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Reducing AHI to below 2
#1
Question 
Reducing AHI to below 2
Hello Everyone,

Thank you for this site, it has been the best source of information as I try to optimise my CPAP use.

I would like to get my AHI consistently below 2 if possible. I am only learning so far and there is so much to absorb on top of life itself!

My sleep technician is really unhelpful (apologies to all the wonderful sleep tech's out there) he talks about my sleep report and tells me I am consistently having clusters in the first hour of trying to get to sleep - and I am looking at my OSCAR data and it doesn't show that. I guess he is overworked because he has told me there is no point putting in the effort to reduce AHI further, even though I told him I can feel a significant difference when it is (rarely) below 1 or 2. I have occasional 7+ and know I can't drive on those days which is frustrating, he says don't worry about it! I am not an anxious person yet that is how I am treated.

In addition, the most recent data shows a Cheyne-Stokes pattern which hasn't happened before.

My apologies for the complaining tone, I would really appreciate if someone could look at the screenshots here and let me know if there is anything I can do to improve AHI.

Best regards, Elizabeth
PS I've put one bad night, one average night and an overall summary graph thingy, happy to provide more (first time so hope ok)

           
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#2
RE: Reducing AHI to below 2
Welcome to the forum.
You have been using your AutoSet for 2.5 months. That means your Central apnea is persistent. Your AutoSet cannot treat your Central apnea so we must avoid it. Our first try is to reduce your EPR to 1. I expect some increase in obstructive events and a reduction in Central events.

CSR, ResMed calls all periodic breathing CSR. We like to see a 5 minute zoomed view of the periodic breathing just to eliminate bad things like CSR. This series is not long enough to be of concern, and it is unlikely to be CSR.

Try the EPR change and repost and we can see what needs to change.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Reducing AHI to below 2
(05-02-2020, 08:06 AM)bonjour Wrote: Welcome to the forum.
You have been using your AutoSet for 2.5 months.  That means your Central apnea is persistent.  Your AutoSet cannot treat your Central apnea so we must avoid it.  Our first try is to reduce your EPR to 1.  I expect some increase in obstructive events and a reduction in Central events.

CSR, ResMed calls all periodic breathing CSR.  We like to see a 5 minute zoomed view of the periodic breathing just to eliminate bad things like CSR.  This series is not long enough to be of concern, and it is unlikely to be CSR.  

Try the EPR change and repost and we can see what needs to change.

Thanks Bonjour,

I appreciate your help very much. EPR is currently 3, do I reduce it to 1 straight away or do it in stages?

Yes I have been concerned that my AHI is often mostly central apnoeas.

I am new to this, I'm wondering what the mechanism is here that will help. 
I've added a zoom shot of the CSR but not sure if it is zoomed enough to be of use!

I'm in Australia, so off to bed now, I'll put EPR down. I have to say my health is phenomenally improved since starting CPAP therapy.

Many thanks,

Fran


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#4
RE: Reducing AHI to below 2
Hi again Bonjour,

I reduced EPR to 2 last night and here are the results.

Total CA may be misleading as I think the last hour or so I was waking up and trying to go back to sleep, checking phone etc - it seems to register CA when I am  awake reading a book etc.

Many thanks,
Elizabeth


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#5
RE: Reducing AHI to below 2
(05-02-2020, 09:32 AM)Elizabethwa Wrote:
(05-02-2020, 08:06 AM)bonjour Wrote: Welcome to the forum.
You have been using your AutoSet for 2.5 months.  That means your Central apnea is persistent.  Your AutoSet cannot treat your Central apnea so we must avoid it.  Our first try is to reduce your EPR to 1.  I expect some increase in obstructive events and a reduction in Central events.

CSR, ResMed calls all periodic breathing CSR.  We like to see a 5 minute zoomed view of the periodic breathing just to eliminate bad things like CSR.  This series is not long enough to be of concern, and it is unlikely to be CSR.  

Try the EPR change and repost and we can see what needs to change.

Thanks Bonjour,

I appreciate your help very much. EPR is currently 3, do I reduce it to 1 straight away or do it in stages?

Yes I have been concerned that my AHI is often mostly central apnoeas.

I am new to this, I'm wondering what the mechanism is here that will help. 
I've added a zoom shot of the CSR but not sure if it is zoomed enough to be of use!

I'm in Australia, so off to bed now, I'll put EPR down. I have to say my health is phenomenally improved since starting CPAP therapy.

Many thanks,

Fran

Hi Bonjour,

Here are my graphs after reducing EPR to 2, all good I think, but is there anything I could change or improve? I am especially pleased with today's results AHI 1.63   so I will reduce to EPR to 1 tonight and hopefully leave it at that level if CA is acceptable.

