Over a month and AHI's still high

[AshSF]

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).

[Gulfbreezey]

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.

[Gulfbreezey]

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:

Have picked two charts. Will put one here and have to put the other on another reply because of size limits. Thanks.[attachment=1317]

[Gulfbreezey]

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.

---

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:

Here's the 2nd chart.

[attachment=1318]

[Gulfbreezey]

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.

[quiescence at last]

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

[DeepBreathing]

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.

[Gulfbreezey]

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.

[Sleeprider]

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.

[quiescence at last]

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