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Newbie questions (AHI, PB)
Hi everyone, first time post, I have read a lot of threads and appreciate all of your insights.

So, I have OSA with an AHI of something like 17 on my side and 55 on my back. Never adjusted to CPAP well though started trying to use it again recently because I want to sleep better. When I would begin falling asleep it would feel like the pressure was too much or I would stop breathing, so I would talk it off. Pressure was 10.

Went to see the sleep doctor, am now on an APAP trial with pressure setting of 6-16. They originally had me 4-14 but after a week of that I told them 4 was too weak. The one I am on is a Philips Respironics System One with Aflex.

So after the first night, I managed to keep it on for 6 hours and had an AHI of roughly 11, periodic breathing of 4%, and 90% pressure of 10.5. Last night I managed to keep it on for over 8 hours (a personal best! go me) and had an AHI of 9.5, periodic breathing of 2% and 90% pressure of 9.5. Still waking up a bit but obviously I don't expect that to resolve immediately. I was awake for a bit around 4 or 430am this morning (for maybe 30 or 45 minutes... which I never stay awake that long but attribute it to adjusting to the machine) and I am wondering if that explains the improvements in my numbers.

I guess my questions are:
- does it take a while for AHI to come down to <5? i.e. is it related to a period of comfort and adjustment to the machine?

- periodic breathing... is it also something that adjusts/resolves over time? Is 2-4% a concern this early into a trial with such a wide range of pressures? I did find this earlier today: In the case of inadequate or excessive titration, the breathing pattern can be stabilized by simply retitrating the patient using careful attention to detail. In the case of treatment-emergent central apneas, data suggest these events generally resolve spontaneously over time.

- they have me on the aflex but I have read here there are therapeutic trade offs in exchange for comfort. Could I expect improvement in my AHI/PB if on cflex? At this point while I still try to get used to the machine I like the exhalation relief but I don't really get the point of inhalation relief and I am not sure I need it. If there is relief on both I don't understand when/how the machine will actually get up to pressure.

I go back to the APAP provider Monday and they reset the machine to whatever my 90% pressure is and put it in CPAP mode and then I see the doc again on March 24.

Anyways, a lot there. I'm sorry. A lot on my mind and no one to talk to who "gets it". Thanks everyone.
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i am also brand new at this.... so check with an old-timer...

my understanding is that an APAP machine self adjusts to your breathing... so if it starts off at 4,, it will keep adjusting the pressure up as u need it,, with a max of 15 or whatever the max setting is on your machine...
your machine will give u readings of what it did during the nite... everynite will vary depending what u ate and how tired u r etc... check the average..
u may also have a button that will start the machine off at 4, allowing u to fall asleep easier rather than starting at 10 and trying to fall asleep...

there may b another button to adjust the c-flex ??... i have mine set at 3 which makes breathing out easier... i've tried all the settings,, i like #3 setting...

i also bought a finger oximeter that records,, i wear it everynite... it gives u pulse & oxygen readings...

it has improved my sleeping patterns... D
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Jamiedk86, the results anyone has to CPAP therapy is an individual matter, and it's hard to generalize. Your AHI number are relatively high, but we don't know what events are making up the AHI from your post. If it is predominately hypopnea and obstructive, I might draw a different conclusion from if your events are mainly clear airway (central) apnea. It's normal to go through an adjustment period, and we see members that greatly improve over the course of a few weeks. Others are almost immediately. Your situation is clearly improved with PAP so keep trying.

If you really want to get into the details, you'll need to post some charts or data.
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Hi jamiedk86,
WELCOME! to the forum.!
Much success to you with your CPAP therapy.
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Jamiedk86, Another piece of data to check is your leak rate. If it gets too high, the machine cannot provide accurate readings for other data--something to keep in mind. Also, when you go back to your sleep doc, you might want to try to get him/her to write a script that allows you to keep your machine on the APAP mode, rather than CPAP. Agreeing to let him/her set the pressure range may help get you this APAP option. It worked for me. Your doc may tell you, as mine did, that there is no clinical evidence that APAP provides better therapy than CPAP. I accept this point, but APAP provides me with much more comfortable treatment, and I'm sure others here will agree. I have times where my pressure needs change from week to week or even night to night, and the machine in APAP can keep up with this. When pressure needs are lower than the 90% CPAP figure, APAP's lower pressure response makes it easier to control mask leaks.

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Thanks everyone for your replies! Smile

My leak rate is 0% with the new mask on each of the three nights of this trial. Was ridiculously high before during my trial with the machine last week using a hybrid mask.

AHI keeps trending down. Was 7.7 last night. And PB was 1%. So everything is moving in the right direction. Kept the mask on the whole night again. 90% pressure was 11 last night.

I will endeavour to eventually post some charts or data if I don't keep showing progress.

And thank you Dawei, I will talk to my Doc about that. I think he will be tremendously pleased with the compliance I am getting with the APAP vs 0% compliance with my CPAP prior to this. I am just so excited to be making any progress. Words cannot begin to describe how much this means to me.

Thanks again for the replies!
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Glad to hear that you are again trying to adjust to the use of the CPAP/APAP use. Sounds like your first attempt was unsuccessful do to a comfort issue.. The APAP may indeed give you more adaptability do the flexible pressures. There must be a balance between comfort and therapy. Each is necessary for good compliance and therapy. Your PB and AHI will continue to improve as you diligently use your equipment. Adaptation is not an over-night thing.
Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
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