Post Reply 
Over a month and AHI's still high
Author Message
AshSF Online

Advisory Members

Posts: 356
Joined: Oct 2014

Machine: PRS1 D560TS
Mask Type: Nasal pillows
Mask Make & Model: ResMed P10, Bkup: Airfit F10 & Quattro Air
Humidifier: PRS1 60 series with Heated Tube
CPAP Pressure: 8 - 8 w/ Aflex 3
CPAP Software: SleepyHead

Other Comments: Using APAP mode with fixed pressure

Sex: Male
Location:

Post: #11
RE: Over a month and AHI's still high
You may want to do the following:
1) Raise minimum pressure to 6cm H20. Raise maximum pressure to 10cm H20.
2) Set A-flex to 3. This will make sure your EPAP is the same as it was at the start of 4cm pressure.
3) Do this for 10+ days. Then evaluate your pressure needs again.

When we start xPAP therapy, a lot of central events start showing up (even if the original sleep study didn't show any). This is probably due to our body learning to breathe against pressure and xPAP being better in removing CO2 from your lungs. Typically, the central events settle down to negligible soon. Since you have been on xPAP for only ~30 days, your Central Apnea events have not settled to a low value yet. If your central event portion of AHI doesn't go down below 5 after 60 more days of xPAP, then its a cause of concern that you may need a different kind of machine (a bilevel or an ASV machine).

Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
02-28-2015 01:56 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Gulfbreezey Offline

Preferred Members

Posts: 23
Joined: Jan 2015

Machine: PR System One REMstar Auto 560
Mask Type: Nasal pillows
Mask Make & Model: PR Nuance
Humidifier: PR heated matches CPAP
CPAP Pressure: 4 - 8
CPAP Software: SleepyHead Other Software

Other Comments:

Sex: Female
Location: North Florida

Post: #12
RE: Over a month and AHI's still high
(02-28-2015 12:48 AM)DeepBreathing Wrote:  Your results are showing a very high proportion of central apneas. Did these show up in your sleep test?

Here's info from my tests:

First Sleep Test ...
SUMMARY: Total recording time 455.6 minutes with a sleep efficiency 47.5%, Sleep latency 55.0 minutes, and REM latency 203.0 minutes. A/H index is 13.2. REM stage A/H is 41.1. There were 6 Central Apneas, 0 Obstructive Apneas, 0 Mixed Apneas, 40 Hypopneas and 0.0 RERAs. The Resting SPO2 was 91%. The mean SPO2 in non-REM sleep was 90%. The mean SPO2 in REM was 88%. Lowest oxygen saturation was 83%. PLM index was 8.3 per hour, with associated arousal index of 1.2. Audio monitoring of respiration revealed no snoring. EKG showed no significant dysrhythmia.

2nd Test with CPAP
SUMMARY: Total recording time 390.3 minutes with a sleep efficiency 62.7%, Sleep latency 9.0 minutes and REM latency 317.0 minutes. Optimal pressure obtained at 8.0 cmH20, with elimination of snoring. At optimal pressure A/H index is 3.0. The Resting SPO2 was 95%. The mean SPO2 in non-REM sleep was 93%. The mean SPO2 in REM was 94%. Lowest oxygen saturation was 97%, no significant desaturations post-titration. PLM index was 12.2 per hour, with associated arousal index of 1.0.
02-28-2015 04:43 PM
Find all posts by this user Post Reply Quote this message in a reply
Gulfbreezey Offline

Preferred Members

Posts: 23
Joined: Jan 2015

Machine: PR System One REMstar Auto 560
Mask Type: Nasal pillows
Mask Make & Model: PR Nuance
Humidifier: PR heated matches CPAP
CPAP Pressure: 4 - 8
CPAP Software: SleepyHead Other Software

Other Comments:

Sex: Female
Location: North Florida

Post: #13
RE: Over a month and AHI's still high
(02-27-2015 08:38 PM)Sleeprider Wrote:  It would be great if you would post the detailed graph of a night you are concerned about, including the left window with the machine, event summary, settings, and the detail graphs of Events, Flow rate, Pressure and Leaks.

