[CPAP] AHI Creeping Up

[Marillion]

Thank you Opalrose!  Very much appreciated.  I will check my stats and adjust accordingly.  Currently my 90% seems to hover around 10.6 and sometimes over 11.  I set my machine currently to 9.6-15.

My appologies for taking this off your topic Cadogan!!  I'll step back now.

[cadogan]

This forum is so good.  I am so impressed with the expertise of those that participate.

It also confirms that this CPAP process is incredibly iterative. You need to keep at it - experimenting with all the variables until the AHI numbers improve - guided by the great feedback received here.

Also, the terrific software provides the next day numbers and allows us to refine our sleep dynamics.  But the negative: it is very time consuming, and the dials and settings are not especially intuitive.

As to last nights results:

As you know from this thread, I have moved from Mask to Nasal Pillow.  But what you don't know: I have two nasal pillow P10s - an old one and a new one.  I had been using the old one, and the leak rates were constant and off the charts.

So last night I experimented.  I started with the old one---and then about two hours into sleep, woke up, and switched.  

This morning results seem to confirm that the old one may be broken...it leaks a ton...the new one, hardly at all.  The before/after apnea readings are quite different, and go down dramatically.  So I now look forward to seeing the results tonight with the new one for the entire night.

I also reset the ramp to 6, at sleeprider's suggestion.

I am still puzzled why the AHI readings are so different between the nasal pillow and the face mask.   The nasal pillow readings - with the new device - are normal.  But when using the face mask, I record abundant CAs and other apneas.  Hopefully my resmed device is recording results properly...Anyway, just abit puzzling.

Last night results:

http://imgur.com/a/pnHwH

[Crimson Nape]

cadogan,
I've found that the P10 "Achilles Heel"  seems to be its linear resistance diminishing over time.   Basically, they collapse back into themselves.  I inserted o-rings on the stem under each nasal pillow to provide support.    This has been working without leaks now for 7 months.   I plan to see just how long I can get off of a set of Pillows.

[cadogan]

Good morning.  I have been using the nasal pillow with decent success.  Sometimes the day-to-day variation of the AHI drives me crazy, but the good news, is that AHI has been reduced to around 5.

I have three problems from the data below.

First, my CAs are high, amounting to 90% of my apneas.  They seem to occur whether I have leakage or not.

Second, I have leakage, which I think is a function of getting the pillow to stay in the nostrils and not move around during the night.

And third, my nostril gets clogged up at some point in the night (this night after 3.5 hours), and I just say the heck with it, and pull the nasal pillows off.

Any and all feedback, suggestions, welcome!

Thanks

http://imgur.com/a/kZsHv

[Sleeprider]

Results look decent, and if I had to choose what events are okay, I'd have to go with the CA. On average, your leak rate is okay, although you might include that on the chart.  Aside from the AHI driving you crazy, are you feeling reasonably rested and like you're benefitting from CPAP?  Has your doctor given you any feedback on this?

[cadogan]

Last night's results seem a touch better. There are slightly more obstructives and fewer CAs. I think the main problem with the Obstructive is the leak rate, which became pronounced several hours into sleep - similar to the previous night. I tighten the nasal pillows hard into the nostrils, but then it becomes uncomfortable after 3.5 hours, and I pull it off for the evening. My goal is to keep it on for the entire night comfortably.

FYI. I cancelled the titration study. Just didn't want to incur the cost while my results remain under 5. Going to experiment here for awhile, and see if I can get it in the 2-3 range.

Thanks as always.

http://imgur.com/a/leNSJ

[Sleeprider]

Your results are not unreasonable, and might be improved on APAP. Hard to tell without seeing if those OA events are accompanied by flow limitation. The same strategy of keeping pressure low would apply, but having a range of pressure available for OA could be helpful.

I don't recall if you had a titration study previously and if so what the results were. I know you initially had very high OA and that was resolved through managing your tendency to tuck your chin and obstruct the airway physically. After that, you returned to a pressure of 7.0 (from 8.0) due to onset of some centrals. So, your treatment has been to this point a balancing act of managing body position and pressure for OA, and lower pressure for CA. I could see you on an APAP with a pressure range of 6.6 to 8.0. That is a narrow range, but may be just what it takes.

You might try taking a few tenths of pressure off and see what becomes of the CA at 6.6 cm. If that increases OA, then we know your pressure of 7.0 is really a tipping point.

[cadogan]

Great suggestions, as always sleep rider.

I did have a titration study at Cornell Sleep Center in NY.  Probably 3-5 years ago, not sure.  Then diagnosed with mild sleep apnea.  Not sure I kept results, but the study suggested I only needed modest pressure.  Maybe I have it filed away some where.  I will look, but not certain it still is meaningful years later.

I will take a notch off the pressure, and see if that brings CA down.  I also like your idea of APAP in a narrow range, 6.8 to 8.0.  But a stupid question.  Does my resmed elite s9 have APAP capability?  I probably should take a look at the manual.

Here is the flow limitation chart from last night by the way:

http://imgur.com/a/ecF91

Thanks again

[Sleeprider]

Your S9 Elite is fixed pressure, and nothing like auto trial or anything. You might keep your eyes out for a new machine. There is a Resmed Airsense 10 Autoset on Amazon for $695.

Find your study and keep it in your most valuable files. That sleep study can help you avoid future diagnostic sleep studies, and should serve for insurance justification of medical necessity for life. BTW, unless you are doing a bilevel or ASV titration, I think that a new study would be a waste of time and money. You are capable of CPAP titration, or just get an auto.

I would have expected to see more FL or snores correspond to the OA. Might be interesting to zoom in on the flow rate line at those events and look at duration and whether there is any recovery breath. Can't see much from the mask pressure graph.

[cadogan]

I thought I had read in the manual that you can adjust the min and the max pressure, and take it off CPAP...not sure...need to recheck.

And here is the zoom showing recovery breadths after an obstructive event.

Thanks

http://imgur.com/a/ZoHLq