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New to Treatment- Looking for Guidance to Improve AHI
#1
New to Treatment- Looking for Guidance to Improve AHI
Hello all and Happy Holidays.  I started my PAP journey this week with a ResMed 10 AirSense AutoSet.  I am excited to start treating my OSA and happy to have discovered such a wealth of information in these message boards.  I was diagnosed with moderate OSA using an at-home sleep study.  Night 1 had an AHI of 14.7.  Night 2 had an AHI of 21.4.

I attach my Oscar screenshots (hopefully formatted correctly) for each of the past four nights (the 4th night will be attached to my second post).  The first night I was using a ResMed N20 nasal mask.  The other nights I was using a ResMed N30i nasal cushion.  The first three nights the machine was set to 5-15.  The fourth night I tried raising the minimum pressure to 8 and turning off ramp.

I am off to a good start with the treatment in the sense that I have no trouble wearing the mask all night and falling and staying asleep.  The first few nights I had a couple of episodes of rainout, but I now have that sorted.  My concern, however, is that my best AHI has been 4.8 and all others have been above 5.  Last night was 15, but I suspect something odd was going on in the last hour or so of sleep.

I am hoping the collective wisdom of the board may have suggestions for calibrating my settings so that I can bring my AHI consistently below 5, and hopefully much lower than that.  Thank you in advance.

           

Here is Oscar for night 4.
   
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#2
RE: New to Treatment- Looking for Guidance to Improve AHI
You have a
 Couple of things going on.  First you have positional apnea, in other words your sleeping position is cutting off your airway. It is usually “chin tucking” you are sleeping with your chin close or touching your chest. It is cutting off air and NO settings on your pap machine can help that. You have to avoid that position. Sometimes  said it is as simple as not sleeping on your back or changing the height of your pillow. If it can NOT be eliminated by simple methods then many people have found help by using a collar (link at the bottom of the post)

Next you have a lot of centrals - they can be brought on when you are first starting therapy. One help is to eliminate EPR. You have it set at max of 3. I would try to turn it off. 

Also your low number is to low. I would suggest 9.

Last yo have a ramp of 45 minutes. While you are on ramp you are getting NO therapy. If you can turn it off. If not limit as much as possible. 

Those are a lot of changes and most of the time we like to do one at a time but I think thes will help you greatly and then we can start to make suggestions that can fine tue your therapy.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: New to Treatment- Looking for Guidance to Improve AHI
Thank you so much for sharing your insights.  I turned ramp off last night.  So we can check that one off the list.  I also raised minimum pressure to 8 last night.  I will try increasing to 9 tonight.  I will change out my pillow, and if that doesn't work try a collar.

As for the centrals, my sleep study did show that I had some pre-treatment.  1st night of the study CAI was 0.8.  2nd night of the study CAI was 1.2.  I will definitely turn off EPR. Is there anything else I can do to help reduce centrals?
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#4
RE: New to Treatment- Looking for Guidance to Improve AHI
Usually central are caused because your body regulates breathing depending on CO2 levels. Your therapy is getting rid of more CO2 so your body does not need as much oxygen and as you get use to the therapy they lessen.  Another is the swing from high to low setting and some find a constant pressure (straight Cpap) helps. And iIF none of that helps there are special pap machines that are used for centrals. But those are more expensive and most are helped with what you will be doing.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: New to Treatment- Looking for Guidance to Improve AHI
I thought I would also mention that everyone has centrals but many are not reported.  All a central is a pause in breathing without any obstruction found.  In other words holding your breath.  They are not reported unless they are at least 10 seconds in duration.  You may hold your breath for a few seconds while turning over in bed or pulling up the covers but it is not 10 seconds or more.  So again we all have "centrals" every night.  And of course the ones reported are not an intentional holding your breath but your body just not taking a breath for some reason.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#6
RE: New to Treatment- Looking for Guidance to Improve AHI
Yep no Ramp, you may get away with bumping to 7-9 but above 5. Maybe the EPR needs dropped, but that and pressure both will be trial and error. CA are likely the newness to PAP and higher exhalation CO2 efficiency. And ditto the soft cervical collar to combat positional apnea clusters.

Welcome to the forum.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: New to Treatment- Looking for Guidance to Improve AHI
The pattern of clustered obstructive apnea and hypopnea is what points us to positional apnea. You should read these two wiki articles.
Positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical collar: http://www.apneaboard.com/wiki/index.php...cal_Collar
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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#8
RE: New to Treatment- Looking for Guidance to Improve AHI
Thanks to all for the advice.  It is great to have such a knowledgeable and supportive community.  I ran out to CVS to get a soft collar and will give that a try tonight.  Will also bump min pressure to 9 and turn off EPR.  Do I need to bump up the max pressure too?  In the graphs it looks like I occasionally hit the 15 it has been set at.
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#9
RE: New to Treatment- Looking for Guidance to Improve AHI
If you resolve the positional apnea, pressure requirements will drop...a lot. We have seen mixed results with the CVS and drugstore collars. The ideal fit, supports the jaw and chin without being tight on the throat. There are links to some reviews in the wiki. Anyway, the collar you got may be perfect or not, and don't be discouraged if the first one you try is not perfect.
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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#10
RE: New to Treatment- Looking for Guidance to Improve AHI
IMO if nothing else that collar can demonstrate if it'll help out even if that particular collar might be less comfortable or consistent result wise.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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