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Ultra high AHI with new machine
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vsheline Online

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #21
RE: Ultra high AHI with new machine
(11-15-2014 10:53 PM)fede Wrote:  pressure was under 16cmH2O for 95% of the time.

Hi fede,

The 95 percentile pressure is the pressure you were at or below for at least 95% of the night (while machine running). It is also the pressure you were at or above for at least 5% of the night.

So your 95% pressure was 16, which happens to be the same as your Max Pressure setting. So you spent at least 5% of the night with your pressure maxed out at 16. We would need to look at the detailed data to know whether you spent 5% of the night maxed out, or 10% or 20% or whatever. You spent at least 5% maxed out at 16, meaning that the machine likely wanted to go higher but could not.

If you are not experiencing problems from high pressure, such as a painful amount of aerophagia (air swallowing) or ear problems or eye problems, then it seems like you should consider increasing the Max Pressure setting to 20, since it seems like 16 is too low to avoid your obstructive apneas. The pressure only goes as high as it needs to, to avoid obstructive Flow Limitation or hypopneas or apneas.

But perhaps more helpful would be to make sure you are staying off your back the whole night. Obstructive Sleep Apnea is usually very strongly positional, with flat on our back usually being the worst position. If you stay off your back your pressure needs might be much less, and 8 or 10 or 12 might be adequate for you.

Some people arrange pillows to keep themself from rolling onto their side, but I would think that approach might not work reliably. Some people wear a light knapsack to bed filled with something bulky but light, such as three tubes of tennis balls. I think one forum member has found success using a couple of stretch belts to hold something like a rolled-up small towel along his spine, to keep him from sleeping on his back.

I wear a teeshirt with a couple tennis balls in pockets sewn along my spine between my shoulder blades and higher, so that when I roll onto my back while asleep I wake up just enough to keep rolling until I am on my other side.

Take care,
--- Vaughn

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 11-16-2014 12:09 AM by vsheline.)
11-15-2014 11:41 PM
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vsheline Online

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #22
RE: Ultra high AHI with new machine
(10-23-2014 04:13 PM)fede Wrote:  My 90% leak rate for 30 days average is 2.40. My AHI 30 day average is 22.23; Obstructive is 16.97; hypopnea is 3.27 and CA is 1.95.

(11-15-2014 05:07 PM)fede Wrote:  Last night though, my AI =18.05; HI=2.78; CA= 0.83; UAI=0.56 -- all equal to AHI 22.22.

The problem is mainly obstructive apneas.

Looks like only a few are centrals. Central Apnea Index (average number of central apneas per hour) was only 1.95 or 0.83.

By the way, UA (Unknown Apnea) type refers to apneas which occur while the unintentional Leak is over 30 Liter/minute, which is too high for the machine to reliably differentiate central from obstructive, so it doesn't try.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 11-16-2014 11:45 PM by vsheline.)
11-15-2014 11:43 PM
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fede Offline

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Posts: 22
Joined: Oct 2014

Machine: resmed s9 autoset
Mask Type: Full face mask
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CPAP Pressure: 8-20
CPAP Software: SleepyHead

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Sex: Male
Location: Grand Junction CO

Post: #23
RE: Ultra high AHI with new machine
(11-15-2014 11:41 PM)vsheline Wrote:  
(11-15-2014 10:53 PM)fede Wrote:  pressure was under 16cmH2O for 95% of the time.

Hi fede,

The 95 percentile pressure is the pressure you were at or below for at least 95% of the night (while machine running). It is also the pressure you were at or above for at least 5% of the night.

So your 95% pressure was 16, which happens to be the same as your Max Pressure setting. So you spent at least 5% of the night with your pressure maxed out at 16. We would need to look at the detailed data to know whether you spent 5% of the night maxed out, or 10% or 20% or whatever. You spent at least 5% maxed out at 16, meaning that the machine likely wanted to go higher but could not.

If you are not experiencing problems from high pressure, such as a painful amount of aerophagia (air swallowing) or ear problems or eye problems, then it seems like you should consider increasing the Max Pressure setting to 20, since it seems like 16 is too low to avoid your obstructive apneas. The pressure only goes as high as it needs to, to avoid obstructive Flow Limitation or hypopneas or apneas.

