Need help lowering AHI
I've been using a CPAP for just over 2 months and am having a hard time adjusting to it and getting an acceptable AHI. I've been using the machine regularly, and am sleeping mostly a bit better than before, but the sleep improvement is not as much as I think it should be.
I'm currently using a Philips Respironics DreamStation with a DreamWear nasal mask and a chin strap. I also have a Amara View mask but have had problems getting it to comfortably seal (I have a beard). I'm mostly sleeping on my side which seems to help a bit with the AHI.
I currently have my settings from 9 - 12 cmH2O. I have a 20 minute ramp starting at 7 but I'm not using that any more. I turned off the pressure relief because I found it hard to fall asleep with that.
The doctor started me at 4 - 20 but I couldn't breathe at 4 so I raised that to 6 and then 8. At the last doctor appointment he changed settings to 7 - 17. That didn't do much so I've raised the bottom number in steps to 9 in hopes of improving AHI and sleep quality. I lowered the 20 to 12 because the machine would keep waking me up when it ramped to a high of 16-17 and I couldn't fall back asleep. 9 - 12 helped me sleep (most often) through the night with only one bathroom break, but I sometimes have trouble getting back to sleep. I'm currently working to raise the 12 in small increments as I get accustomed to it.
I've been tracking SleepyHead data and taking notes each morning on sleep quality. I'm attaching some recent SleepyHead graphs. I'm hoping someone can provide some suggestions for improving AHI and sleep quality.
Thanks!
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RE: Need help lowering AHI
Hi tbotting,
WELCOME! to the forum.!
Hang in there for answers to your questions and good luck with CPAP therapy.
trish6hundred
RE: Need help lowering AHI
hang in there, people with more experience than I will be chiming in. Guessing that they will want to take a closer look at least one of the periodic breathing sections. They will most likely talk about the centrals you are seeing also.
RE: Need help lowering AHI
Welcome to the forum, We will help you to get settled.
So you understand how much pressure you are dealing with, I'd like you to get a tall glass of water and a straw. I want you to immerse the straw into the water to depths of 2, 4, 6, and 8 inches and blow out thru the straw at each. Every 2 inches is an additional 5 cmw, so 5, 10, 15, 20 cmw, basically the FULL range of pressures your machine is capable of producing. (don't be fussy, these numbers are close enough) I'd bet that you had no issues with any of these, including the whopping 20 cmw.
To help you get used to the higher pressures I'd like you to set your machine for a range 10-10 cmw put your CPAP on and read a book or watch TV for a while (30 minutes or so).
Then bump the pressure up 1 cmw and repeat. Repeat until you reach 17 cmw. This doesn't need to happen in one day. Be sure to reset your machine to your nightly settings.
On the Ramp, most of us do not use a ramp. At most we used it initially as we were getting used to therapy, but ramp time does not deliver therapeutic pressures so if you can you are better without it.
based on the charts you presented I would up the minimum to 10 cmw.
Fred
RE: Need help lowering AHI
Yes, it's not much pressure, but so far it's been waking me up. Whether it's the pressure, or the change in pressure or the noise from machine or vent I don't know. I'll gradually get used to it. 7 used to feel like a lot. Now at 9 I sometimes check to see if the machine is actually on. I'll get the upper limit up as well, eventually, if needed. I'll try the minimum at 10 and see how that goes. I've been taking 2-3 nights to try each change so I'll be back in a couple days...
(02-18-2018, 04:29 PM)bonjour Wrote: Welcome to the forum, We will help you to get settled.
So you understand how much pressure you are dealing with, I'd like you to get a tall glass of water and a straw. I want you to immerse the straw into the water to depths of 2, 4, 6, and 8 inches and blow out thru the straw at each. Every 2 inches is an additional 5 cmw, so 5, 10, 15, 20 cmw, basically the FULL range of pressures your machine is capable of producing. (don't be fussy, these numbers are close enough) I'd bet that you had no issues with any of these, including the whopping 20 cmw.
To help you get used to the higher pressures I'd like you to set your machine for a range 10-10 cmw put your CPAP on and read a book or watch TV for a while (30 minutes or so).
Then bump the pressure up 1 cmw and repeat. Repeat until you reach 17 cmw. This doesn't need to happen in one day. Be sure to reset your machine to your nightly settings.
On the Ramp, most of us do not use a ramp. At most we used it initially as we were getting used to therapy, but ramp time does not deliver therapeutic pressures so if you can you are better without it.
based on the charts you presented I would up the minimum to 10 cmw.
Fred
02-19-2018, 12:20 AM
(This post was last modified: 02-19-2018, 12:23 AM by ajack.)
RE: Need help lowering AHI
Yes, you soon get use to the pressure.
I too would bump min to 10 and then see how it goes. You may need to raise your max out of the way, try 15 or 20, It normally doesn't matter if you set high, the machine uses what it needs. You do want at least 2-3 above the 95% number, to give the machine room to move.
RE: Need help lowering AHI
After 2 bad nights at 10-13 pressure, finally a pretty good night!
[attachment=4541]
The 2nd part of the night was mostly junk data as I often have trouble falling asleep after getting up. The CPAP can't tell if I'm awake or sleeping and I can't seem to breath on my own in a manner that is acceptable to the machine.
I'm going to continue at 10-13 for awhile and, if things steady out, gradually raise the upper limit.
RE: Need help lowering AHI
It's not too pretty, but if the time after the brief break is junk, let's leave it at that. A close-up of what was going on at 1:30 might be interesting...no more than 2-minutes including flow rate.
RE: Need help lowering AHI
(02-21-2018, 05:51 PM)Sleeprider Wrote: It's not too pretty, but if the time after the brief break is junk, let's leave it at that. A close-up of what was going on at 1:30 might be interesting...no more than 2-minutes including flow rate.
[attachment=4542]
RE: Need help lowering AHI
All of those flat-topped inspirations are flow-liited, and it has a slightly periodic pattern. You can ignore the PB flag. It's a little surprising your machine stays at the minimum pressure during this time as the Resmed would be boosting pressure for the flow limits. You might want to try Flex at 1. Wish I could get you on the Resmed Airsense 10 Autoset. I don't think any of this would be happening.
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