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Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
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AnthonyNYC Offline

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Posts: 2
Joined: Apr 2013

Machine: Resmed S9 Elite
Mask Type: Nasal mask
Mask Make & Model: Drive Medical
Humidifier: Resmed
CPAP Pressure: 17
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Long Island NY

Post: #1
Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
First thank you all for the information and this forum. It has been a valuable resource to me.

A little background, I'm 39 years old, 5ft 11 inches, 230 lbs (dropped from 275). For years I have snored and for years I have been told I stop breathing. I would always dose off during the day but thought it was just part of working a graveyard shift. My daughter recently videotaped me sleeping. I realized this was a lot more serious and setup a sleep study. Spending quite some time reading about Sleep Apnea was shocking.

Results of the Sleep Study:

Total Sleep Time - 397.5 minutes
Efficiency - 85%
Stage N1 - 24.5 minutes
Stage N2 - 363.5 minutes
Stage N3 - 0.0 minutes
Stage R (rem) - 9.5 minutes

873 Obstructive Apneas, 0 Central, 0 mixed
Index 131.8 per hour of sleep
Over AHI was 133.7 events per hour of sleep
AHI was 134.4 during non-rem and 107.4 rem
Overall RDI (Respiratory Disturbance Index) was 133.7 events per hour of sleep.

Mean SpO2 during sleep time 98.8%
Minimum SpO2 89%
0 Limb movements
0 Cardiac Arrhythmias
0 Evidence of Cheyne Strokes

I'm a stomach sleeper but for the sleep study I was told not to sleep on my back or sides. I could understand Apneas on my back but still having Apnea's on my side surprised me.

Last Friday I picked up a Resmed S9 Elite with the humidifier, climate control hose and a standard nose mask as well as a full face mask. Pressure is set to 17cm/h2o.

First night sleeping with the machine the pressure was unbearable. 17cm was blowing the mask off my face, leaks were hard to keep under control. Woke up with stomach pain after a few hours, was building air pressure in my stomach and let out the longest burp ever.

Tried contacting the DME but no return call from them, doc was not going to be in until Tuesday. I drove over 3 hours to pick up this machine since I wanted in right away. I was not sure what to do but then found this forum.

I found the info on how to turn down the pressure. I turned it down to 15 but that was still too much. I turned it down to 12 and tried sleeping with it there. I figured turning down the pressure was better than not sleeping with the machine at all. Turning down the pressure helped! I slept only for a few hours but it was uninterrupted sleep.

Spending more time reading I now downloaded the Resmed software. It is awesome this software is somewhat hidden but still available for us. My snore index is almost 0, I was shocked. I was in denial that this was accurate that I used a sound recorder with wav format and recorded myself all night, no more snoring. Obstructive Apneas have improved from over 800 to less than 3!

I looks like I need the higher pressure as I get into deeper sleep. Even though I have 1-3 Apneas, it appears I am waking up shortly after these and not going back to sleep. I do feel better and I am not sleepy BUT I am not sleeping for 5-8 hours straight. I keep waking up after 2-3 hours. I have a few questions:

1. Is it common to have AHI reading as high as mine? DME says that is one of the highest pressure he has seen. It would be nice if I could someone see AHI readings per forum member!

2. I keep waking up after only a few hours of sleep with the mask. Without the machine I would sleep 8-10 hours and get interrupted sleep but I would not wake up at all, has anyone experienced waking up so frequently and any reason why?

3. I would like to see data of other forum members, if you have screenshots of your Resmed or Sleephead data can you please post the links? I would like to compare breathing patterns.

4. I don't have access to an EEG but would like to know if I am getting deep sleep. Is there a way to tell by the flow wave data or maybe a cheaper EEG?

5. If I slept with very few apneas in 3 hours of sleep with a pressure of 12 or 13. Would it be possible that I would need more pressure for longer sleep? From what I read I most likely would have completed a few cycles for 1/2/3/Rem already but I am not sure.

Thank you all in advance. Resmed if you read this I will recommend your product to everyone I know. Thank you for allowing the Resmed software to be somewhat available. I understand the dangers of making changes but in my case I am going to a lower pressure. If I was not able to lower from the original 17 I would have returned this machine already.

Anthony
04-18-2013 02:33 AM
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DocWils Offline

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Posts: 1,271
Joined: Jul 2012

Machine: Philips Remstar series 60
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10
Humidifier: same as machine
CPAP Pressure: 5-15
CPAP Software: SleepyHead

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Sex: Male
Location: Switzerland

Post: #2
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
Hi, welcome to the forum. I'll just answer a few of your questions.
Your waking up is due to you being used to doing so, it will take a while and you will adjust - we all went through some sort of period like that as well, it is just that the brain is now used to that pattern, and it needs to get back to a normal pattern, which will take time. Don't worry - it fixes itself at different rates for different people, but you really shouldn't worry too much on that point.

