AHI won't go below 9 - sleephead screenshot

[shona]

hi guys

Would appreciate some help

My husband was diagnosed with SA back in August (my original thread is here: /forums/Thread-CPAP-newbie-questions)

We purchased a Philips Respironics System One DS560HS and a Resmed F10 full face mask from Supplier #2.

For those in Perth Australia, before spending hundreds on a mask, I found a place that will rent you any mask so you can test for comfort/sizing for about $25 a week - Air Liquide Healthcare in Nedlands

He was still getting significant large leaks with the F10 because he sleeps with his mouth open and it meant the mask was shifting up on his face, so he tried a chin strap in addition. The chin strap was then modified by a friend so it is now part of the F10 strapping, which seems to be working better, as I can't actually hear it leaking out now, but I don't really know how to read the sleepyhead charts or what an acceptable leak number really is.

* Mid-September: his sleep specialist told him to start on pressure 5-15 when we first got the machine
* Over the next month we put the pressure up to 7-17 as his AHI was still very high
* 17-October: specialist asked him to do a second sleep study in their clinic to check machine is all good, they were happy to leave it at 7-17.
* 28-October: follow up sleep specialist appointment - he just said everything looks ok - aim to get AHI under 4 and see you in 6 months

I've phoned the sleep specialist reception and they were not very helpful with any suggestions on where we go from here to get the AHI down. She said he can either pay $150 to see the specialist again (he is not keen on this as he didn't do anything at the last appt) or they "normally tell people to call Perth CPAP but they probably won't help you as you bought the machine online"

Here is last night's data (AHI 9.28). It won't let me post the img or url code as I haven't made 4 posts yet. I can post more nights screenshots if it helps.

(copy the link below into your browser and it will come up) - fixed it, Moderator

http://home.shona.org/photogallery/uploa...161215.jpg

thank you in advance for any advice

PS. he knows he doesn't get enough hours of sleep, we are working on that!

[AshSF]

The minimum pressure is too low. Try raising minimum pressure in 0.5cm increments and evaluate. I am guessing that ultimately, it will take a min pressure of 12+ to take care of this AHI.

I am recommending 0.5 cm increments so that therapy can be tolerated and adjusted to gradually by the user.

[pholynyk]

Further to the recommendations from AshSF, I would suggest staying a minimum of 3-4 days, up to a week, at each new pressure. This will give his body time to adapt to the changes. The goal, in addition to lowering the AHI, will be to have the minimum pressure about 2 cmH20 below the 95% pressure. The maximum pressure may need to be raised to keep it above the 95% pressure - usually a couple of cm is enough. As you increase the pressure, it will be important to watch out for increased Clear Airway events and Periodic Breathing. Right now the CA events appear to come as he falls asleep and wakes up; there's no problem with that.

[OpalRose]

shona,
It's unfortunate you are not getting good advice from your sleep specialist, but this seems to be the norm for most of us. They do like to charge alot for very little help. The bottom line is that they usually don't know what to do or how to make changes to improve therapy.

With that said.....I agree that the minimum pressure is too low, and that eventually will have to be raised to at least 12cm. But do it slowly. I know some say to raise it .5cm at a time, but if it were me, i would be raising it to 8cm, then watch for 4 or 5 days, then up it again .5cm and watch again as long as your numbers improve.

Try these changes and let us know if there is improvement.

[shona]

Thanks everyone, I really appreciate the help.

We will raise the minimum to 8 tonight and see how it goes over the next few nights.

When he raised the maximum pressure from 15-17 back in September, he did it gradually, but when he raised the minimum from 5-7 he did that in just 2 nights (up to 6 one night, then to 7 the next night) with no apparent issues.

If there is no discomfort / interruption to sleep experienced, is it ok to raise the pressure that quickly? (Or even if he feels fine, it is damaging to the body and better to raise it only 0.5 or 1 every few days?)

Also are the leak rate and total leaks ok on the graphs? The only figure I understand really is the "time over leak redline 0.573%" which I guess means it is ok as it is only a very small amount of the night that his mask is leaking at an unacceptable level?

Thank you

[OpalRose]

If your husband wasn't bothered by the pressure increase first time around, this shouldnt bother him, but comfort and sleep are most important. If you feel better by taking it slower, please do so.

The reason I suggested to bump up minimum pressure by 1cm is because his current pressure of 7 is too far away from his 95% pressure of 16.5, and the apap will take longer to respond to apnea events.

Just to clarify: 95% pressure (16.5) means your husband was at that pressure (and under) for 95% of the time.

The leak rate look fine.

[Mosquitobait]

You certainly can bump up right to 8. In fact, many people start at 8 because they can't breathe at 6. I tried it out with a nap first and it was fine so I left it for overnight and no problems. Some folks are much more sensitive though. Don't know where he falls in the spectrum.

Anything higher than 8 should be very incremental though. I was looking at my Sleepyhead data on a daily basis at that time to see what happened (and that things didn't get worse).

[Gideon]

I have to ask, since he is above 11cmH2O for almost all the night, why not try min at 11 to start, maybe a trial while reading or watching TV to see if he can tollerate that pressure as a start?

Fred

[Sleeprider]

Good call Fred. The range from 7-10 is pretty useless and keeps letting the machine fall out of therapy pressure. Events are overwhelmingly obstructive. The first hypopnea and apnea begin within 10 minutes of startup, so this low starting pressure allows things to start fast.

There is another case on the forum recently posted by "Merideth" who has similar OA clusters. We found those were likely related to her chin dropping and occluding the airway. Sometimes it works to use ergonomic pillows or soft cervical collars to stop these events. So there might be an alternative to higher pressure, if we can help people avoid those postures.