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Still Over 3 AHI at 15 cm
#1
Still Over 3 AHI at 15 cm
I've been using CPAP for a year and a half. I've been tracking my stuff all the while in SleepyHead, and increasing my pressure. Check my history, and you'll see 3 more of these posts.

I'm up to a static 15cm of pressure. I also wear a stiff foam cervical collar. I have at the moment given up on getting off of my back (despite a nice mattress topper and a side-sleeping pillow... I just can't fall asleep on my side). I tolerate 15cm just fine. Beyond that, not so much. On the few occasions I've gone higher, my machine reports a higher than usual AHI, with some centrals. Not sure how many of those are real, and how many are false reports from me lying awake, unable to sleep.

Anywhere from 2.5-3.5 AHI is pretty typical. I feel best following the odd night where my score dips below 2. Still not great. When I look at my charts, I see a lot of unreported jagged bits on my flow rate graph. I don't know what to make of that. I suspect I have UARS. I have an in-lab coming up in December that I've been waiting like 5 months for.

In the meantime, what more can I do here? Is it possible that I would benefit more from BiPAP?

I'm happy to post more charts. 

Here's a recent night, where I slept for 11 freaking hours and still woke up tired.

I've had people tell me in other threads that my charts look fine. I struggle with that --- given that it seems like every chart I see on here is sub 1 AHI --- and given how sh**ty I feel every morning, and the sense I have that my sleep is still fractured and shallow.

Bless you all!


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#2
RE: Still Over 3 AHI at 15 cm
You should post the flow limitation graph as well but you definitely seem like you would be a good candidate for a Bilevel device (preferably Resmed Vauto)
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#3
RE: Still Over 3 AHI at 15 cm
(10-30-2019, 08:23 PM)Michaely6 Wrote: You should post the flow limitation graph as well but you definitely seem like you would be a good candidate for a Bilevel device (preferably Resmed Vauto)

Do you mean the Flow Rate graph, or something else? I'm not seeing "Flow Limitations".

Here's a close-up from the same night. I see unmarked events like these sprinkled all over the place, every night (admittedly, this one appears slightly more severe than most).


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#4
RE: Still Over 3 AHI at 15 cm
PR machines do not have a Flow Limit graph, they do have FL Events.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#5
RE: Still Over 3 AHI at 15 cm
(10-30-2019, 08:38 PM)bonjour Wrote: PR machines do not have a Flow Limit graph, they do have FL Events.

In that case, no reported FL events that particular night. Looking back, I generally have between 0 and 4 reported for a given night.

Here's one from a couple of nights ago, for what it's worth.


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#6
RE: Still Over 3 AHI at 15 cm
I was just about to say disregard because I remember reading that dreamstation does not have flow limitation graph
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#7
RE: Still Over 3 AHI at 15 cm
Rcol,

I had a high incidence of CA and other events for the four weeks I was using a Dreamstation Auto, on trial from my DME. After switching to a ResMed AirSense 10 AutoSet (For Her, it was the only one they had for a trial), most of the events went away and I felt much more rested in the morning. You may find other posts from people with a similar experience. It could be a difference in the control algorithms between the two machines. Your experience may be different.

Alas, after receiving my very own new AirSense 10 AutoSet from the DME yesterday, I'm again saw a higher number of events and felt all fogged in this morning. It's a bit of a process, isn't it.
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#8
RE: Still Over 3 AHI at 15 cm
I own and used that machine at high pressures.  That machine running really in old school CPAP mode with no comfort setting enabled 15cm H2O.. I would not call that 'fine'.. I would say that looks painful to me.   


First I noticed a good number of events in clusters so would recommend if you have not a look at positional fixes.  Some of the fastest and easiest to put in place.  

In short, sleep on your slide not your back and stick out your chin when you sleep.  

Two good links.. the second from Bonjour's sig above. 

http://www.apneaboard.com/wiki/index.php...onal_Apnea

http://www.apneaboard.com/wiki/index.php...cal_Collar


Second, are you comfortable that you have titrated that machine to it's best possible settings?  If from owning that machine and seeing others use it .. sometimes it gets sillier rather than better at high pressure and lower pressures perform better.   So an immediate thought for me is if you have not exhausted a really good a titration round to find out all your options is to titrate from scratch using a APAP titration approach.   