So long as your overall AHI remains below 5, you are considered to be no longer suffering from clinical sleep apnoea. Getting an AHI of 0 is simply a silly idea, it can be done but it is meaningless, as it doesn't happen in real life without a mask for "normal"people.

Using higher pressures may well have been a good start, but it needs to ramp up. Also, you should have a way of activating a sort of pressure relief system, called A-Flex or C-Flex on Philips machines, (I forget what it is called on Resmed machines), which, when activated lowers the pressure on the outbreath a bit, which would help prevent the bloated pain you are getting in you tummy, which is air getting swallowed.

The rest of the forum will now jump in and give you TONS of information, so get ready for it. You are in good, helping hands here.
04-18-2013 05:46 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

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Post: #3
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
Hi Anthony!

Welcome

What DocWils said.

I can't believe they stuck you on 17cm pressure right away!
If I started out with that I'd think the machine was trying to blow my brains out. Sad
I spent a few weeks working up to to those pressures and it was still rough at first.
Grrr. What is the matter with these people?
...
Now I am used to it and the S9 floats me from 15 to 19cm as needed.
I still swallow some air now & then so I am getting much better at burping. Smile

Now I am averaging an AHI around 1.0 to 1.5. Not bad at all but it took a while to get here!

Hang in there and check out the links here for fixing those leaks! It's a process.

Sleep-well

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
04-18-2013 06:04 AM
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AnthonyNYC Offline

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Posts: 2
Joined: Apr 2013

Machine: Resmed S9 Elite
Mask Type: Nasal mask
Mask Make & Model: Drive Medical
Humidifier: Resmed
CPAP Pressure: 17
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Long Island NY

Post: #4
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
(04-18-2013 05:46 AM)DocWils Wrote:  Hi, welcome to the forum. I'll just answer a few of your questions.
Your waking up is due to you being used to doing so, it will take a while and you will adjust - we all went through some sort of period like that as well, it is just that the brain is now used to that pattern, and it needs to get back to a normal pattern, which will take time. Don't worry - it fixes itself at different rates for different people, but you really shouldn't worry too much on that point.

So long as your overall AHI remains below 5, you are considered to be no longer suffering from clinical sleep apnoea. Getting an AHI of 0 is simply a silly idea, it can be done but it is meaningless, as it doesn't happen in real life without a mask for "normal"people.

Using higher pressures may well have been a good start, but it needs to ramp up. Also, you should have a way of activating a sort of pressure relief system, called A-Flex or C-Flex on Philips machines, (I forget what it is called on Resmed machines), which, when activated lowers the pressure on the outbreath a bit, which would help prevent the bloated pain you are getting in you tummy, which is air getting swallowed.

The rest of the forum will now jump in and give you TONS of information, so get ready for it. You are in good, helping hands here.

Thanks for the reply Doc, I will call the DME and see if I can get an Auto one but I doubt they will.

(04-18-2013 06:04 AM)Shastzi Wrote:  Hi Anthony!

Welcome

What DocWils said.

I can't believe they stuck you on 17cm pressure right away!
If I started out with that I'd think the machine was trying to blow my brains out. Sad
I spent a few weeks working up to to those pressures and it was still rough at first.
Grrr. What is the matter with these people?
...
Now I am used to it and the S9 floats me from 15 to 19cm as needed.
I still swallow some air now & then so I am getting much better at burping. Smile

Now I am averaging an AHI around 1.0 to 1.5. Not bad at all but it took a while to get here!

Hang in there and check out the links here for fixing those leaks! It's a process.

Sleep-well

Thanks for the reply Shastzi. So far even with pressures of 12-13 I am under 5 for interruptions. The machine says it and also the Rescan software shows it. If I am under 5 currently, is there any reason to raise the pressure slowly until I get to the prescribed 17?
04-18-2013 07:27 AM
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Bompa Offline

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Posts: 854
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Machine: DreamStation Pro
Mask Type: Nasal pillows
Mask Make & Model: Nuance Pro
Humidifier: DreamStation Heated Humidifer
CPAP Pressure: 12.0
CPAP Software: SleepyHead Other Software

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Sex: Male
Location: Falkenburg,

Post: #5
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
(04-18-2013 05:46 AM)DocWils Wrote:  Also, you should have a way of activating a sort of pressure relief system, called A-Flex or C-Flex on Philips machines, (I forget what it is called on Resmed machines), which, when activated lowers the pressure on the outbreath a bit, which would help prevent the bloated pain you are getting in you tummy, which is air getting swallowed.

The rest of the forum will now jump in and give you TONS of information, so get ready for it. You are in good, helping hands here.

