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[Pressure] Cannot find a pressure level consistently reducing AHI below 5
#1
Cannot find a pressure level consistently reducing AHI below 5
Hi to everyone,
After many years passing in fatigue, one day I started to measure my deep sleep duration thanks to my smart watch. The first results showed me that my deep sleep time is only 10 or 15 minutes and some times even 0 (The mean value of people is 90 minutes).

I was always very tired but not suspicious that I had a sleep apnea because my wife said that I was very rarely snoring and she did not feel a respiratory interruption during my sleep. Also, my weight was not so much. (my body index: 26kg / m2)
But the measured deep sleeping time had an indication about a sleep problem. I measured the oxygen level with a PulseOxymeter and found that my oxygen level during sleep time could be down to %79. Then of course I went to have a sleep test. and finally Test Result was AHI: 23.

Since my insurance company did not meet the CPAP device and pressure calibration, I bought an APAP device with my own money. I tried to determine my optimum pressure range. After every night I examined the data with Sleepyhead and decided the next days pressure trial. Below, there are my pressure trials and my first 17 days results with Resmed s9 Autoset. 

The last five AHI's are 8.1  / 3.2 / 3.4 / 4.3 and 8.3 with a constant 8.4 cm H20 pressure. I do my best to find my pressure level. But at the result, my last AHI values is not stable. Can anyone comment my trials below and show me what is wrong? I cannot find a pressure level which responds an AHI which is stable below 5. 

Day_Pmin__Pmax_EPR_ AHI___#OA__#CA
01___4.0__15.0____3___37.5___34___328
02___4.0__15.0____3___17.5___21___123
03___6.0___9.0____3___13.0___24____78
04___7.2___8.6____3____6.8____8____37
05___7.8___8.2____3____7.0___13____38
06___8.0___8.4____3____5.0____7____30
07___9.4__11.2____3___14.2___15____90
08___9.2___9.6____3___14.5___26___104
09___9.4___9.4____3___11.8___20___100
10___9.4___9.4____3____3.8____4____21
11___9.4___9.4____3____4.7____4____24
12___9.4___9.4____2____8.2____4____44
13___8.4___8.4____3____8.1____5____55
14___8.4___8.4____3____3.2____9____13
15___8.4___8.4____3____3.4____7____14
16___8.4___8.4____3____4.3____7____29
17___8.4___8.4____3____8.3____9____43 
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#2
RE: Cannot find a pressure level consistently reducing AHI below 5
I found that I had to use my machine for a few weeks at a given pressure to get a good feel for the pressure I needed. Ten years ago the sleep doctor started me at 14 and then 15 and I am now at 11.5 (for several years). My average AHI for the last year was 1.8 but I had some excursions up to 8. I think you need to go by the average.
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#3
RE: Cannot find a pressure level consistently reducing AHI below 5
If it were me, I would use the auto mode and set the min pressure at 9 and the max at 20. Then download the sleepyhead program at the top of the page and get some sleepyhead charts up. I wouldn't worry about the CA for now, new users often get pressure induced CA in the beginning. The OA may settle too, as your body adjusts to pressure.
You also use the AHI as the number you have in a hour, total number isn't that important.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Cannot find a pressure level consistently reducing AHI below 5
Hello Kgunen

Welcome to the forum.

With 4 posts, you will be able to post sleepyhead data as this is the most effective way help can be effective. (but before that do so with a gap with an imgur address).

Any interpretation of the data you have posted can only be a best guess without further charts to clarify. It appears that you probably started with too low pressure at 4cm H2O. You may have accumulated lots of apneas before the pressure was raised sufficiently to deal with it. Did you have ramp time on? If so, what was it?

I can see you began to raise the minimum but unfortunately then reduced the maximum, perhaps at which point then the obstructions came in and were not dealt with effectively by the lowered higher pressure. You were changing settings far too often to start with but later stayed at the same but perhaps too low a pressure.

I would suggest you stay at 8 minimum and raise your maximum to say 12 or 13 and see where that takes you.
Sleepyhead in 5 easy steps
Beginner's Guide to SleepyHead

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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#5
RE: Cannot find a pressure level consistently reducing AHI below 5
Hi kgunen,
WELCOME! to the forum.!
Good luck with CPAP therapy, hang in there for more responses to your post.
trish6hundred
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#6
RE: Cannot find a pressure level consistently reducing AHI below 5
Your last 7 days show an average estimated AHI of 5.7. I would stay with CPAP 8.4 for now, try lowering EPR, and also check SleepyHead to see if a lot of the CAs are happening while you are awake (and therefore shouldn't be counted).
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#7
RE: Cannot find a pressure level consistently reducing AHI below 5
“Stable” can be an elusive term here. Primarily is probably better. It took me a couple months to get under 5 for 7 days. Now after 2 years I am primarily at 1 with a range from 0 to 2. 

The good news, however, is that for the month of December, my average is looking to be >1 for the month and the last 2 weeks every day >1. 

Patience and a lot of tweaking.
CPAP is a journey like “The Wizard of Oz”. It’s a long slow journey. You will face many problems and pick up many friends along the way. Just because you reach the poppies, it doesn’t mean you are in Kansas. 
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#8
RE: Cannot find a pressure level consistently reducing AHI below 5
It looks to me like you get good results with pressure at 9.4, but you have continuing CA events. The solution to that is to reduce EPR. If you reduce EPR and CA is controlled, you can start lowering Pmin for more comfort if you choose. EPR is likely contributing to your CA events, and changing that setting to 1 or off will probably eliminate most or all of them.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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
RE: Cannot find a pressure level consistently reducing AHI below 5
Hi kgunen. Welcome to Apnea Board.

On every night and every pressure combination you are experiencing more central apneas than obstructive. However you haven't given us the results for hypopneas, which we also need to see. Can you go back to your original sleep study and see what the central apnea index was? This is the important baseline we need before we start guessing whether or not these centrals will go away.
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#10
RE: Cannot find a pressure level consistently reducing AHI below 5
Thank you for your comments.
I uploaded the SleepyHead screenshots to imgur. You can see them my following messages.
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