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Require Help to Reduce AHI
#1
Require Help to Reduce AHI
    [attachment=14444]Hi, I have decided to seek your assistance in how to reduce my AHI. I have had my Dreamstation Auto CPAP machine since May 2019. I have obtained fluctuating AHI readings and seek guidance in how to maximise the benefits of my CPAP machine.

My Details are:
Dreamstation Auto CPAP AUX500T15
Pressure Min 4 Max 20
Ramp 4  Time 15 mins
Flex 1

30 Day Data
 Therapy hrs            6.7
  AHI                      5.7
  Mask Fit               100%
  Periodic Breathing  6%
  90% Pressure        7.8

Thanks. 

Attached is my Sleep Study Report and last 3 night's Oscar screen shots.


.pdf   Sleep Study 16 April 2019 1.pdf (Size: 435.36 KB / Downloads: 31)    
.pdf   Sleep Study 16 April 2019 1.pdf (Size: 435.36 KB / Downloads: 31)

               


Attached Files
.pdf   Sleep Study 16 April 2019 2.pdf.pdf (Size: 736.1 KB / Downloads: 17)
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#2
RE: Require Help to Reduce AHI
Hi there.  You can see, in your pressure chart, that your requirements are very low for much of the early sleep time, but then they begin to rise quite substantially.  The feature I see at that bad spot is a lot of clustering of events over a short duration.  Typically that means it is related to the position in which you are sleeping, and more specifically to the angle of the head relative to the body.  The head has tucked so that the chin is toward the chest.  This raises the likelihood of events of a kind, and in deeper sleep we aren't so easily aroused, so they continue to happen apace.

Please wait for other observations from members who will also contribute, but I'm guessing that you tuck your chin at times and that you might benefit greatly from wearing a soft foam cervical collar available at large department stores with pharmacies, or at medical supplies stores, or even on-line.
Serial Tapist
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#3
RE: Require Help to Reduce AHI
I agree with mesentaria. The positional issue is especially evident on Aug 11 and recommend a soft cervical collar. You should also benefit from increasing your minimum pressure to 6 and flex to 2 which should reduce RERAS which aren't included in the AHI but also disrupt sleep. and OA.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#4
RE: Require Help to Reduce AHI
Min pressure to 6 as Flex will reduce your IPAP (inhale) pressure by about 2 cmw but it is variable and not as effective as either BiLevel Pressure Support or ResMed's EPR. As stated above that should help with Flow Limitations and RERAs. (If you have RERAs you have Flow Limitations of concern)

Then re-evaluate
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#5
RE: Require Help to Reduce AHI
Hi, could you please review the last three nights results based on the previous recommendation to increase minimum pressure to 6 and Flex to 2.
I have noticed an improvement in the AHI results based on the recommendations, but still an appreciable variance over the three nights. Any further recommendations would be greatly appreciated.

I do experience waking up during the night but have problem getting back to sleep,

Thanks.

                     
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#6
RE: Require Help to Reduce AHI
Should have stated that I had no problem getting back to sleep
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#7
RE: Require Help to Reduce AHI
(08-17-2019, 11:15 PM)Jsam4578 Wrote: Should have stated that I had no problem getting back to sleep

That’s a good sign that you can get back to sleep easily. Also, it’s quite normal to wake up frequently when your new at this. Also, AHI readings will be variable night to night.

I believe it’s time to adjust your minimum pressure to 7cm. Keep Flex at 2 for now. Give it a few days to note changes and how you feel.

The DreamStation is going to be slow to react to apnea events compared to using a ResMed machine. When using a Respironics machine, you need the minimum pressure set a bit higher.

Look at your median and 95% pressure readings. Set your pressures accordingly...approximately 2cm below the 95% number.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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: Require Help to Reduce AHI
Appreciate the feedback and will increase pressure as advised. 
How do I identify if the previous increase in minimum pressure from 4 to 6 has improved my issues with flow limitation and Rera’s.
Thanks
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#9
RE: Require Help to Reduce AHI
By seeing if the RERAs and Flow limitations have diminished.
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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#10
RE: Require Help to Reduce AHI
The charts from the nights with the highest AHI show more clustering of obstructive events, primarily hypoponea. If you haven't already tried a soft cervical collar I think you should to prevent chin tucking.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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