Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
I am posting on behalf of an elderly aunt who has been struggling getting a good nights sleep for a while and has high apnea levels.
She is using a Resmed 10 with pressure set to 4-20.
The Sleep tech either isnt too skilled or doesnt want to put too much time fine tuning the Resmed machine. So I've been researching how to achieve the best results.
I have attached the settings and two Oscar screenshots. The AHI levels vary from night to night.
Any advice to achieve better results will be much appreciated.
You are having positional apnea. You can see positional apnea where either H or Oa events are clustered together. Getting rid of as many as you can will lower your AHI. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
Also, raise the min to 7 and make sure the EPR is set to 3. This will NOT help the positional apnea but may help the flow limits.
(Just to clarify -- the OP is writing on behalf of an elderly aunt.)
I agree with staceyburke's advice and just wanted to add a bit more detail.
Please switch from Soft Response to Standard Response. Raise the ramp minimum to 7 as well as the overall pressure minimum setting. These measures may help some with the heavy flow limitations, though I suspect they are mostly positional, along with the obstructive apnea events.
I see that machine usage is about 6 hours per night. Does your aunt do some additional sleeping without the machine?
The good news is that the leak graph looks excellent.
Thank you for your help. Agreed that the mask seal is excellent, we tried 6 different masks including half face and pillows to get this stage, so it wasnt just luck. Was using a Resmed small full face, it would be fine then it would have massive leaks up to half an hour. A bigger mask was the ticket.
What is the difference between soft and standard response?
My aunt is a back and side sleeper, but she says it seems easier to sleep on the back with a mask on, as to avoid it getting moved when sleeping on ones side. My Aunt hasnt been sleeping well for a while. She may get 5 hours a night, so when watching TV she may fall asleep.
With soft response, the pressure increases more gradually in response to OAs, snores, and FLs. If the change to standard response bothers your aunt, change it back to soft.
Your work on masks really paid off!
I'm sorry your aunt can't sleep longer at night; sounds like that's been a problem for a while. Ideally she would use CPAP when she naps, but that may just be impractical.
I hope the measures suggested by staceyburke will help.
02-24-2025, 07:45 PM (This post was last modified: 02-24-2025, 08:09 PM by ejbpesca.)
RE: Help with high AHI level and complex results
When I sleep on my side there are no clusters of apneas. When I roll to my back the clusters begin. The clusters have been called positional apneas.
Some think of positional apneas as only being caused by airways being pinched when the head or jaw lowers in a sleeping position like on your back, but they also can be due to tissues collapsing due to gravity when sleeping on your back and that can be helped by min. pressure increase which to me is a classic example of why some have sleep apnea only when sleeping on their back. My severe apnea occurs when I sleep on my back. I recently have gotten therapy for my positional apneas through increasing min. pressure and turning off EPR. By increasing min. pressure and turning off EPR I have gone from AHIs >5s, up to 17.0, to < 5s as low as 0.45!
My machines have always been set by a DME at 8-20 pressures. By bringing min. up to 10.5 and max down to 15 my therapy has improved greatly.
I am still adjusting after 18 years of CPAP therapy because for me increased pressure can mean large leaks. The ResMed F40 mask has helped greatly with leaks I got from F10 and F20. Higher min. pressure also gives me other problems so I am continuously adjusting it, but I'm so glad to see positional apneas gone when I increase pressure.
Other apneas that occur during back sleeping are treated by some by using a soft cervical collar to prevent the head from lowering and/or jaw from dropping which can pinch airways. A collar did not help me but min. pressure increase did. What has helped too with therapy, in general, is using a thin pillow that will not push my head forward when on my back or upward to the side when side sleeping.
When I sleep on my side I don't need the higher pressure but in the back position, I do. Using EPR 3 and min. 8 pressure is not enough to address my positional apneas. Turning EPR off and raising min to 10 dramatically improved my AHI scores and clusters were gone. I will be trying EPR at 1 tonight in hopes of getting flow limitations down.
I would try increasing the min. pressure to 8, EPR off, and look for a much lower AHI then increase min. pressure more if needed. EPR can be turned back on gradually after an effective min. pressure is found. With a higher min. pressure my machine does not spike to 20 which has allowed me to bring max. down to 15.
For me, positional apnea can be treated by pressure increase, for others it is not.
I only give suggestions from experience as a fellow CPAP user, not professional advice.
Resmed is flagging a lot of Cheyne-Stokes respiration event. Please take a look at the screenshots and let me know if it is something I should be concerned about.
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.
Machine: Lowenstein Luisa Mask Type: Full face mask Mask Make & Model: Resmed Quattro FX Humidifier: separate F&P humidifier CPAP Pressure: Epap 4-20 PS 4-20; "auto" rate CPAP Software: Not using software
Other Comments: Using 45 degree angle upper body wedge (36"x36") and 4.5"soft cervical collar; 500 assured tidal vol
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.