WillSleep

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#9
RE: Still Over 3 AHI at 15 cm
(10-30-2019, 08:58 PM)encourage Wrote: Rcol,

I had a high incidence of CA and other events for the four weeks I was using a Dreamstation Auto, on trial from my DME. After switching to a ResMed AirSense 10 AutoSet (For Her, it was the only one they had for a trial), most of the events went away and I felt much more rested in the morning. You may find other posts from people with a similar experience. It could be a difference in the control algorithms between the two machines. Your experience may be different.

Alas, after receiving my very own new AirSense 10 AutoSet from the DME yesterday, I'm again saw a higher number of events and felt all fogged in this morning. It's a bit of a process, isn't it.

If I'm getting flow limitations caused by too high of expiratory pressure, that's one thing. Other than that, I'm skeptical that I'd see better results with a different machine. I'm not relying on the algorithm as it is, since I usually just use CPAP mode.
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#10
RE: Still Over 3 AHI at 15 cm
(10-30-2019, 09:07 PM)WillSleep Wrote: I own and used that machine at high pressures.  That machine running really in old school CPAP mode with no comfort setting enabled 15cm H2O.. I would not call that 'fine'.. I would say that looks painful to me.   


First I noticed a good number of events in clusters so would recommend if you have not a look at positional fixes.  Some of the fastest and easiest to put in place.  

In short, sleep on your slide not your back and stick out your chin when you sleep.  

Two good links.. the second from Bonjour's sig above. 

http://www.apneaboard.com/wiki/index.php...onal_Apnea

http://www.apneaboard.com/wiki/index.php...cal_Collar

I've tried a few different cervical collars. Currently I use one that is quite rigid and definitely prevents the chin tucking.

I suspect that my main source of obstruction is a small-ish jaw and a large tongue. Every dentist/ortho I've ever been to has commented on how "little room" I have, and I've had multiple extractions. I also had a lot of sinus problems growing up - largely resolved now (I've had tonsillectomy, adenoidectomy, and turbinate reduction). From what I 've read, this sounds like classic UARS to me. I saw an ENT and he basically just stuck a scope up my nose and told me my sinuses look fine, but did mention some narrowing at the tongue base. He said he was surprised I even have the level of obstruction reported on the home test.

Deep down I'm hoping my in-lab shows SEVERE RERAs/Arousals, and that I can eventually get myself in to see an orthodontist about some kind of expansion. I'm not sure what all is available in my area -- every ortho I can find that specializes in sleep just has a blurb about advancement devices on their website. I'm hoping my ENT can recommend someone who actually knows something about airway and can give me an honest assessment (and I'm totally open to the possibility that I'm completely wrong).

It would be significantly easier to just get an advancement device, but I'm skeptical that will actually help me.

I do notice slightly less tension in my mouth/throat when I'm on my side or on my stomach, but it doesn't totally go away. I struggle with shoulder pain and arms falling asleep when I'm on my side.

Quote:Second, are you comfortable that you have titrated that machine to it's best possible settings?  If from owning that machine and seeing others use it .. sometimes it gets sillier rather than better at high pressure and lower pressures perform better.   So an immediate thought for me is if you have not exhausted a really good a titration round to find out all your options is to titrate from scratch using a APAP titration approach.   


WillSleep


I'm not sure.

My score seems to consistently improve as I bump up the pressure, until around 12cm. Between 12 and 15, it's less obvious. I seem to get more nights under 2 AHI on 15cm, but I've had a few fluke nights on lower pressures. 

It's clear to me that the PR APAP algorithm is pretty unsuited to whatever I have going on. When I've used APAP mode, regardless of where I set the minimum pressure, the machine reported 95% pressure is ALWAYS 0.5 cm above the minimum. No matter what. I could set it to 8cm, and I'd have an AHI of 5-7 with a 95% pressure of 8.5cm. Even if I set the minimum to 15.5, the 95% will be 16. I tried explaining this to my sleep tech, who suggested I lower it from 14 to like ~10, and she didn't seem to understand what I was asking. I don't know what to make of that.

The pressure really doesn't bother me at this point. I used to get horrible aerophagia above 12cm. Now I only get slight bloating - I think a combination of my body just getting used to it, and the cervical collar doing something good. I still have to use ramp to fall asleep, but when I wake up in the morning, the pressure feels "normal".
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