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[Treatment] New CPAP user desires lower AHI suggestions
#1
Cool 
New CPAP user desires lower AHI suggestions
Apologies if I have posted in the wrong section. Unsure
First...what a great source of info. Kudos to the creator and moderators. Thanks 

I'll try to be brief....

My in home sleep study indicated "severe" apnea with AHI of 30.9.
In lab titration study with pressures from 5 - 13 indicated ideal CPAP pressure at 9 cm H2O.
I only exhibited one central apnea at pressure 5, and one hypopnea at 8,  and no other incidents above
pressure 8.
So doctor,  prescribed a CPAP machine set at a pressure of 9.


My friend gave me his gently used resmed S9 Autoset with humidifier 5i (with about 2000 hrs run time).
I  bought a P & K Vitera full mask (medium) with a resmed heated climateline hose.
I setup the machine in CPAP mode,  pressure fixed at 9, with NO EPR,  NO ramp.

I don't appear to have any mask leaks, and I get the green smiley face consistently.
AHI for first 8 days of therapy have been as follows:

20.1
10.6
9.3
15.3
23.8
19.6
21.4
16.4

Let me say, even if I see no improvement in AHI, this cpap experience would still be a success,  because one of the unforeseen benefits has been reducing my restroom trips from 4-5 per night to 1 per night! That is
incredible.  Totally unexpected.  I am not waking every 1.5 - 2 hrs for a trip to the restroom.

My original reason for the sleep study is I have had general fatigue for several years that seemingly has no
cause.    For the last few days,  I don't feel like taking a nap after being awake for 2-3 hours,  so I know the
therapy is working.

Questions are:  1.   How do I get this AHI down to a reasonable level? Any suggestions are appreciated.
                       2.  Would I benefit trying it in AUTO mode,  perhaps pressure min of 7,  max of 10?

There don't appear to be any mask/hose leaks.  I sleep sometimes on my back, though prefer my right side.

Thanks so much to responder(s).
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#2
RE: New CPAP user desires lower AHI suggestions
Welcome to the forum.
We really prefer to provide advice based on data, ratyher than guess.  The data we perfer is from OSCAR which will provide info down to a breath by breath basis when needed.  This requires an SD card (less than or equal to 31GB, 4-8GB works fine, go cheap) and a SD card reader.  Much Much better data than the MyAir app.

The ROT says to increase pressure, BUT without knowing the breakdown of the AHI numbers in many different ways we cannot do anything but guess.  It is ebtirely possible taht a pressure increase may cause a increase in AHI.  This is why we need to see the charts.

USe F12 to take a screenshot and attach to your post and we will have the data we need to really help you.

BTW, your AHI numbers are totally unacceptable.  We can do better!

edit: I forgot to answer your 2 questions

1. The above is how to improve
2. We will likely have you try Auto mode because it does help us to optimize your settings.  Typical starting value would be 6-19 EPR=2 fulltime, no ramp.  Your may be different which is why to see your charts first.
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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#3
RE: New CPAP user desires lower AHI suggestions
Thanks for the prompt reply.
I am waiting for an SD card ordered online,  to be delivered by USPS.  
Obviously,  things are slowed a bit with this COVID.  

I've downloaded Oscar,   so when I get the SD card in hand,  I will collect a few nights
worth of data for examination,  and get back with you.
Thanks
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#4
RE: New CPAP user desires lower AHI suggestions
   
Bonjour, I've collected two nights data on new SD card,  and managed to somehow drop AHI
to 2.31.  Previous night was 12.1,  and previous best in the 12 nights I have been CPAPing
was 9.3,  so 2.31 is quite a reduction.
I paid extra attention to fitting my mask before retiring, and positioned the side straps
a bit lower on my face.   I also made an attempt to sleep on my right side all night (no supine
position).
I would still be interested in your take on the Oscar charts I've attached,  with the goal of
reducing AHI further.  Thanks.
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#5
RE: New CPAP user desires lower AHI suggestions
There is little to improve on based on this one chart which is apparently the exception. I'd actually be more interested in your apparently more typical night of 12.1 AHI.
My guess is that tiyr Central events are much higher, right?

For a variety of reasons Central Apneas, for those of you who have "won" this lottery, behave consistently in an inconsistent manner.
I think, but have yet to see actual evidence, that you may have Treatment-Emergent Central Apnea. Doctors like to wait this one out, it takes 2-3 months and then it fades away. It is likely that a zoomed 15-minute view of the Flow Rate would look like the waves on the ocean. If so this is likely the CO2 influenced breathing of Treatment-Emergeent Central Apnea. BUT, let's proove it before we actually call it that. This is what I mean by basing it on data and not a guess.
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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#6
RE: New CPAP user desires lower AHI suggestions
   
I've attached the previous night's charts with AHI 12.15 if that is helpful.
Thanks so much.
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#7
RE: New CPAP user desires lower AHI suggestions
Very much so, you are simply tucking your chin and NOT having what I guessed as Treatment-Emergent Central Apnea.. It is extremely obvious. Look at the Soft Cervical collar link in my signature. There are charts in that wiki article that look very much like yours here. BUT, let's see if this recurs as I suspect it will and if it does you need to get a collar and the difference will be as significant as the difference in the two charts that you currently have. Many people do this and the chart is obvious and yet doctors do not recognize the pattern or the solution.
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: New CPAP user desires lower AHI suggestions
You noted that you stayed off your back on the good night, and lo and behold, on the chart for your bad night we see the clustering that is typical for postural problems.

If you can successfully stay off your back, I'm going to bet your AHI stays generally low, with perhaps some fluctuation in CAs as you adapt to PAP. Do you think you can become a side-sleeper?
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#9
RE: New CPAP user desires lower AHI suggestions
Thanks for looking at the 2nd charts.
Fyi, I was mostly a side sleeper prior to starting this cpap therapy.   I started laying
on my back more because of the potential mask leak problems with laying on
my side.  So, to answer your question,  YES I will try to exclusively sleep on my
side from here on out,  and deal with any potential mask leakage as it occurs.


I had briefly read the cervical collar article earlier today,  and I will now read
it in its entirety. 

Do you think I would benefit from adding the EPR  into the mix,  or changing
the machine from CPAP to AUTO mode,  or should I just leave as is for now to
see if I can get consistently low AHI night to night with the current settings?
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#10
RE: New CPAP user desires lower AHI suggestions
In your place, I would leave the settings alone for now so you can do some good experimentation to see what results you have from (a) slide-sleeping, (b) using a collar, or © both.

Try a solution for several nights, as one night does not a trend make. I'll be very interested to know how it goes; keep us posted, would you?
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