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suggestions to lower ahi
#1
suggestions to lower ahi
Hi everyone,

I'm looking for suggestions to lower my AHI to a better level. 

I'm a long time user of CPAP since 2008, diagnosed at 87 With cpap therapy, I got my ahi below 4.

Over time, I stopped using the data module on my DeVilbiss IntelliPAP AutoAdjust as I found it clunky to use and got tired of medical professionals nearly dropping the data module. A couple of years ago, I lost some weight. Recently I decided I should monitor it my therapy more closely and downloaded Oscar, tried it last night so I'm a new user to both it & this forum.

This is the terrible result (which shocked me).

I suspect the biggest problem is my mask. It's a full face mask (I'm a combined nose/mouth breather) and move around in my sleep (side/back sleeper in the same night). I suspect I'm getting a lot of mask leaks. This particular mask is a new copy of the mask I've worn for years. (A Fisher & Paykel 432). I suspect I need to try another mask as this model seems to leak too much for me now even though it once worked in the past. 


 I also suspect I have positional apnea (which I've read about here)  although I need to work on the leak problem first to see if it resolves with another mask. 

As well, how are settings? Do I need a bipap? Or should I not worry about this until I've gotten the mask leakage problem solved?

I'm a Canadian so it takes time for new masks to get her. (I use Supplier #1 since I've had bad experiences with Canadian vendors). 

I'd appreciate suggestions. 

Thank you

hopefully I've done this attachment correctly. I don't see flow rate, is this because of the high rate of mask leakage? 
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#2
RE: suggestions to lower ahi
I agree with you, you have to address the leaks before you even know what your real AHI is. Everyone has different face and what works for one will not work for another. With that being said I have found the ResMed F30 AND F30i are very good masks. 

I suggest that you use YouTube and search for a particular mask and see a review on that mask. There is a review or many reviews on the same mask. It gives you a much better chance of getting one that works for you.
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: suggestions to lower ahi
Your chart looks surprisingly like mine did.
My orig Rx was 19 CPAP and my brick would only go to 18, the DME said that was "All right", what did I know. The bearing in the brick were screaming an I asked for a CPAP that provided data, actually an APAP. They said the only thing they could give me was a dataless Brick, so I bought a DX54 from Supplier #1.

I to was on a FFM and had leaks and was shown nasal masks and in the office I had no problem breathing nasally. So I got the ResMed Mirage Activa Nasal mask. This is a great mask for movers because the 'seal' literally floats on your face held in place by the pressure, and the more pressure the better. The seal portion of the mask is attached by a bellows that allows about a half-inch movement in ANY direction. The straps just hold the mask in place and have nothing to do with the seal. Fitted. and with no leaks, and under pressure, I can press the mask a half-inch closer to my face, there is that much movement allowed. To manage my leaks I taped my lips until I mastered nasal breathing.

Because of my high pressures, and fairly consistent high AHI readings the doc gave me an Rx for a BiLevel and I got my VAuto. Keep in mind that the only solution the Doctor sees per the charts is more pressure. I very strongly suspect that a detailed look at your Flow Rate chart would show a lot of Flow limits that the VAuto or a ResMed for that matter, would handle very well with pressure support or EPR (within its limits)
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#4
RE: suggestions to lower ahi
I like when I'm under 1.... 1 is too much for me. Think of it as you're being woken up once an hour and in bed for 6 hours. Not good in my estimation. It's how you feel that matters most. I was on a APAP, and considered it worthless. HAd a second sleep study and am now on a VPAP. The VPAP has other settings APAP's don't have for more efficient therapy. Post a recent report and maybe we can assist you futher.
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#5
RE: suggestions to lower ahi
Thank you for all the suggestions.  BTW the data I posted is last night's so it's the most recent report I have. 

I'm considering an ResMed F20Touch or F30 as both seem to be good for restless sleepers. Unfortunately I have to go a Canadian dealer as ResMed (and Phillips)  will not allow American dealers to ship to Canadians. This means spending more money and potentially not getting a free mask exchange if the mask doesn't fit properly.

As well, I have to go to my doctor to get a current prescription, so it will have to take a big longer.

Unfortunately it's impossible to get a sleep study right now. My entire province (Ontario) is under stay at home orders which will probably be extended and sleep studies are not being done currently.
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#6
RE: suggestions to lower ahi
forget the f30.... the nose section cushion is too flexible. Leak city when on your side, and it appears you are a restless sleeper? Your current mask seems to be a good one. F&P is a good mask overall. You should not be able to pull the mask away from your face when tugging at it from the frame. If the cushion moves away from your face, adjust until it does doesn't. Pressure will make it a bit tighter but should be comfortable. A little on th e tight side should be fine but not to tight where it bothers you. You could try ebay to get what you need. I like F&P Vitera
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#7
RE: suggestions to lower ahi
FWIW I've had the F20 mask, both silicone AirFit and memory foam AirTouch. I had consistent leaks that were a disruption. I switched to Fisher and Paykel Vitera and it's much better in comfort and leak control. I'd also consider you might want to look at that F&P mask line, regardless of pillows, nasal, or full face. The ResMed P10 pillows are still great if you can use that. The Activa is still out there at some outlets.
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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#8
RE: suggestions to lower ahi
Thank you all for your help.  Thanks

After researching different masks, I've ordered a ResMed f20 Air Touch to try from a Canadian vendor. It looks like it will be good for my restless sleep and with the memory foam, it should be better for avoiding leaks. Although the vendor's price was expensive, they do have a 30 day mask exchange program if it's wrong size or doesn't work for me. I remember it took me several tries to find my last mask and I thought that the ability to exchange for another mask was more important than price. If it doesn't work, I'll try another. It should be here fairly quickly as the vendor is here in Toronto.  


I'll keep looking at my data and hope to get better control of the leaks with a different mask. Once the leaks are under control, at that point if my ahi and pressure remain high, I'll look at foam cervical collar for positional apnea and then if I need (hopefully not), changing to a different type of machine rather than an apap.
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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#9
RE: suggestions to lower ahi
You can switch between memory foam to silicone just by swapping cushions if you want to try both. On the F20 that is.
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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#10
RE: suggestions to lower ahi
(05-09-2021, 07:25 PM)SarcasticDave94 Wrote: You can switch between memory foam to silicone just by swapping cushions if you want to try both. On the F20 that is.

Thank you, I saw that. I went with the foam to start because my current mask has s foam layer (although it's more rigid than memory foam). I'm hopeful I will find a mask that doesn't leak for me although I know it can take several tries.
Core Products Foam Cervical Collar
Canadian, diagnosed OSA in 2008 with 87 AHI
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