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Trying to lower AHI, need OSCAR help
#1
Trying to lower AHI, need OSCAR help
Hello all, I have browsed this website for many years to understand and help with my CPAP use, I have been using CPAP since 2018ish.  However, I switched a couple of weeks ago to a new auto CPAP vs. BiPap machine. My AHIs have been pretty high around 14 since I made the switch. Last night was the lowest at 6.35 and I had one other low night at 8.35.  I am on an auto Resmed Airsense 11 with a full face mask.  In the past, I was on a BiPap with nasal pillows. My AHI would be around 5-6, never went lower than a 3, on my old machine and the main issue I had there was aerophagia if the pressure was too high.  My high pressure was at about a 16, if over that I couldn't tolerate the gas.  My new sleep doc said my low and high numbers were so close, he didn't think a Bipap was needed.  I was having dry mouth recently, so I was obviously getting a lot of leakage.  (I decided on a full face with my new machine, because I had tried taping my mouth, chin straps, etc and nothing seemed to work.)  So, I'm trying to determine why my AHIs are so high, but my auto machine isn't responding with a higher pressure to lower my events. I have downloaded Oscar and gotten my data, but don't know what to look for, though I did read through some of the how to guides, etc.     (I did tweak a few settings when I first got the machine, but then set it back on what it was originally.  You'll see one night I put the low at 10, but my doc had said to put it at 4.)  I did a home study for this machine, so I didn't get a titration with my latest study. I was expecting to do much better on an auto machine.  I never got OSCAR on my old machine because it was working fine for the most part so I don't have anything to compare it to.  I'm attaching two nights: my best and one of the others.  Any help learning how to understand all of this is GREATLY appreciated.  I think I read somewhere to put about 3 minutes of data in the screenshot, but I don't know which 3 minutes to use.


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#2
RE: Trying to lower AHI, need OSCAR help
Welcome  

You presently have very high flow limits.  Right now you need to raise your EPR to 3.  If that doesn't bring them down enough you may need to return to your bi-level machine.

You are also experiencing positional apnea.  This cannot be fixed by a setting.  It can be solved sometimes by sleeping on a lower pillow or by wearing a soft cervical collar.  PA is caused when your chin falls toward your chest, cutting off air flow, somewhat like a kinked hose cuts off water flow.  Most people end up needing the collar.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#3
RE: Trying to lower AHI, need OSCAR help
Thank you for the suggestions. I’ll see if they help.
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#4
RE: Trying to lower AHI, need OSCAR help
Your min pressure is also 4cm, you need to raise that to at least 7cm, knock down your max pressure from 20cm to 16cm too, and set EPR to 3 please as Deborah stated, that should help the OA and FL events a bit, try it out for awhile too before bed to see how it feels. Smile
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#5
RE: Trying to lower AHI, need OSCAR help
Ok, I increased my minimum to 10 and max to 16. EPR 3. Got a neck brace. I’m traveling so I can’t download data, but since the changes AHI ONE NIGHT WAS 9.5, today 12.6. 

If the neck brace takes care of the PA, shouldn’t the machine push enough air to compensate. 

By the way, the pressures don’t bother me. I put on my mask, and now with neck brace, and go to sleep.  We do sleep on a mattress on an incline already. I remember at one time they were suggesting I spend a couple hundred on a special pillow to keep me on my side. Would that help at all?  Also, I first tried a Mandibular Advancement Device but it didn’t work on its own. But after I got my machine, I continued to use it because I figured if it helped keep my airway open it was good. However, a few months ago I got a crown and the dentist did not do a good job fitting the crown and MAD together. I’m wondering if that would help if I got another one. 
Any other ideas are appreciated.
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#6
RE: Trying to lower AHI, need OSCAR help
The only way I stopped my positional apnea was by sleeping on my side.  A soft cervical collar did not help me much.  
I am not an expert...just a long time user.
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#7
RE: Trying to lower AHI, need OSCAR help
It would help clients understand whether from the doctor or service provider or operating manual, about EPR is to tell them the number means it's temporarily reducing the pressure by 1,2 or 3 cm when exhaling instead of treating it like some other function like it's opening a trap door to let air out.

Then it would be more obvious very low ranges won't allow EPR to work at all or very well. Just put in the manual that your pressure is either say 9 on CPAP when you inhale and 6 when you exhale, and 9-20 on APAP means it's 6-17 when you exhale.

If the range is set very low like starting at 4, it would strangle me just like ramping does. I've never tolerated ramping because it's nothing more to me than not getting enough air pressure, on purpose, for 15 minutes or 20 minutes. The old pressure gauge whipping up to the minimum APAP or fixed CPAP pressure is a sign to me that proper airflow is arriving PDQ.
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#8
RE: Trying to lower AHI, need OSCAR help
Thank you. I’ve tried several types of pillows or things like the tennis ball at my back, without much success. What did you find to help you stay on your side?
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#9
RE: Trying to lower AHI, need OSCAR help
I just put an extra pillow and a folded blanket behind my back when I am on my side.   Actually works pretty well for me.
I am not an expert...just a long time user.
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#10
RE: Trying to lower AHI, need OSCAR help
I sleep on my back due to lower back pain and have 0.something AHIs almost every night, so back sleeping doesn't have to be a problem.  

The new settings should certainly not have caused a higher AHI, and the neck collar does not seem to be helping either.  On your trip are you at a significantly higher altitude?  For some folks that can cause higher AHIs.  When you return, post your bad nights and maybe we will see what is causing the problem.  I still think you may need to go back to using your bi-level machine or get a new one if it's not working right.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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