Still getting high Hypopneas

[kaiasgram]

Thanks, that's helpful. Interesting -- your pressure never hit the Max, and the 95% number means that your pressure was at or below 12.70 for 95% of the night. So if that was my SH report I think I would increase the Min pressure a little and see if the Flow limitations and hypopneas start to decrease.

Yeah I did try that already but didn't see any improvement. It may not have been enough. And as you say, the upper pressure isn't being hit, so...hmm....I'm still a bit mystified by it.

Did your Flow Limitation graph look a little prettier (emptier!) when you increased the Min pressure? If so, it might be a sign that your airway needed a little more support to stay open, and perhaps increasing the Min pressure even a little more might bring the hypopneas down.

[andyjh64]

Thanks, that's helpful. Interesting -- your pressure never hit the Max, and the 95% number means that your pressure was at or below 12.70 for 95% of the night. So if that was my SH report I think I would increase the Min pressure a little and see if the Flow limitations and hypopneas start to decrease.

Yeah I did try that already but didn't see any improvement. It may not have been enough. And as you say, the upper pressure isn't being hit, so...hmm....I'm still a bit mystified by it.

Did your Flow Limitation graph look a little prettier (emptier!) when you increased the Min pressure? If so, it might be a sign that your airway needed a little more support to stay open, and perhaps increasing the Min pressure even a little more might bring the hypopneas down.

Slightly. I'll try increasing it to 9 (currently 8.2) or do you suggest a bigger increase?

[kaiasgram]

I think gradual is always better. That bump to 9 sounds good -- watch it for a week or so and then re-evaluate. If no change, bump it up a little more. As long as you can tolerate the pressure and you feel OK, and no new problems are showing up in your data, you could continue bumping and watching -- I'll bet eventually you'll see some improvement in your hypopnea numbers.

[OpalRose]

andyjh64,
You can also turn the ramp feature off, it doesn't look like it would be beneficial to you.
I do agree that the minimum pressure bump to 9 may help, but give it some time to work.

One other issue would be to work on your leaks.

[AshSF]

Andyjh64: Since you are not using EPR currently, one of the strategies to take care of hypos would be to use EPR.

On your machine you can set the pressure range and EPR. Your current range is 8.2+. Once you switch on EPR, your set pressure = IPAP (Pressure provided by machine while inhalation) and your EPAP (pressure provided by machine during exhalation) = IPAP - EPR.

According to titration guidelines, IPAP takes care of any remaining hypopneas after EPAP has taken care of obstructive Apneas. So here is what you do to start:
1) set your EPR to 1.
2) Since this will reduce your EPAP on your current pressure range, you should up your pressure range by 1. So make your pressure range 9.2+.
3) Evaluate the result after 10 days.

If you find a benefit, you can then raise the EPR to 2, pressure range to 10.2+. Evaluate for 10 days.

If you still have hypopneas then take EPR to 3 and pressure range to 11.2+.

If hypopneas are still there, you can get a Bilevel machine.

While following this strategy, you may find that you are getting some clear airway events initially. They typically go away in a few days. But if they don't then you may need to evaluate to see if the reduction in Hypopnea is worth it for a few more CAs.

Keep this thread updated with whatever strategy you employ and the results.

Good luck.

[quiescence at last]

Looking at just the one night is not extremely satisfying, as you might be surprised how much the treatment (and need for it) varies from night to night.

However, my observations from http://www.apneaboard.com/forums/attachm...p?aid=1676 are:

Your pressure really does not ever return to below 10 for any of the treatment time. (eliminating the very first ramp and the immediate increase at about 12:15 (00:15).)

From that observation, I would guess that any increase in minimum pressure that is still below 10 is not going to decrease any of the results. I would still take small incremental steps to reach a start pressure of about 11. What is usually suggested is that the minimum pressure be adjusted by no more than 1 cmH2O about every 4 days.

What we usually find out is our own sweet spot ends up being above the original median pressure (yours being 10.92 cm) and no more than 2 cm below our original 95% pressure (yours being 12.7 cm). This suggests I would set my pressure above the greater value (10.92 or 12.7-2.0=10.7) - suggesting a pressure of about 11 cm.

For the near term (if it remains comfortable) suggest ramp start at 8, ramp time 5 minutes, start pressure 10. Keep 4 nights, then adjust ramp to 9, and start pressure to 11.

My note about comfort is really about how the pressure feels to you while you are falling asleep. Once you adjust to being just fine with the effective treatment (11cm) as a start pressure, eliminating the ramp is a great idea. Many suggest dumping the ramp right away.

QAL

ps. other general observations are: (1) that hypopneas seem to be happening at higher pressures, but still seem to correlate with the higher flow limitations. (2) CA events seem rare and are not in the periods of higher pressure and not combined with regions of hypopnea as seen in some patients. (3) Leaks seem to be confined to small episodes. None of (1) thru (3) suggest changes should be made in your treatment or habits, and (2) is actually a good sign.

pps. EPR is fine to add if you want to try it. Some have found that they can eliminate some H by trading it for CA (generally with increased pressure), but also found that it decreased their satisfaction with sleep quality. Some have found that they can trade some H for some OA (generally by decreasing pressure). I initially feel neither apply to your case, since I think your H are happening as a natural consequence of a healthy central nervous system feedback to make up for (slight) flow limitations.

[zonk]

Hi andyjh64
You had higher hypopnea count with your old S8 AutoSet and now the S9 AutoSet report the same thing
Both machines are quite different, the 8 did not distinguish between open airways and closed airways events but the S9 can distinguish between them and respond differently, no pressure increase if central events are detected
This is above my paygrade, time to see a competent sleep doctor

Food of thought http://www.resmed.com/au/en/consumer/sup...toset.html

Q. How does the device know to adjust pressure in AutoSet mode?

A. After you fall asleep and your pressure needs begin to vary, your AutoSet device responds to three separate parameters, based on the degree of airway blockage caused by your sleep apnea: inspiratory flow limitation, snore, and apnea. AutoSet devices automatically increase pressure as airway blockage starts to occur in order to minimise the chances of it developing into apneas.

Q. How does AutoSet handle hypopnea events?

A. AutoSet devices only respond to hypopnea events when they're associated with airway blockage. Hypopneas that are not associated with airway blockage cannot be treated with increased pressure, and as such an AutoSet device pressure will not increase in these cases. Talk to your doctor or ResMed accredited outlet about which devices can treat hypopnea events.

[andyjh64]

Thanks very much all of you for these very helpful observations/advice