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New to Cpap, High AHI, Please help
#1
I am new to CPAP and I'm 4 days into treatment. During these 4 days of treatment my AHI average is 22.6. What guidance do you have on reducing my AHI, should I up the pressure? I will also get an appointment to talk to my doctor.

Diagnosis: I was diagnosed on Jan 10 with severe OSA, 63.2 AHI and 63.4 RDI during REM. At the second sleep study on Cpap the results were "At higher Cpap pressure the study demonstrated imporvment of the RDI to 11.6 per hour @ 15cmH20." Prescribed Cpap at 16 cmH20 with close follow-up.

My Equipment & Settings:
Cpap: Resmed S9 Autoset
Mask: Resmed Quattro FX
Cpap pressure: 16
Software: Sleepyhead

4 Day Summary of Cpap treatment:
AHI: 22.6
CA: 1.47
OA: 17.22
H: 3.97
Avg Leak: 0.53
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#2
I believe one or two months are needed to really get in tune with the machine and to determine your proper pressure. Though you can change the pressure, I would not change it on the basis of four nights, and I would not advise a newcomer to change their pressure unless absolutely necessary. At this stage you need to be in close contact with your doctor. Raising the pressure may cause central apneas to pop up (a central is where the brain does not tell the body to breathe, or they can be caused from respiratory depression from narcotic pain meds) or from too high a pressure. It's good you have an autoset- you are getting into the pressure range where a cpap would be uncomfortable and where mask leaks may be hard to control. So hang in there, memorize your instruction manual, download the clinical manual, but don't worrry about making changes at this time. Write down any problems and thoughts about your treatment so you have your list ready and can just hand it to the doctor (make a copy for both of you) at your next appointment. This is really important so you're not scrambling to remember what you wanted to talk to the doc about. Keep active on the forum, bring large or small problems to us for help, but keep the doc in the loop until you're well educated on sleep disordered breathing, ask about any terms you don't understand. Concentrate on getting good sleep using the machine.
I'm glad you found us and wish you the best sleep ever, Rodneydu2. Remember treatment is a process, not the destination.
Mary
PS: you got a great machine and mask and seem to be well on your way to understanding your treatment. Just don't get in a hurry.
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#3
(02-08-2013, 10:53 AM)rodneydu2 Wrote: I am new to CPAP and I'm 4 days into treatment. During these 4 days of treatment my AHI average is 22.6. What guidance do you have on reducing my AHI, should I up the pressure? I will also get an appointment to talk to my doctor.

Diagnosis: I was diagnosed on Jan 10 with severe OSA, 63.2 AHI and 63.4 RDI during REM. At the second sleep study on Cpap the results were "At higher Cpap pressure the study demonstrated imporvment of the RDI to 11.6 per hour @ 15cmH20." Prescribed Cpap at 16 cmH20 with close follow-up.

My Equipment & Settings:
Cpap: Resmed S9 Autoset
Mask: Resmed Quattro FX
Cpap pressure: 16
Software: Sleepyhead

4 Day Summary of Cpap treatment:
AHI: 22.6
CA: 1.47
OA: 17.22
H: 3.97
Avg Leak: 0.53

As Zimlich said; it's probably too early to be making any conclusions or changes. Take a little time just getting used to the mask, pressure, etc. Your average leak looks great by the way.

In the meantime, arm yourself with some questions for your follow-up visit:

Does your doctor know you have a machine capable of auto-titration?
(Your AutoSet is designed to be able to be set within a pressure range, instead of just one pressure. The machine can increase and decrease pressures within that range in order to clear obstructions as they arise. I.E. set to 16 - 20, it will stay at 16 until indicators suggest you are beginning to have an obstructive event - it will then raise pressures to prevent or clear obstruction. As breathing continues without obstruction the AutoSet lowers pressures back to the low end setting)


Why does s/he not what you to use the auto setting?


Does s/he know that the AutoSet is capable of differentiating between clear airway events (CAs usually Central Apnea) and does not raise pressures when the airway is clear?


Are there other health issues to consider? Is this why s/he hasn't ordered the machine be set in auto mode? Is there a reason to limit your pressure to 16, even though you continue to have a high number of Obstructive Apneas?


If there aren't other compelling health issues and your doctor just says s/he doesn't like AutoPAP or doesn't think it works and your AHI is still high by the time you go to the follow-up appointment - then ask him/her to explain to you why you should believe HIS/HER method is working well.


Sleep-well



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#4
Hi rodneydu2,
WELCOME! to the forum.!
I wouldn't change your pressure just yet because you have only been at this 4 days, it's a bit too early for that. One thing you could do is to ask about trying a different mask, full-face masks, (FFMs) can be very proned to leaks and there are many different masks to try. The mask can be the most difficult part of CPAP therapy and it can take LOTS of PATIENCE.
It would be a good idea to talk to your Dr. about these problems you are having.
Best of luck to you with your CPAP therapy and hang in there for more responses to your post.
trish6hundred
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#5
keep up with the doctor as close follow-up is recommended
keep in mind machine data looked at as a trend and four days is a short time and don,t make a trend

how many hours are you sleeping, are you sleeping right thru
if not, what waken you up

the average leak something to do with SleepyHead
whats the median, 95% percentile and maximum leak




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#6
(02-08-2013, 10:53 AM)rodneydu2 Wrote: I am new to CPAP and I'm 4 days into treatment. During these 4 days of treatment my AHI average is 22.6.

You should see it drop in the next few days. If not, I would suggest you call your doctor or equipment provider. Tell them you're concerned and you want to send them your data.

You don't want to go making adjustments to your pressure now and then have to go in later and explain to the doctor that you took it upon yourself to fiddle with the settings.

If things don't get better, and your doctor is uncooperative, let us know. At that point you might want to consider putting your machine in auto mode.

For now, though, keep an eye on your AHI and see how it changes. What's important now is the make up of your AHI. There are three separate indices that add up to your AHI. Can you tell us the values of these? The CA, the OA, and the hypopnea indices.




Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#7
(02-08-2013, 03:01 PM)zonk Wrote: keep up with the doctor as close follow-up is recommended
keep in mind machine data looked at as a trend and four days is a short time and don,t make a trend

how many hours are you sleeping, are you sleeping right thru
if not, what waken you up

the average leak something to do with SleepyHead
whats the median, 95% percentile and maximum leak


Thanks for your help. I have a Drs appt next Friday and will ask him the questions.

SleepyHead shows ~7.25 hours of sleep, however I do awake 3 or 4 times since I am getting adjusted to the mask.

My SleepyHead info is: 95% Leaks is 9.60, Avg Leak 1.24
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#8
The machine doesn't know if you are awake or asleep so it just keeps plodding along.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#9
...A Zeo will tell you if you had any waking events and when they occurred.
Wink
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#10
(02-08-2013, 07:57 PM)rodneydu2 Wrote: Thanks for your help. I have a Drs appt next Friday and will ask him the questions.

Hi rodneydu2, welcome to Apnea Board!

Bring your memory card with you to the doc.

Also, I suggest printing out and bringing to your doctor the time plots showing when your events are happening and how long the events are lasting. Any doctor worth having will appreciate having this info to properly optimize your treatment.

Don't be shy. Ask doc to change your prescription to Auto mode, 16-20 cmH2O, with EPR set for control by patient.

Since your AHI is not yet very good, if EPR (Expiration Pressure Relief) is OFF then leave it turned off (I think EPR can sometimes reduce effectiveness if in CPAP node, but EPR should be fine to use in APAP mode) but ask for EPR to be set to patient control so you can experiment to see what EPR amount works best for you.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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