-15. This posted result is after the setting was updated to 5-15.

That's based on one night's sleep while hooked up to all kinds of wires and gadgets. It's a good starting point, and it checks for things no CPAP machine could ever detect, but when you're sleeping normally with your own machine hooked up, you get data that you can use to improve on those settings.

You can see clusters of hypopneas when your pressure is low. It's these clusters that are at least partially responsible for triggering the machine to raise the pressure, thus stopping them or reducing their frequency. Likely their duration, too.

So I agree that raising that lower end is the right thing to do. Maybe set the range at 10 to 15.

I also see extended periods of high leak rate. Borderline high, but still, high. You may be mouth-leaking. That will interfere with your therapy, but even if it doesn't it will still interfere with your sleep. Try a chin strap. If that doesn't work, a full face mask.
Sleepster
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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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#6
(05-13-2016, 09:46 PM)Sleepster Wrote:
(05-13-2016, 03:01 PM)thasan26 Wrote: I had a new sleep Study done last week. According to the report my new setting should be 5-15. This posted result is after the setting was updated to 5-15.

That's based on one night's sleep while hooked up to all kinds of wires and gadgets. It's a good starting point, and it checks for things no CPAP machine could ever detect, but when you're sleeping normally with your own machine hooked up, you get data that you can use to improve on those settings.

You can see clusters of hypopneas when your pressure is low. It's these clusters that are at least partially responsible for triggering the machine to raise the pressure, thus stopping them or reducing their frequency. Likely their duration, too.

So I agree that raising that lower end is the right thing to do. Maybe set the range at 10 to 15.

I also see extended periods of high leak rate. Borderline high, but still, high. You may be mouth-leaking. That will interfere with your therapy, but even if it doesn't it will still interfere with your sleep. Try a chin strap. If that doesn't work, a full face mask.

Thanks for the tips. I will give these options a try!!
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#7
(05-13-2016, 02:05 PM)thasan26 Wrote: Any idea how to improve my HI? Please see the attached file.
If the machine as in profile "ResMed AutoSet Spirit" (S7 or S8), in my experience with S8 AutoSet, did have a lots of hypoponeas scored but hardly any scored with S9 and AirSense 10 AutoSets
S8 AutoSet didn't treat apnea above 10 as thought above 10 are centrals, best left alone, but still increase pressure in response to snoring and flow limitation. S9 and AirSense 10 AutoSets treat apnea above 10 and can distinguish between obstructive apnea and central apnea, does not increase pressure if central apnea is detected

Leak is verging on the high side, you might need chinstrap, better mask fit, and reducing the gap between the lower and higher pressure helps
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#8
(05-13-2016, 09:46 PM)Sleepster Wrote: So I agree that raising that lower end is the right thing to do. Maybe set the range at 10 to 15.

Yes, after raising the Min Pressure gradually.


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#9
(05-13-2016, 02:40 PM)justMongo Wrote: looks to me like you need a higher min pressure.

Would the same apply to ASV as well? I've been using an ASV machine for 16 days now. In that 16 days...

I've never had an AHI above 1 (the highest so far was 0.8)

I've only had one event that registered as "UA" which from what I understand could have been obstructive... but the waveform needs to be analyzed to figure it out.

The rest of the events when I have them are hypopneas.

Realistically, I'm doing so well (numbers wise, haven't noticed any changes in how I feel yet) on ASV that I don't need to change anything... but the perfectionist and scientist in me is curious. My currents settings have an EPAP of 4 with min PS of 6 and max of 15. My 95% IPAP is usually around 15 and my 90% IPAP over the past week was 14.56. My average IPAP over the last week was 12.29. I seem to hit the max IPAP of 19 every night if I'm reading SleepyHead correct... 99.9% sure I am (is that something that needs to go up?... again, given that I've had an AHI of 0 for 6 nights over the past 11 days (1 day I didn't use the machine) I'd say the settings are pretty good and going higher might be something that wakes me up)).
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#10
(05-15-2016, 09:34 AM)shewhorn Wrote:
(05-13-2016, 02:40 PM)justMongo Wrote: looks to me like you need a higher min pressure.

Would the same apply to ASV as well? I've been using an ASV machine for 16 days now. In that 16 days...
Without seeing your data there is no way to tell what may or may not be appropriate.