But perhaps more helpful would be to make sure you are staying off your back the whole night. Obstructive Sleep Apnea is usually very strongly positional, with flat on our back usually being the worst position. If you stay off your back your pressure needs might be much less, and 8 or 10 or 12 might be adequate for you.

Some people arrange pillows to keep themself from rolling onto their side, but I would think that approach might not work reliably. Some people wear a light knapsack to bed filled with something bulky but light, such as three tubes of tennis balls. I think one forum member has found success using a couple of stretch belts to hold something like a rolled-up small towel along his spine, to keep him from sleeping on his back.

I wear a teeshirt with a couple tennis balls in pockets sewn along my spine between my shoulder blades and higher, so that when I roll onto my back while asleep I wake up just enough to keep rolling until I am on my other side.

Take care,
--- Vaughn
Thank you for your wonderful advice. I will surely begin trying these things out
11-16-2014 09:08 AM
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fede Offline

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Posts: 22
Joined: Oct 2014

Machine: resmed s9 autoset
Mask Type: Full face mask
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CPAP Pressure: 8-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Grand Junction CO

Post: #24
RE: Ultra high AHI with new machine
It's been 3 1/2 months and I've used my Apap RESMED AUTO S9, 100%. It's now set at 10-19 for pressure. What still bothers me is my AHI readings fluctuate some times from AHI 2.0 to AHI 18.5. If you average them it is about AHI 12.0. Is there any way to get into the acceptable range regularly? I have little to no leak, I sleep about 7 1/2 hours regularly. Surely there is something keeping me from having AHI readings below 5.0. I also bought an oximeter and it reads good heartbeat and oxygen levels all night using the machine. Before usage of CPAP, my oxygen saturations were poor, so the machine is helping there immensely. Any suggestions? Thanks to all who reply.
02-02-2015 09:00 AM
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Crimson Nape Offline

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Post: #25
RE: Ultra high AHI with new machine
(02-02-2015 09:00 AM)fede Wrote:  It's been 3 1/2 months and I've used my Apap RESMED AUTO S9, 100%. It's now set at 10-19 for pressure. What still bothers me is my AHI readings fluctuate some times from AHI 2.0 to AHI 18.5. If you average them it is about AHI 12.0. Is there any way to get into the acceptable range regularly? I have little to no leak, I sleep about 7 1/2 hours regularly. Surely there is something keeping me from having AHI readings below 5.0. I also bought an oximeter and it reads good heartbeat and oxygen levels all night using the machine. Before usage of CPAP, my oxygen saturations were poor, so the machine is helping there immensely. Any suggestions? Thanks to all who reply.

Hi Fede,
Please post your recent pressure and leak stats. Thanks!

Statistics prove that people who have more birthdays live longer.
02-02-2015 09:14 AM
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quiescence at last Offline

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Post: #26
RE: Ultra high AHI with new machine
yeah, can you give us a chart like this to give an overview -

[Image: H4V5vz4.png]

and something like this for a representative day:

(at least the top 4 graphs, plus leakage.)

[Image: rCg2r4c.png]

it also helps if you snapshot the screen when all the statistical data is showing, like this:

[Image: attachment.php?thumbnail=1211]

Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
02-02-2015 12:01 PM
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retired_guy Offline

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Post: #27
RE: Ultra high AHI with new machine
Fede, very often when someone tends to go from low ahi to high ahi it's simply a matter of sleeping position. Specifically, the higher readings will occur when you are on your back. Work on "sleeping posture." Do whatever you need to do to keep from rolling over onto your back. If not possible, then at least use a pillow under your neck to help your chin stay higher than your navel. That can help keep the airway open. And raise the head of the bed. How much? Just some, so that if you are on your back you can actually see your feet.

