AHI high using machine

[spc23]

I use the auto feauture and it rarely goes above 11 but last night my AHI was 15. No leaks. Any ideas?

[Tez62]

Welcome spc23, the best way to tell is if you use free software called sleepyhead, you can then look at your data and see what the issue is, it could be possibly be mask leaks. If you could update your Machine desription in your profile a bit more as some CPAPs are not data capable and you won't be able to read the data.

You can download the software from the link below.
http://sourceforge.net/projects/sleepyhead

[PaulaO2]

Okay, you mean your AHI rarely goes over 11 but now it went over 15?

Do you use software to look at the data?

How long have you used CPAP?

[spc23]

[quote='PaulaO2' pid='50349' dateline='1385340506']
Okay, you mean your AHI rarely goes over 11 but now it went over 15?

Do you use software to look at the data?

How long have you used CPAP?

/quote]

sorry I meant pressure is rarely above 11, averaging around 10 with no large leaks indicated. From night to night the AHI varies from 5 up to 15. I do awake with uncomfortable pressue so I ramp it down to get back to sleep. This happens several times in 6 hours. I have been using CPAP for over a year. I do not have software and from what I am reading my Philips Respironics Remstar Auto A flex machine does not work well with any free soft ware. My DME provider has recently changed due to Medicare coverage and I haven't had good response in contacting them. I don't see the sleep dr. again until June. I understood that the auto setting should increase the pressure as needed but does it also decrease? Not feeling rested, ready to quit!

[robysue]

sorry I meant pressure is rarely above 11, averaging around 10 with no large leaks indicated. From night to night the AHI varies from 5 up to 15. I do awake with uncomfortable pressue so I ramp it down to get back to sleep. This happens several times in 6 hours. I have been using CPAP for over a year.

So you're getting the data off the System One's LCD each morning?

Some questions:

Are you using an APAP range? If so, what's the minimum pressure setting? What's the maximum pressure setting? You'll need to get into the clinical menu to check these settings if you do not know them.

You say you are using the ramp several times a night. That may explain the higher than desired AHI. What is your beginning ramp pressure set to? What is your ramp time set to? You should be able to find the beginning ramp pressure in the patient set up menu, but the ramp time setting will only be visible in the clinical menu.

When you wake up "with uncomfortable pressure", what exactly is "uncomfortable" and how does hitting the ramp relieve the discomfort? Is the problem air in your stomach? Is the problem that it is hard to exhale against the pressure? Is the exhaust flow hitting your arms or chest or bouncing off the covers and hitting your eyes?

I do not have software and from what I am reading my Philips Respironics Remstar Auto A flex machine does not work well with any free soft ware.

SleepyHead should work just fine with your machine. If you use a Windows machine, you can just download SleepyHead 0.9.3 from sourceforge.

If you use a Mac, you will also need to download a patch if you are using a Series 60 System One machine. You can figure out which kind of System One you have by taking the water tank out of the humidifier and turning the whole thing upside down. The model number on the blower unit will have a three digit number in it. It will most likely be a 550 or a 560. If it's a 550, you don't need the patch; if it's a 560, you do need the patch. Should you need the patch, there is a link to it in the SleepyHead Software Download Link thread in the Private Files and Links area of the Apnea Board Forum pages that is accessible only to registered members. If you have trouble finding this link, PM me and I'll send you some detailed instructions on how to get there.

My DME provider has recently changed due to Medicare coverage and I haven't had good response in contacting them. I don't see the sleep dr. again until June. I understood that the auto setting should increase the pressure as needed but does it also decrease? Not feeling rested, ready to quit!

First, yes, the pressure DOES decrease---if the decrease in pressure does not lead to a worsening in the shape of the inspiratory part of the wave flow. In other words, the machine is tracking a whole lot of variables that affect how your inhalations actually look on graph paper. And when it decreases the pressure, it checks the shape of inhalations as they show up on graph paper. And if it detects subtle changes that indicate the airway may be becoming less stable, the machine will not decrease the pressure any further than the current pressure setting.