The summary data really doesn't tell us how events are getting past your pressure settings. I think you need to be on minimum pressure of 6.0 and maximum of 14.0 and see where that takes us. The graph we're looking for should look something like this:

[Image: 9h2EgUbl.png]

Have picked two charts. Will put one here and have to put the other on another reply because of size limits. Thanks.    
02-28-2015 05:03 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Gulfbreezey Offline

Preferred Members

Posts: 23
Joined: Jan 2015

Machine: PR System One REMstar Auto 560
Mask Type: Nasal pillows
Mask Make & Model: PR Nuance
Humidifier: PR heated matches CPAP
CPAP Pressure: 4 - 8
CPAP Software: SleepyHead Other Software

Other Comments:

Sex: Female
Location: North Florida

Post: #14
RE: Over a month and AHI's still high
(02-27-2015 03:20 PM)Gulfbreezey Wrote:  
(02-27-2015 02:08 PM)SailingAway Wrote:  It would make it a lot easier to answer your questions if you would post the SleepyHead screenshots of what's going on with you.

I hope these are what you wanted.
Thanks!

Removed these charts because they were taking up most of my space and I was told the daily charts would be more helpful. Thanks.
(02-27-2015 08:38 PM)Sleeprider Wrote:  It would be great if you would post the detailed graph of a night you are concerned about, including the left window with the machine, event summary, settings, and the detail graphs of Events, Flow rate, Pressure and Leaks.

The summary data really doesn't tell us how events are getting past your pressure settings. I think you need to be on minimum pressure of 6.0 and maximum of 14.0 and see where that takes us. The graph we're looking for should look something like this:

[Image: 9h2EgUbl.png]

Here's the 2nd chart.

   
(This post was last modified: 02-28-2015 05:09 PM by Gulfbreezey.)
02-28-2015 05:07 PM
Find all posts by this user Post Reply Quote this message in a reply
Gulfbreezey Offline

Preferred Members

Posts: 23
Joined: Jan 2015

Machine: PR System One REMstar Auto 560
Mask Type: Nasal pillows
Mask Make & Model: PR Nuance
Humidifier: PR heated matches CPAP
CPAP Pressure: 4 - 8
CPAP Software: SleepyHead Other Software

Other Comments:

Sex: Female
Location: North Florida

Post: #15
RE: Over a month and AHI's still high
(02-27-2015 01:10 PM)Gulfbreezey Wrote:  I am sleeping some better but I'm not getting those magic numbers of 5 and under for AHI's.

Looking for what to look at in SleepyHead to figure out what my settings should be. I'd really like to get this numbers down.

In the 34 days I've had one low of 5.2 and 2 in the low/middle 6's. The rest of the nights go from 9 to 18. Average is 11.29.

Thanks for any help.

To all who are helping me. First off thank you so much for your time and concern!

I cannot right now modify the settings on my machine myself because I'm on Medicare payments for it and the DME has to control the machine's pressure settings as I understand it. Yesterday I asked my DME to send a current report to my doctor and I will call my doctor next week after he gets the report and try and talk him into changing my prescription to your great recommendations here.

My doctor is usually most receptive to my health recommendations. When I got the original prescription I wanted him to give me the 8cmH20 for my APAP at +- 3 but he was worried about going over the recommended 8. I think my suggestion of 5-11 at that time would have been pretty good. He was concerned about 11 potentially being too much pressure as he doesn't understand xPAP very well. You have any good words to keep him from worrying about the pressure increase?

Thanks to everyone as I am learning so much about my machine, SleepyHead usage/reading and how to work on my problem.
02-28-2015 05:18 PM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
quiescence at last Offline

Advisory Members

Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #16
RE: Over a month and AHI's still high
so even at min 8 to max 8 you'd be better off. can you determine what position you are in during your most cluttered episodes? Unfortunately your sleep studies do not relate what your scores are supine vs on your side. Once you find this out, you can make arrangements to stay on your left side, right side, or back to minimize the apneas. Also, if back sleep is the culprit, you should elevate the head of your bed, if possible, even just 2 inches will make a difference. Others have suggested sleeping some of the night in a recliner, with your head above the height of your knees.

I am not aware if this board has had any occurrence of the machine being taken away because the patient changed the settings. I hope someone more knowledgeable will answer that one.

Usually, the only thing they really care about is that you are committed to using the CPAP faithfully.

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
(This post was last modified: 02-28-2015 10:37 PM by quiescence at last.)
02-28-2015 10:35 PM
Find all posts by this user Post Reply Quote this message in a reply
DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,293
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #17
RE: Over a month and AHI's still high
You can see that the pressure is maxing out at 8 for long periods. This indicates the machine wants to go higher to treat the events you're experiencing. I think you definitely need to increase the max pressure - talk to your doctor or take it into your own hands if you're so inclined.