Many thanks, Elizabeth


       
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#6
RE: Reducing AHI to below 2
Hi Bonjour,

Many thanks for your advice, lowering the EPR has helped a lot in reducing AHI.

Still getting some centrals but since AHI is hovering at less than 2.5 and beginning to regularly be below 2, I am thrilled.
And despite my sleep tech saying that any changes below AHI 5 make no real difference, he also advised that occasional high AHI (around 9) doesn't matter, I DO feel better!

I am suffering with bush-fire induced asthma (at this time of year in Australia they burn off forest floor to help reduce summer risks) at the moment and my CPAP is helping a lot. I am using ventolin and steroid inhaler and my AHI is staying around 1.5.
I have left EPR at 2 as that helped but will likely go to 1 once asthma has settled down.

I very much appreciate your advice (although it causes me to get more and more mad with my provider, not sure what to do about that!).

In appreciation, Fran
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#7
RE: Reducing AHI to below 2
Here is the mechanism that is happening with EPR. Knowledge of this may or may not help with your asthma.

Higher breathing efficiancy is caused by higher pressure support which is the difference between inhale and exhale pressures. We accomplish this with EPR on your machine.  EPR is considered a 'comfort' feature and as such cannot have a therapeutic benefit, wrong, it does, big time.
This increase in efficiency increases the absorbing of oxygen into the blood, good (see how this might help your asthma a little).  It also increases the flushing of CO2 out of the system, and in some people, a little too much as it decreased the CO2 concentration to below the apneic threshold which cause a Central apnea to occur.  With you not taking a breath the CO2 builds up and you take a breath   what helps here is lowering the EPR/PS to decrease this efficiency and thus prevent the CO2 from dropping below the apneic threshold.

It is the CO2 levels in your blood that provide the primary driver to breathe.

I suspect that on bad asthma  nights the increased EPR may help you breathe, with the consequences of some increased centrals.  Knowing how EPR is working for you should help you to achieve a balance.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: Reducing AHI to below 2
           
(05-15-2020, 09:23 AM)bonjour Wrote: Here is the mechanism that is happening with EPR. Knowledge of this may or may not help with your asthma.

Higher breathing efficiancy is caused by higher pressure support which is the difference between inhale and exhale pressures. We accomplish this with EPR on your machine.  EPR is considered a 'comfort' feature and as such cannot have a therapeutic benefit, wrong, it does, big time.
This increase in efficiency increases the absorbing of oxygen into the blood, good (see how this might help your asthma a little).  It also increases the flushing of CO2 out of the system, and in some people, a little too much as it decreased the CO2 concentration to below the apneic threshold which cause a Central apnea to occur.  With you not taking a breath the CO2 builds up and you take a breath   what helps here is lowering the EPR/PS to decrease this efficiency and thus prevent the CO2 from dropping below the apneic threshold.

It is the CO2 levels in your blood that provide the primary driver to breathe.

I suspect that on bad asthma  nights the increased EPR may help you breathe, with the consequences of some increased centrals.  Knowing how EPR is working for you should help you to achieve a balance.

Thanks Bonjour,
this brought back distant memories of my nursing days and reminded me of the dangers of giving asthmatic patient too much oxygen.
After a week of treatment and no environmental smoke my asthma improved, interestingly so did AHI while on inhalers.

I have now reduced EPR to 1 and was thinking of keeping it there but I have a query.
My AHI is more consistently below 2.
Still have centrals,  but overall having much better sleep experience, I wonder is it possible the centrals would reduce or disappear if I switched EPR to 0?

Again, many thanks for explaining to me, it really helps. If only there was a book given out to us when we are thrown into the world of CPAP, I am so glad I found this site.

Elizabeth
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#9
RE: Reducing AHI to below 2
Per my own experience with CA, it's been revealed that these events have a consistent inconsistency to them. You think you've got them under control and with nothing changing there they are again.

As for EPR of 0, you could try it and see if it helps. Some users benefit from reduction of pressure swings.
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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#10
RE: Reducing AHI to below 2
Your AHI is under 2, don't worry about the numbers. Instead concentrate on how you feel.
You have an apparent reduction in CAI, as Dave said centrals have a consistent quality about them in that they are Consistently Inconsistent. Expect them to vary.

Try reducing EPR to 0, but NOTE how you feel with that change.
Also lower your max pressure, I'd set your Max at 9, and likely try to lower it more to reduce the pressure variability. The goal is to get you even more comfortable.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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