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Trying to reduce my AHI
#1
Trying to reduce my AHI
Hi all,

I got some great help here a couple of years ago and succeeded in getting my AHI down to about 1.5 using my old Dreamstation. A few months later, I got a Resmed AirSense 10 Autoset and went through a similar process of changing the settings to reduce my ASI down to a very consistent 0.4. I felt great for a good while - this changed my life completely and I lost weight and started exercising more and just had an amazing quality of life.

Unfortunately I've had a tough time with my health over the last year (this has resulted in me putting on about 50 lbs) and unfortunately my AHI has risen to 3 or 4 again. I've a very tough job and I'm finding it very hard to keep going at work with my ASI so high. I'm back to feeling hungover every morning and am waking up with a thumping headache.

Unfortunately I can't really remember how to read the graphs and figure out what settings to adjust, so I'm not sure what settings I need to change to help reduce my AHI. 

I've attached the OSCAR graphs from a couple of recent nights. I hope I've laid them out okay - I tried to follow the instructions.

I'd be very grateful for any help you could give.

Thanks for reading and I hope you're all keeping well,
Tess

P.S. I've tried switching back to the Dreamstation for a few nights as an experiment to see if that would help, but it didn't. So I'll probably just stick with the ResMed.


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#2
RE: Trying to reduce my AHI
I would suggest to raise your max to 20 (you were bumping the top of 15) and lower the low to 12 with an epr=3.  That should help the Flow limits. The way you have it set now your top and bottom are nearly the same. With 20 as a high you will probable not ever reach that number.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Trying to reduce my AHI
I'd agree with stacey on the setting edit, especially adding in EPR which stands for Exhale Pressure Relief. It may improve both therapy result and feeling more comfortable.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Trying to reduce my AHI
Thanks for your replies staceyburke and SarcasticDave94. I think I made all the changes you mentioned staceyburke before sleeping last night.

I've attached my OSCAR info from last night. It seems like I slept on my side for a good part of the night and this caused pretty bad leaks, so I'm not sure if there's any useful information in the graphs. I tend to sleep on my side maybe once a week, so it's not a constant problem but does happen occasionally.

I was definitely more comfortable with the new settings.


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#5
RE: Trying to reduce my AHI
Hi tiredtess,
The Obstructives showing up on your graphs show small clusters grouped together, which suggests you are sleeping in such a way that causes you to tuck your chin to your chest. This can cut off your airway and can occur whether you sleep on your back or side. Also can be caused by sleeping on a bed pillow that is too high. You also need to watch the leaks, maybe a new or different mask is in order.

http://www.apneaboard.com/wiki/index.php...cal_Collar
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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#6
RE: Trying to reduce my AHI
You did better in almost all types of apnea.  But as you know the leaks were a problem.  Leaks are a problem for most people and is something that we (me too) must keep working to improve.  First thing is to try to refit the mask.  Do it while in your normal sleeping position.  Don't over-tighten that is also something many people do to try to stop leaks.

As Opalrose said you are having clusters of events and that usually is chin tucking.  that also needs to be addressed.  But I have to say good job with the pressures it looks like this is on the right track.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Trying to reduce my AHI
I'll be curious how you do with the new settings plus a soft cervical collar. If you continue to have an obstructive index over 2, you might want to inch your minimum pressure up. But do stick with what you have until you can gauge the effects of a collar.

One nice point to notice: with the introduction of EPR, your flow limitations went way down. Over time, this may help you sleep more soundly.

Do you have a sense of whether your leaks are from your mask? Might they be from your mouth? The little spikes are probably mask leaks, but I do wonder whether the "plateau" leaks are from your mouth.
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#8
RE: Trying to reduce my AHI
Thank you all so much for all of your advice. I can't tell you how much I appreciate it.

I followed your instructions staceyburke and refit the mask last night from scratch - it does seem to have helped the leaks a lot!

I've attached my graphs from last night now. I'm feeling a lot better today. I did have a bit of a headache when I woke up, but it cleared reasonably quickly.

I'll definitely order a cervical collar and give it a try. Honestly - I'd try anything! Thanks for your suggestion OpalRose. I opened a new mask a few weeks ago when I first started trying to address these issues, so I don't think the mask is worn or anything. (I also replaced my heated hose, the filter, and the humidifier tank at the same time just to rule out as many things as I could.) However, it could be that I might do better with a different mask. Previously I did have an AHI of 0.4 while wearing this mask, but I have put on weight since then and I have increased the max pressure since then too so perhaps the mask isn't as suitable for me as it was before.

Dormeo, I think the leaks are from the mask - sometimes the sound of the air coming from the mask even wakes me! 

Thanks again,
Tess


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#9
RE: Trying to reduce my AHI
Congrats, that chart looks a lot better. Keep working at it and it'll pay off.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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