[CPAP] AHI Creeping Up

[cadogan]

My AHI is creeping up.  I recently changed my pressure settings from 5 to 7, and am now averaging an AHI of 20.  I'm not that familiar with the RESMED Elite machine, and the proper settings, but I will forward my sleepyhead user statistics and perhaps someone could give me some advice.  I am using a full face mask.  Any ideas on improving my AHI.  It was decent last year, but over the last three months has increased a lot.

Thanks!

[cadogan]

I tried to post my sleepyhead data, but it wouldn't allow me because of space limitations on the file.  I was going to post a screenshot of the overview page.

[Crimson Nape]

Your post count must be over 4 to be able to post any images. In the meantime, here are 3 helpful sites for you:

Beginner's Guide o SleepyHead

Organize Your SleepyHead Charts

Using imgur to post your Charts

[Crimson Nape]

cadogan's charts:

[Crimson Nape]

I just noticed that you're only showing large leaks and hypopneas.  Look in the lower left corner of the Daily graphs and make sure all event flags are green. Also your ramp seems to be set to start you a 4cm. Most people feel starved for air at this setting and need to increase it to around 7cm to feel normal.

Did you start a new medication or indulge in alcohol prior to bedtime?

[Beej]

Note: the answer may not be increasing the pressure. Too much pressure may be worse - it was for me.

[trish6hundred]

Hi cadogan,
WELCOME! to the forum.!
Good luck to you as you continue your CPAP therapy, hang in there for more responses to your post.

[Sleeprider]

You are currently using a fixed CPAP pressure of 7 with EPR at 1. you are experiencing abundant obstructive apnea. I completely disagree with Beej on this one, and recommend you start self-titrating by increasing pressure in 1 cm increments until AHI is consistently less than 4. In addition, the clustering of your events suggests that there is a sleep position element to your problem. You may find considerable relief by preventing your chin from tucking towards your chest by using either a soft cervical collar, or some kind of pillow that avoids your chin dropping down. Back sleeping (supine), can also contribute to obstructive apnea, however, it's usually best to find a pressure that is more effective than what you are currently experiencing before resorting to other methods. The fact that mask leaks correlate to the apnea clusters suggests to me, your head is tipping onto your shoulder or chest, dislodging the mask and closing your airway. I think this may the biggest contributor to your problem.

Your pressure at 7.0 is quite low. You used 8 cm pressure back in April with the result of 2.67 AHI. It looks like you have not tried higher pressures. Increasing pressure should be a simple choice, and I would not hesitate to continue increasing pressure until your reach 12 cm. If you don't see considerable relief by that pressure, we should revisit this recommendation. You should see a steady improvement as pressure increases, and I think realistically you may end up at around 10 cm. If you have the results of your sleep study, or a study that set your CPAP pressure, it will help if you share that.

[cadogan]

Thanks so much.  I will start self titrating, and see.  Also, may go out and buy a cervical collar and see if that helps.  What is EPR...you say it is set at 1.  Should I revisit that also?

[OpalRose]

EPR (Expiratory Relief Pressue) This drops the pressure in your case by 1cm when you exhale.

You may need it as your start to raise your minimum pressure, just to feel more comfy and be able to breath out against the pressure. I would leave it alone for now. If you start to see more Clear Airways as you raise pressure then you should turn it off.