Next, since you are having problems and you are not getting much response from your DME, it's time to start calling the sleep doc's office. Yes, you have an official follow up appointment, but it's not until next June. And that's not good enough since you're ready to quit NOW. So it's quite reasonable to call the doc's office NOW to let them know you're not doing well in terms of adjusting to CPAP therapy.

When you call the sleep doc's office you need to tell the receptionist that you are really struggling and that you've had no real luck in contacting the new DME. Tell the receptionist that you are frustrated to the point where you are seriously thinking about just giving up and quitting. And that at this point you NEED to have the doc or a nurse or a PA call you back and talk about the problems you are facing in your adjustment.

It will help if you can give the doc/nurse/PA some hint as to what your major issues are. Since you say you're waking up multiple times each night uncomfortable due to the pressure and you are repeatedly hitting the ramp button, start there. But try to tease apart what it is about the pressure that's bothering you to the point where you are waking up. Is it air in the stomach? Is it air blowing in your eyes? Is it simply that it becomes way to hard to exhale comfortably?

Once the doc/nurse/PA knows what kind of problem you're dealing with and how much this is affecting you and close you are to just quitting, they'll give you some suggestions on what to try AND they may just move that next follow up appointment up a whole lot closer to NOW rather than waiting for another 7-8 months before seeing you.

[zonk]

sorry I meant pressure is rarely above 11, averaging around 10 with no large leaks indicated. From night to night the AHI varies from 5 up to 15. I do awake with uncomfortable pressue so I ramp it down to get back to sleep. This happens several times in 6 hours. I have been using CPAP for over a year.

SleepyHead download link http://www.apneaboard.com/forums/Thread-...structions

The machine have no way of knowing if you were asleep or awake at the time scoring apnea events. Don,t worry about AHI numbers at this stage, just concentrate on improving sleep quality ... quitting is not an option.

The pressure reporting on LCD screen is 90% percentile pressure which means pressure was at or below that number for 90% of the time and higher for the other 10%. The software pressure graph show pressure fluctuation between minimum and maximum pressure setting (5-16 as shown in your user profile)

APAP is not for everyone, if you are constantly disturb by pressure movement, try tighter range as fluctuation would be less noticeable or set the machine on fixed pressure so it deliver a constant pressure all night long

[spc23]

sorry I meant pressure is rarely above 11, averaging around 10 with no large leaks indicated. From night to night the AHI varies from 5 up to 15. I do awake with uncomfortable pressue so I ramp it down to get back to sleep. This happens several times in 6 hours. I have been using CPAP for over a year.

So you're getting the data off the System One's LCD each morning?

Some questions:

Are you using an APAP range? If so, what's the minimum pressure setting? What's the maximum pressure setting? You'll need to get into the clinical menu to check these settings if you do not know them.

the range is 5-16,

You say you are using the ramp several times a night. That may explain the higher than desired AHI. What is your beginning ramp pressure set to? What is your ramp time set to? You should be able to find the beginning ramp pressure in the patient set up menu, but the ramp time setting will only be visible in the clinical menu.

ramp starts at 4 and it takes 45 min to increase. I assume that is 5 and keeps on going as is needed.

When you wake up "with uncomfortable pressure", what exactly is "uncomfortable" and how does hitting the ramp relieve the discomfort? Is the problem air in your stomach? Is the problem that it is hard to exhale against the pressure? Is the exhaust flow hitting your arms or chest or bouncing off the covers and hitting your eyes?

I just wake up, pressure is higher and I can hear it and the air seems cold now that it is winter. I had the auto humidifier set for 5 but when I check the plate it is cold. I have since taken off the auto mode for humidifier, which senses room temp, etc. Now when I awake, I can feel the humidity so I turn that down too. I use a Remzz liner to help with leaks but I think maybe what I am hearing is small leakage that wakes me up. When I ramp it down, it is quiet again and I can fall back asleep. I don't sense that the exhaust is hitting covers or pillow but that maybe the source of the noise. I am usually on my back as that is when I snore. When I awake, I ramp it down, turn on my side and go back to sleep only to repeat the process later in the night. If the ramp stays at 4-5 for 45 min, that may be why the pressure for 90% of the time is only 10-11. Could it be that when I wake it is up to 16 and that is why it is louder and uncomfortable? When I first got my machine it was set for 16 and I couldn't even get to sleep in the 45 min ramp time. Then it would almost blow my mask off. The sleep dr. told me to use the Remzz's and then the auto setting and I was at least able to get to sleep.