What DocWils was referring to on ResMed Elite (My machine) is the EPR setting. You access this the same way as you did to set your pressure. Set the EPR at 3. If you're like me you'll find a big difference.
Coffee
04-18-2013 08:29 AM
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trish6hundred Offline

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Posts: 6,430
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #6
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
Hi AnthonyNYC,
WELCOME! to the forum.!
I would just leave your pressure where you have it for a week or so, so you can get used to it. When you do start making changes to your pressure, do it in small amounts 'til you get to the recommended pressure so you don't throw your body into more of a tailspin.
Best of luck and hang in there for more suggestions.

trish6hundred
04-18-2013 10:20 AM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #7
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
Hang in there Anthony and stay vigilent.
The big deal with the pressure setting is you want it high enough to keep the OA down but low enough so you have minimal pressure side effects. (swallowing huge amounts of air & Gastro-intestinal reflux can be annoying)

You say you are 'under 5', do you mean for AHI? (if so that is pretty good)

Good luck! Smile

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
04-18-2013 12:09 PM
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Sleepster Offline
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Machine: ResMed AirCurve10 VAuto
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Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #8
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
The air bloating your stomach is called aerophagia. It tends to subside so perhaps eventually you can raise your pressure back up.

The usual remedy for aerophagia is a bilevel machine (also called a BiPAP). It lowers the pressure on exhale.

Also recommended for someone with high pressures is a APAP, a machine which automatically adjusts the pressure as you sleep. So if indeed you do need a higher pressure during deeper sleep stages the machine would automatically do that for you.

There are machines that combine these two features, called auto bilevel machines. I don't know if your doctor will prescribe one of these machines for you but it can't hurt to ask.

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.
04-18-2013 07:52 PM
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zonk Offline

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Post: #9
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
(04-18-2013 02:33 AM)AnthonyNYC Wrote:  I figured turning down the pressure was better than not sleeping with the machine at all.

I have a few questions:

1. Is it common to have AHI reading as high as mine? DME says that is one of the highest pressure he has seen. It would be nice if I could someone see AHI readings per forum member!

2. I keep waking up after only a few hours of sleep with the mask. Without the machine I would sleep 8-10 hours and get interrupted sleep but I would not wake up at all, has anyone experienced waking up so frequently and any reason why?

3. I would like to see data of other forum members, if you have screenshots of your Resmed or Sleephead data can you please post the links? I would like to compare breathing patterns.

4. I don't have access to an EEG but would like to know if I am getting deep sleep. Is there a way to tell by the flow wave data or maybe a cheaper EEG?

5. If I slept with very few apneas in 3 hours of sleep with a pressure of 12 or 13. Would it be possible that I would need more pressure for longer sleep? From what I read I most likely would have completed a few cycles for 1/2/3/Rem already but I am not sure.
Hi Anthony
Agree, whatever it take to be compliant with therapy and assess the situation

1- Mine is not high as yours but high enough ... RDI 85
My sleep study report from our old forum: http://www.apneaboard.com/forums/Thread-the-journey-continues

2- Yes, you,re not alone .. can take a while adjusting and finding the right mask ... the right mask is essential for effective treatment

3- Don,t have a clue how to post screenshots

4- No idea but go how you feel. whats your leak rates?

5- I don,t think ... more pressure equal longer sleep. Higher pressure can be disruptive to your sleep and can cause all sort pf problems including aerophagia, leaks, and high leaks means ineffective therapy (some leaks acceptable as long as don,t cause any sleep disturbance)
Most of the time of your sleep study spent in stage 2 sleep and no stage 3 or REM sleep. Did you had titration study?

I find strange too telling you not to sleep on your back or sides.
04-19-2013 01:28 AM
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imfletch Offline

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Machine: ResMed S9 AutoSet
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CPAP Pressure: 16
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Pensacola, FL

Post: #10
RE: Need Help Please - AHI of 133, Total of 873 Obstructive Apneas
Anthony,
First, congratulations on taking the first step toward a truly new life!

My first observation is OMG.. I thought MY apenea was bad with 58 events per hour. Yours, on the other hand, is off the chart! On the good side, however, apparently your events are short-lived however because your oxygen sats never drop very low. Mine, for example, dropped to 61% during my sleep study.

All that said, getting used to breathing against pressure truly takes time, but you CAN do it. If your machine is ResMed, look for something called EPR (Exhalation Press Relief) and set it to 3. This provides a 3 cm H2) drop in pressure as you exhale.

As your apnea improves, your life will change. Mine is so different: I no longer fall asleep at traffic lights, (or while driving!!!!!). I wake with so much energy that one Saturday morning I was up at 5 a.m., outside and washing the car.

As far as the air-swallowing...we need to decide what type mask you have. If it is a full face mask, you might want to switch to nasal pillows. Some people have a great deal of trouble using nasal pillows at higher pressures, but my pressure is 16 and I manage just fine. (I did NOT at first, however).

The end of all this is to say, hang in there. Do NOT give up and keep trying. It is do-able!

--Jim
04-22-2013 03:44 PM
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