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How to reduce AHI index?
#11
RE: How to reduce AHI index?
(08-22-2017, 01:13 PM)Sleeprider Wrote: Low pressure clearly result in obstructed breathing as we see from the use of ramp on 8/21 and the relatively low minimum pressure on 8/19.  My impression is that you need a minimum pressure of 9 maximum pressure 14 with whatever flex level you find comfortable.  I think there is a possibility that you experience some degree of positional obstruction, and either a pillow that supports your neck or a soft cervical collar could help with some of the events.  The central or clear apenea don't appear to be a serious problem, and are likely a matter of sleep disturbance and you just need time to adapt to CPAP.  

This is going to improve with time, but I think the higher minimum pressure on auto mode is going to help you get there faster.

Hi Sleeprider,

thanks a lot for your fast and detailed response.

Following your suggestions I had obtained great results today morning; the AHI index decreased to 1.35.
I used a T-shirt with a tennis ball on the back to sleep on the side and avoid potential positional obstruction.

Note: My doctor had suggested this T-shirt before starting with CPAP therapy, but I never used after that the CPAP therapy started.

22/08 - Auto CPAP, pressure 9-14, AHI 1.35

[Image: ZbYJZxT.png]

Should I do anything else to further optimize the therapy?

Why the Auto CPAP can't decrease the AHI index without a positional tool (T-shirt, pillow etc)?

Thanks a lot for your support.
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#12
RE: How to reduce AHI index?
oops wrong post
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#13
RE: How to reduce AHI index?
Attanasio, those are great results and your problem seems to be fully resolved with the CPAP and positional therapy. We want you to be as comfortable as possible, so look for ways that you can effect a good sleeping position with maximum comfort. The soft cervical collar is a way for you to be able to sleep on your side or back and still maintain a clear airway. Give that a try and experiment with other ways you can comfortably avoid the airway obstruction...good job!
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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#14
RE: How to reduce AHI index?
Some time back, I posted my SleepyHead data, which showed AHI figures in the high 20's to mid 30's. The pressure at the time was set at 10-15. My sleep doc gradually raised the pressure to a range of 13-18 and my AHI's now run in the 2-3 range pretty consistently.
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#15
RE: How to reduce AHI index?
(08-23-2017, 11:59 AM)Sleeprider Wrote: Attanasio, those are great results and your problem seems to be fully resolved with the CPAP and positional therapy.   We want you to be as comfortable as possible, so look for ways that you can effect a good sleeping position with maximum comfort.  The soft cervical collar is a way for you to be able to sleep on your side or back and still maintain a clear airway.   Give that a try and experiment with other ways you can comfortably avoid the airway obstruction...good job!

Hi Sleeprider,

I'm continuing the therapy with quite good results in terms of AHI index.

Considering the following 2 screenshots (23/08, 24/08), could you explain why the AHI index is about the same although the obstructive apnea events are absent in the 24/08?


23/08

[Image: 0nq5rit.png]


24/08

[Image: vfO83PE.png]

Thanks.
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#16
RE: How to reduce AHI index?
One thing that puzzles me about your SH data. You've set your min IPAP to 9 yet your lowest reading is 5. This doesn't appear to make sense. From your graph you've got A-Flex set at about 2.5 so from my understanding the lowest EPAP reading you would get should be about 6.5 give or take and your IPAP should not go below 9. Maybe someone else on this forum can clear up the reasons for those figures.
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#17
RE: How to reduce AHI index?
Attanasio89, API is OA+H+CA. You add all three to get your index number.

holden4th, He has his ramp pressure set at 4. It drifted down to 3.7 which isn't uncommon.
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Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#18
RE: How to reduce AHI index?
Attanasio, as noted above you are using a relatively low ramp at the beginning of therapy. You may notice that based on the flow rate graph, you are working hard for air during that time as shown by the high amplitude flow rates during ramp. You might want to increase the ramp pressure or turn it off.

The AHI event rate is the sum of OA+CA+H, so the numbers are correct, but the distribution of events changes. I think things look great for now, however eventually you should trial a minimum pressure of 9.5. That small change might improve things just a bit. We will pull back to 9.0 if that is not the case.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#19
RE: How to reduce AHI index?
(08-23-2017, 02:26 AM)Attanasio89 Wrote: [quote pid='219783' dateline='1503425604']

I used a T-shirt with a tennis ball on the back to sleep on the side and avoid potential positional obstruction.

Note: My doctor had suggested this T-shirt before starting with CPAP therapy, but I never used after that the CPAP therapy started.


Should I do anything else to further optimize the therapy?

Why the Auto CPAP can't decrease the AHI index without a positional tool (T-shirt, pillow etc)?

Thanks a lot for your support.

[/quote]
Placing a pillow behind your back when laying on you side, will prevent you from laying flat on you back if you rollover during the night, and it won't wake you up like the tennis ball does.  Still giving you the benefit of sleeping on your side to reduce positional apneas.
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#20
RE: How to reduce AHI index?
(08-25-2017, 08:35 AM)Sleeprider Wrote: Attanasio, as noted above you are using a relatively low ramp at the beginning of therapy.  You may notice that based on the flow rate graph, you are working hard for air during that time as shown by the high amplitude flow rates during ramp. You might want to increase the ramp pressure or turn it off.  

The AHI event rate is the sum of OA+CA+H, so the numbers are correct, but the distribution of events changes.  I think things look great for now, however eventually you should trial a minimum pressure of 9.5.  That small change might improve things just a bit.  We will pull back to 9.0 if that is not the case.

Thanks for the explanation. 
Tonight I will try with a minimum pressure of 9.5.
Could you suggest the ramp pressure I should use?
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