I do not have software and from what I am reading my Philips Respironics Remstar Auto A flex machine does not work well with any free soft ware.

SleepyHead should work just fine with your machine. If you use a Windows machine, you can just download SleepyHead 0.9.3 from sourceforge.

If you use a Mac, you will also need to download a patch if you are using a Series 60 System One machine. You can figure out which kind of System One you have by taking the water tank out of the humidifier and turning the whole thing upside down. The model number on the blower unit will have a three digit number in it. It will most likely be a 550 or a 560. If it's a 550, you don't need the patch; if it's a 560, you do need the patch. Should you need the patch, there is a link to it in the SleepyHead Software Download Link thread in the Private Files and Links area of the Apnea Board Forum pages that is accessible only to registered members. If you have trouble finding this link, PM me and I'll send you some detailed instructions on how to get there.

It is 560P, but my computer is 64 and software is 32. Can I still download? Then do I put the SD card into my computer?

My DME provider has recently changed due to Medicare coverage and I haven't had good response in contacting them. I don't see the sleep dr. again until June. I understood that the auto setting should increase the pressure as needed but does it also decrease? Not feeling rested, ready to quit!

First, yes, the pressure DOES decrease---if the decrease in pressure does not lead to a worsening in the shape of the inspiratory part of the wave flow. In other words, the machine is tracking a whole lot of variables that affect how your inhalations actually look on graph paper. And when it decreases the pressure, it checks the shape of inhalations as they show up on graph paper. And if it detects subtle changes that indicate the airway may be becoming less stable, the machine will not decrease the pressure any further than the current pressure setting.

Next, since you are having problems and you are not getting much response from your DME, it's time to start calling the sleep doc's office. Yes, you have an official follow up appointment, but it's not until next June. And that's not good enough since you're ready to quit NOW. So it's quite reasonable to call the doc's office NOW to let them know you're not doing well in terms of adjusting to CPAP therapy.

When you call the sleep doc's office you need to tell the receptionist that you are really struggling and that you've had no real luck in contacting the new DME. Tell the receptionist that you are frustrated to the point where you are seriously thinking about just giving up and quitting. And that at this point you NEED to have the doc or a nurse or a PA call you back and talk about the problems you are facing in your adjustment.

It will help if you can give the doc/nurse/PA some hint as to what your major issues are. Since you say you're waking up multiple times each night uncomfortable due to the pressure and you are repeatedly hitting the ramp button, start there. But try to tease apart what it is about the pressure that's bothering you to the point where you are waking up. Is it air in the stomach? Is it air blowing in your eyes? Is it simply that it becomes way to hard to exhale comfortably?

Once the doc/nurse/PA knows what kind of problem you're dealing with and how much this is affecting you and close you are to just quitting, they'll give you some suggestions on what to try AND they may just move that next follow up appointment up a whole lot closer to NOW rather than waiting for another 7-8 months before seeing you.

I will call for an appt. thanks for all the info

[bwexler]

Yes. You can use the 32 bit SleepyHead software on your 64 bit PC.

Do you have a complete copy of your sleep study? If not get a copy. There is a lot of information there that will help us understand your situation. The folks here can explain it to you and help you sort out what is happening.
Don't even think about quitting. Your health is too important to just give up.

[zonk]

ramp starts at 4 and it takes 45 min to increase. I assume that is 5 and keeps on going as is needed.

It take 45 minutes for pressure to increase from 4 to 5 which is not much and too long to be at such low pressure (uncomfortable) also you are not getting any treatment at low pressure. The machine adjust pressure as needed but if the increase start from low starting point might not get there in time to prevent apnea event. Just something to take up with the doctor