10 AHI per hour with cpap - normal?

[mickapoo]

I’m sorry but I’m brand new to cpap. Only been using it a few days. What would be the reason behind increasing the min pressure to 7?

Also I see where it has Pressure Relief under the “My Options” menu but it doesn’t have a numerical setting it only gives me the choice of being on or off (and it was set to ‘on’). 

Thank you for your help!

[PeaceLoveAndPizza]

If you have not done so already, go to the following link and get the clinician manual for your machine. It explains how to change the settings.

https://www.apneaboard.com/adjust-cpap-p...tup-manual

[staceyburke]

EPR is exhale pressure release and it help therapy against flow limits. It also help with a higher min (exhal pressure) tomake it easier to breath out.  

Example - 4 is the absolute lowest a Cpap can go by so if your therapy needs to go for example 9 it takes longer for the machine to go from 4 to 9 than 7 to 9. Using EPR 3 min 7 gives the starting point 7 but the exhale pressure 4 )7-3=4. 

Makes flow limits less and less pressure to exhale.

You first set it to full time then it will let you set it to 1, 2 or 3. Set it to 3

[Expat31]

Hi, 

I understand how bewildering all this is when you are new to CPAP, with so much to learn whilst trying to deal with sleep deprivation.

You have the link on the clinical menu that will enable you to change all your settings.

Just a point on graphs, all we need initially are just 5 graphs (below), which I have given a description for what they are used for. 
Maybe you may want to glance these these to give you an idea what it is all about:-

1.EVENTS
This first graph gives us a quick overview of the night's events, and can give us clues, at a glance, where to focus. 
We get a breakdown of the events making up the AHI; obstructive, central and hypopneas, together with leaks, which can really impact the efficiency of the therapy. In addition, clustering of events can indicate positional apnea. 

2.FLOW RATE
This graph shows us the breathing patterns during the night, breath by breath. We see when arousals happen, when we pause breathing, and other disturbances. We can even zoom in to drill down to get greater detail. 

3.PRESSURE
This obviously shows variation in pressure during the night. Increases in pressure can be caused by the algorithm reacting to a need to open airways due to apnea events. It may also be a reaction to leaks,  or flow limitations (see following graphs below).
 
The optimal minimum pressure is of great importance. As a general rule of thumb, we recommend an initial minimum pressure of 7 with EPR of 3, but it depends on each individual’s needs. 

4.LEAK RATE
These can be either mask or mouth leaks. These often cause considerable arousals and
generally disrupt the therapy. Large leaks are defined for Resmed machines at 24l/m and over. 
Check on the Mask primer so a good fit is achieved to reduce any leaking.

5.FLOW LIMITATIONS 
These are precursors to apnea events, with a narrowing of airways, often accompanied by a resulting pressure increase and an accompanying arousal, and sleep disruption. You will see lots of references in posts to this, and the use of  EPR in the board's Wiki pages.
Ideally the 95% flow limitations should be below 0.1.
 
There are of course other graphs that could be useful, the 5 ones above are just a good basic starting point.

[mickapoo]

Thats a lot of great info, thanks expat31!!

So I did change the min pressure from 6 to 7, and the EPR was already set to 3. I’ll see how it goes tonight. Thanks again!

[mickapoo]

    I'm not sure what is going on, the AHI Is back up to 8.51. Can anyone look at my OSCAR screenshot and give me some advice? Thank you!

[Expat31]

Hi, 

-  At the end of your two sleep sleep segments, you had pretty big leaking that likely was the cause for waking you up. 

-  In addition, it certainly looks like you had periods of positional apnea. Do you think you  may have been sleeping on your back? 

-  Or some pillow issues? Sleeping positions & pillow adjustments (video Mayo)

A good reference source you may want to read is this :- Positional Sleep Apnea wiki.

[mickapoo]

I remember taking my mask off twice while the machine was still on, which I’m assuming is the “leaks” they are showing. 

Yes, I do tend to sleep on my back. 

Thank you for the help!

[Expat31]

I was just looking back at your other graphs and no real evidence of previous leaking, so perhaps this is not a real issue for you, as you have already identified the issue as not sleep related. 

Stacyburke, PeaceLoveandPizza and Deborah K have already identified leaking and the settings, which should do the job nicely. 

Perhaps that night was just a one-off, and in the next few nights things will settle down. 

I think there could be further scope for  minimum pressure increases - we will soon see how this pans out.

Concerning the positional apnea (video), another one to see -Sleeping positions & pillow adjustments (video) 

Apologies, I tend to go overboard on positional apnea, as was a previously a real issue personally for me.

[mickapoo]

Ok thank you. I will watch the videos and see how the next few nights go. ?