Quote:I've never had an AHI above 1 (the highest so far was 0.8)
If your AHI is consistently below 1, there's not really any more tweaking to be done in terms of your machine's settings. Seriously: There's no point in chasing a perfect 0.0 AHI night after night. Most of us are happy if our AHI is below 2.0 or 3.0 most of the time.

Quote:I've only had one event that registered as "UA" which from what I understand could have been obstructive... but the waveform needs to be analyzed to figure it out.
Some ASV machines don't classify apneas and SleepyHead then tends to label them as UA (Unclassified OR Unknown Apneas). Sometimes the wave form will clear it up. Sometimes it won't. But if you've only had one apnea in 16 days of using the machine, you do NOT need to worry about it.

Quote:The rest of the events when I have them are hypopneas.
With a total AHI <= 1.0 for 16 days in a row, you need to quit worrying about figuring what to do about the remaining hypopneas.

Quote:Realistically, I'm doing so well (numbers wise, haven't noticed any changes in how I feel yet) on ASV that I don't need to change anything... but the perfectionist and scientist in me is curious.
Perfection in terms of a perfect 0.0 AHI night after night is an unrealistic goal for PAP therapy. Many people never even reach the point where their AHI is less than 1 on a consistent basis. The goal of PAP is NOT to achieve a 0.0 AHI; the goal of PAP is to reduce the apneas and hypopneas to the point where you can get high quality sleep.

So given your self-reported AHI, it's time for you to focus on whether you are getting high quality sleep. Since you also say that you haven't yet noticed any changes in how you feel, it's easy to understand why you're wanting to do something in an effort to improve things.

But here's what you need to understand: The damage the sleep apnea has caused over the years takes a while to heal. And most people do not feel much better until they've been PAPing for several weeks. Some people don't notice much improvement until they've been PAPing for 3 months or more. It takes a while for the body to heal, but it also takes a while for the body to fully adjust to sleeping well with the machine.

In other words, focus on the non-PAP, non-sleep anpea aspects of your sleep: Are you getting enough sleep? Are you waking up a lot during the night? Are you having trouble getting to sleep? Or staying asleep?

Chances are that at this point you're not feeling any difference for one or more of the following reasons:
  • Your body just needs more time to heal and you'll gradually start feeling better in a few more weeks. Note that most people never have a "A HA" experience where they wake up feeling FANTASTIC one morning. Rather, the improvement in how you feel can be gradual enough where it can be missed. And it's only in retrospect that you realize that you now feel much better than you used to feel on an average day. A journal that focuses on how you feel rather than on what your AHI is can help you identify subtle signs that your body is beginning to heal.
  • You have other non-sleep apnea related sleep problems. Most of these can be addressed by good sleep hygiene practices. Basically you need to be thinking in terms of whether you're getting enough sleep and whether you are doing things (in terms of bedtime, wake up time, and bedroom habits) that make it more difficult to get a good night's sleep.
  • You are dealing with one or more PAP adjustment problems that are NOT related to the machine-scored AHI. In other words, it's possible to have a near perfect AHI, but still have a lot of difficulties sleeping with the mask on. Leaks are an issue for some people: Small leaks that wake you up may need to be addressed even if they're not large enough or long enough to adversely affect your therapy. Sensory overload from the stimuli coming from the machine may need to be addressed: If the machine's noises bother you, you have to find a solution. If the hose or mask is physically irritating you when it touches your skin, you have to find a solution. Sometimes the solution is just to put up with things long enough for the body to learn how to ignore them.



Quote:My currents settings have an EPAP of 4 with min PS of 6 and max of 15. My 95% IPAP is usually around 15 and my 90% IPAP over the past week was 14.56. My average IPAP over the last week was 12.29. I seem to hit the max IPAP of 19 every night if I'm reading SleepyHead correct... 99.9% sure I am (is that something that needs to go up?... again, given that I've had an AHI of 0 for 6 nights over the past 11 days (1 day I didn't use the machine) I'd say the settings are pretty good and going higher might be something that wakes me up)).
I would leave the settings alone.

Here's the thing: ASV settings are more difficult to tweak than plain old APAP/BiPAP settings. In addition to min/max Pressure settings, the ASV settings also control how fast and how far to increase the IPAP in response to breathing patterns that suggest a developing potential problem central apneas. To prevent the CAs from happening, the machine drastically increases the IPAP pressure while leaving the EPAP alone in an effort to trigger inhalations as well as keep your CO2 levels from going into a undershoot/overshoot cycle that is common in central sleep apnea.

Questions about SleepyHead?
See my Guide to SleepyHead
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