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[Treatment] AHI below 5, 10-20 hypopneas nightly, don't feel any different
#1
AHI below 5, 10-20 hypopneas nightly, don't feel any different
Hello all,

Like so many I am a newly diagnosed CPAP user and new to this forum. I have been using my machine every night since May 2, 2018 (3 weeks now). My sleep study AHI was 8.3 and with auto CPAP it fluctuates between 3-5. I realize this is considered "treated," however, I seem to be having 10-20 hypopneas every night and don't feel any more energized/less sleepy in the daytime than before using CPAP. I could easily nap at any time of the day if I laid down and it's worst around 2-4pm.

My prescribed pressure is 5-20 cmH2O and I am using the Philips Respironics Dreamstation Auto CPAP with flex set to 1. I use nasal gel pillows and have no issues with mask leak, discomfort, or adjusting to therapy itself.

When the auto-min pressure is set to 5, the 90% pressure hover around 6.5-7. I perused the wiki, and confusingly, when I increased my auto-min pressure to 7, my AHI jumped to 5.8 and 90% pressure went to 8. 

Almost all my apneas are "clear airway" according to the Dreammapper app.

As far as Sleepyhead data, I will be posting soon when I can access it later today.

Thanks in advance.
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#2
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
You might want to try CPAP mode and try a fixed pressure of 6cm. This might help reduce the Clear Airway events. It doesn't sound like you need much pressure to handle the obstructive events.
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#3
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
If anything, I feel generally a wee bit more groggy all the time, now five months into straight CPAP.  I always slept what I thought was well, not long, but well.  I awoke refreshed, never have/had headaches, no real irritability, never took naps, and never...ever...had to get up to pee two or three times each night.  I was fully asymptomatic.  Except for a sudden onset of atrial fibrillation one day.

My OSA count was deemed to be 30, so at the low end of 'severe'.  Now, I have almost none of those, but I do record an apparent run of maybe three to five CA's each night, none lasting longer than about 19 second.  Most are near 10.

Many people report that they don't 'feel' different, or improved, after some time on PAP. However, their sleep quality has improved directly as a result of improved breathing.  That's a fact.  Few report a eureka experience the second or third night on PAP.  The heavy majority report going months before they grudgingly realize things might actually be better, even if it's just better numbers.

Give it time.  The rest of your life.
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#4
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
I suggest you leave the setting alone and give it a few more weeks. The CA events are most likely false, caused by awakenings as you adjust to your new bed partner. Very common.
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#5
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
Attached is SleepyHead data from May 21 with AHI of 3.42. This is a fairly typical night's data.

   

Clear airway event - 50 sec
   

Hypopnea - 48 sec
   
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#6
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
(05-24-2018, 11:32 AM)questionxenon Wrote: Attached is SleepyHead data from May 21 with AHI of 3.42. This is a fairly typical night's data.



Clear airway event - 50 sec


Hypopnea - 48 sec

It looks like your minimum pressure of 5 is too low. If this was me I would raise the minimum to 6 and try that for a few nights, we might want to raise it again later but that would be a good starting point. I would not worry about the CA's they will diminish over time.
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#7
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
(05-23-2018, 10:31 AM)Walla Walla Wrote: You might want to try CPAP mode and try a fixed pressure of 6cm. This might help reduce the Clear Airway events. It doesn't sound like you need much pressure to handle the obstructive events.

Will do, thanks.

Is there a benefit to using CPAP mode at 6cm instead of setting the auto-min to 6 cm?
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#8
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
(05-24-2018, 01:05 PM)questionxenon Wrote:
(05-23-2018, 10:31 AM)Walla Walla Wrote: You might want to try CPAP mode and try a fixed pressure of 6cm. This might help reduce the Clear Airway events. It doesn't sound like you need much pressure to handle the obstructive events.

Will do, thanks.

Is there a benefit to using CPAP mode at 6cm instead of setting the auto-min to 6 cm?

The idea would be to steady the pressure for a day or two and get a base line. Than slowly increase it 1cm at a time with an eye on the CA events. If you see a sudden increase in CA events than I'd return to the previous pressure.

I think pressure is causing your CA events and this would be a way to nail down what range you can set the pressure at. Once you have that than I'd set it to Auto within that range.
Download SleepyHead
Organize your Sleepyhead Charts
Posting Charts
Beginner's Guide to SleepyHead
Mask Primer
5
Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#9
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
You are not that bad really. A few more CA events than I would like to see, but otherwise it is not to bad.
What you need to do is to stop adjust things so quickly, try a setting, then increase it by one and wait a few days to get an average, then try it up or down depending on how putting up the pressure went, if it was worse, drop the pressure slightly for a few days.
You have to wait a few days between each change in pressure and do not change masks either, this can change results drastically and cause a lot of confusion in the results.
If after a while you have tried higher pressure and lower pressure, then it might be time to think about whether you might need a different type of machine.
>^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^<
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.

I am just a long term user of c.p.a.p. and therefore I have some experience in using these machines and equipment.

However, I am NOT an expert, so advice given should be taken as given in good faith only and NOT medical advice.

Every journey, however large or small starts with the first step.   Coffee
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#10
RE: AHI below 5, 10-20 hypopneas nightly, don't feel any different
The first thing I recommend is to look at the Flex setting you are using, and reduce that to 1. Philips Flex is a weird beast, and most of us don't tolerate it at higher settings, especially with lower pressures like you have.

Your data shows persistent flow limitations and apnea. I would keep the machine in auto mode, but start increasing the minimum pressure in 0.5 cm increments until the AHI approaches 1.0. The reason is the same for all Philips auto CPAP machines, the algorithm keeps pressure too low to control hypopnea, it increases too slowly ahead an event and drops too quickly following. With the Dreamstation, your minimum pressure is critical. If you gradually titrate the minimum pressure upwards, you will find a sweet spot that provides very good treatment. If you rely only on the auto algorithm, it's going to be a long haul. CPAP pressure has the advantage that the Philips will not "test" higher pressures. The algorithm increases pressure by 1.5 cm about every 20 minutes over a 1.5 minute span, to see if better respiratory flow occurs, and the pressure then drops back. This is what gives your Sleepyhead chart the characteristic sawtooth pattern of a Philips machine. Ridiculous algorithm in my opinion, and one of the reasons I strongly prefer the Resmed Autoset.
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