The other thing which I found interesting is that your total AHI is worse (15.06) under therapy than in the sleep test (13.2). And the make-up of your events is substantially different under therapy:

Index__________Study______Therapy
Central________13.0%______56.0%
Obstructive_____0.0%______25.2%
Hypopnea_______87.0%______18.9%


The pressure has caused your centrals to jump dramatically - hopefully this will resolve itself as your body adjusts to CPAP. However, you do need to increases your maximum pressure which may cause the centrals to go even higher in the short term. I note that quite a lot of centrals are clustered around 07:00 - 07:30, when you are probably transitioning out of sleep. It may be that these can be safely ignored if that's the case.

I think the hypopneas and obstructives will go down once the pressure goes up, and changing your sleep posture (as suggested above) may help this further.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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.
03-01-2015 12:39 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
Gulfbreezey Offline

Preferred Members

Posts: 23
Joined: Jan 2015

Machine: PR System One REMstar Auto 560
Mask Type: Nasal pillows
Mask Make & Model: PR Nuance
Humidifier: PR heated matches CPAP
CPAP Pressure: 4 - 8
CPAP Software: SleepyHead Other Software

Other Comments:

Sex: Female
Location: North Florida

Post: #18
RE: Over a month and AHI's still high
DME finally sent a report to my doctor. He wants to see me. Have an appointment next Tuesday. I'm taking a few example reportts to show detail. Even on nights when I get down to 8 or 9 I'm still maxing out a lot.

Will let you all know how it goes.
Thanks again for all the help and info.
03-05-2015 11:32 PM
Find all posts by this user Post Reply Quote this message in a reply
Sleeprider Online
Wiki Editor
Advisory Members

Posts: 3,317
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #19
RE: Over a month and AHI's still high
You may want to discuss moving to bilevel CPAP therapy. With lower exhale pressure, a higher inhale pressure is tolerable and may avoid the creation of centrals. It really depends on the root cause. Relieving exhale pressure can avoid certain types of centrals, but increased ventilation from increased IPAP/EPAP pressure support can also reduce CO2 levels and that can suppress respiration. There is no single right answer. BiPAP does work for many who have centrals, butt do not need ASV or timed respiration backup.

______________________________________________
Organize your SleepyHead Data
Post your SleepyHead Data from Imgur
Robysue's Beginner's Guide to Sleepyhead
03-06-2015 09:09 AM
Find all posts by this user Post Reply Quote this message in a reply

Donate to Apnea Board
quiescence at last Offline

Advisory Members

Posts: 753
Joined: Nov 2014

Machine: REMstar System One with Autoflex
Mask Type: Full face mask
Mask Make & Model: Quattro AirFit F10
Humidifier: yes typical setting = 4
CPAP Pressure: 5-13 Autotritrating CPAP
CPAP Software: SleepyHead EncoreBasic

Other Comments: CMS-50F Plus oximeter /w SPO2 Assistant software. Avowed mouth-breather switching to nose-breathing

Sex: Male
Location: US

Post: #20
RE: Over a month and AHI's still high
I have heard that reducing the difference between inhale and exhale pressure clears up many CPAP initiated CA events. In my own experience this has shown to be true, although I don't have a big problem with CAs at the moment.

I had CAs a fair amount when just starting and they mostly subsided as I got used to the machine.

Good luck in your adventure.

QAL

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
03-06-2015 09:40 AM
Find all posts by this user Post Reply Quote this message in a reply
Post Reply 


Possibly Related Threads...
Thread: Author Replies: Views: Last Post
  Events way too high! sfrasher 22 1,174 11-22-2016 06:35 PM
Last Post: sfrasher
  High AHI (7.5) and don't know why fotomatt1 15 577 11-20-2016 05:38 PM
Last Post: Sleeprider
  AHI index has taken a nose dive the past month pdbabb66 32 1,332 11-09-2016 05:58 PM
Last Post: pdbabb66
  [Pressure] Hypoxic- No Apneas- Pressure Too High? beardog 13 608 11-08-2016 06:19 PM
Last Post: PsychoMike
  Leaks (Too high?) sleepytimegal 9 411 11-06-2016 09:58 PM
Last Post: sleepytimegal
  Symptoms of pressure being too high?? MrEGuy 4 561 10-19-2016 06:32 PM
Last Post: EnigmaGrey
  Why Are AHI High When Wide Awake? Dreams of Green 7 649 10-18-2016 09:35 PM
Last Post: 0rangebear

Forum Jump:

Who's Online (Complete List)