But the preferred thing to start with is sleep on your side, not your back.
(This post was last modified: 02-02-2015 12:36 PM by retired_guy.)
02-02-2015 12:35 PM
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fede Offline

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Posts: 22
Joined: Oct 2014

Machine: resmed s9 autoset
Mask Type: Full face mask
Mask Make & Model: resmed quattro
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CPAP Pressure: 8-20
CPAP Software: SleepyHead

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Sex: Male
Location: Grand Junction CO

Post: #28
RE: Ultra high AHI with new machine
(02-02-2015 09:14 AM)sgearhart Wrote:  
(02-02-2015 09:00 AM)fede Wrote:  It's been 3 1/2 months and I've used my Apap RESMED AUTO S9, 100%. It's now set at 10-19 for pressure. What still bothers me is my AHI readings fluctuate some times from AHI 2.0 to AHI 18.5. If you average them it is about AHI 12.0. Is there any way to get into the acceptable range regularly? I have little to no leak, I sleep about 7 1/2 hours regularly. Surely there is something keeping me from having AHI readings below 5.0. I also bought an oximeter and it reads good heartbeat and oxygen levels all night using the machine. Before usage of CPAP, my oxygen saturations were poor, so the machine is helping there immensely. Any suggestions? Thanks to all who reply.

Hi Fede,
Please post your recent pressure and leak stats. Thanks!
[I'm going to try and post two pdf's of last night and previous night differences. Hope I can do this]


(02-03-2015 12:53 PM)fede Wrote:  [quote='sgearhart' pid='99144' dateline='1422886483']
[quote='fede' pid='99143' dateline='1422885623']
It's been 3 1/2 months and I've used my Apap RESMED AUTO S9, 100%. It's now set at 10-19 for pressure. What still bothers me is my AHI readings fluctuate some times from AHI 2.0 to AHI 18.5. If you average them it is about AHI 12.0. Is there any way to get into the acceptable range regularly? I have little to no leak, I sleep about 7 1/2 hours regularly. Surely there is something keeping me from having AHI readings below 5.0. I also bought an oximeter and it reads good heartbeat and oxygen levels all night using the machine. Before usage of CPAP, my oxygen saturations were poor, so the machine is helping there immensely. Any suggestions? Thanks to all who reply.

Hi Fede,
Please post your recent pressure and leak stats. Thanks!
[I'm going to try and post two pdf's of last night and previous night differences. Hope I can do this]
(This post was last modified: 02-03-2015 12:53 PM by fede.)
02-03-2015 12:53 PM
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fede Offline

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Posts: 22
Joined: Oct 2014

Machine: resmed s9 autoset
Mask Type: Full face mask
Mask Make & Model: resmed quattro
Humidifier: H5i
CPAP Pressure: 8-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Grand Junction CO

Post: #29
RE: Ultra high AHI with new machine
[quote='retired_guy' pid='99162' dateline='1422898540']
Fede, very often when someone tends to go from low ahi to high ahi it's simply a matter of sleeping position. Specifically, the higher readings will occur when you are on your back. Work on "sleeping posture." Do whatever you need to do to keep from rolling over onto your back. If not possible, then at least use a pillow under your neck to help your chin stay higher than your navel. That can help keep the airway open. And raise the head of the bed. How much? Just some, so that if you are on your back you can actually see your feet.

But the preferred thing to start with is sleep on your side, not your back.
[Thnaks, I'll try to control this and see what happens.]
02-03-2015 12:58 PM
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fede Offline

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Posts: 22
Joined: Oct 2014

Machine: resmed s9 autoset
Mask Type: Full face mask
Mask Make & Model: resmed quattro
Humidifier: H5i
CPAP Pressure: 8-20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Grand Junction CO

Post: #30
RE: Ultra high AHI with new machine
(02-02-2015 09:14 AM)sgearhart Wrote:  [quote='fede' pid='99143' dateline='1422885623']
It's been 3 1/2 months and I've used my Apap RESMED AUTO S9, 100%. It's now set at 10-19 for pressure. What still bothers me is my AHI readings fluctuate some times from AHI 2.0 to AHI 18.5. If you average them it is about AHI 12.0. Is there any way to get into the acceptable range regularly? I have little to no leak, I sleep about 7 1/2 hours regularly. Surely there is something keeping me from having AHI readings below 5.0. I also bought an oximeter and it reads good heartbeat and oxygen levels all night using the machine. Before usage of CPAP, my oxygen saturations were poor, so the machine is helping there immensely. Any suggestions? Thanks to all who reply.

Hi Fede,
Please post your recent pressure and leak stats. Thanks!
[I tried posting a pdf file, but nothing seemed to happen. How do I put up a sleepyhead report here?]
02-03-2015 01:06 PM
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