[CPAP] Still have a high AHI, don't know what is happening

[allanri]

Hi all ... I'm new here, and new to CPAP; I've had my machine for just over a week now, and while I have taken to the mask like a duck to water, and I'm managing to sleep with it no problem, my AHI scores are really high still. I'm doing another sleep study on Sunday, and am hoping to see my doctor again at the end of the month, but I'm curious whether this is typical of what happens for new users. 

Some deets:

• Using ResMed Air Sense 10 for Her
  
• Started with VPAP, 6-12 cmH20; doctor changed it to CPAP 9 cm H20 after I complained about high AHI
  
• AHI scores have averaged 18.3 for last week, with a high of almost 25, and a low of 9 one night (the low night was atypical)
  
• I feel like my CSA index seems high ... average of 7.96 since starting
  
• I started with a DreamWear Nasal Mask, but I switched to a full mask because I think my mouth was opening a lot.
  

I'm going to be travelling a lot starting in June, and I'm kind of desperate to find out how I can get this under control before I hit the road. 

Any thoughts would be appreciated!
Allan

[Sleeprider]

Allan, it sounds like you are comfortable with the therapy interface but you are experiencing complex or central apnea. This may or may not clear up, and you should know that if your AHI remains high due to primarily central apnea, the best treatment for that is an adaptive servo ventilator like the Resmed Aircurve 10 ASV.

You can share your results on the forum by using the free #Sleephead software and using the Organize Charts tutorial in my signature. Either the centrals will clear up or they won't and we can't promise anything, but can guide you to the appropriate therapy solution, and perhaps optimize things in the meantime. You are certainly not alone, and we have many members using ASV or on the path to get one. If you search through the threads look for complex and central apnea, or ASV and you will find many others in your situation. For those that do move on to ASV, the therapy results in near-zero events and resolved a lifetime of sleep problems and fatigue.

You can post your charts, and it might be interesting to look at your diagnostic sleep study. It would be interesting to see if central apnea was present in your study, or if this is a CPAP emergent problem. As far as general guidelines, most people with this problem do best with low fixed pressure and no EPR.

[allanri]

Thanks for your (quick) reply.

I don't have the reports from my diagnostic sleep study. I'm going to ask the patient co-ordinator if I can get a copy. In reviewing the report, my doctor didn't say anything about CSA ... he seemed to be focused on my OSA, which he rated "severe".  

I've been wondering about complex sleep apnea, and the possible need for an ASV. I'm hoping the next sleep study will be more revealing.  

FWIW, I've attached a SleepyHead chart from the other night.  I think I might have gone to the washroom and in my sleepy daze,  forgot to put my mask back on again for an hour - hence the gap between about 2:20 and 3:20.

   

[Sleeprider]

Wow, this is all showing up as obstructive! I was thinking more CA from your description. I think you can do two things. First, get a soft cervical collar 2-1/2 to 3 inches tall with a comfortable fit to prevent chin tucking and keep your airway aligned. Second, Try turning off EPR and see if that makes a difference. You need to understand that in using EPR, you are reducing the exhale (EPAP) pressure. This is what controls obstructive apnea, and it is possible that the EPR is aggravating any central apnea issues that exist. Finally, if that doesn't help, get back on Autoset Standard mode at 9.0 to 16.0 pressure, and lets see if that can improve the obstruction.

It's possible that the OA is a CA event and that you are unable to exhale against the pressure, but at this point, I think from the one chart we have, your problem is obstruction, possibly caused by a positional airway alignment problem, with some CA events from the new introduction of CPAP and EPR. This will sort out soon, but I think if you can get a soft cervical collar you will see a big difference from that.

In future graphs, please turn off the monthly calendar by clicking the triangle in the date line.

[allanri]

Hmm ... interesting theory.

My doctor just changed my pressure to 9 the other day, with an EPR of 2.  He wanted to give it a week and see how that looked. I think I’ll stick with that for the time being, after the one week’s worth of data has been sent to him for review , I will try what you suggest. (I don’t want to p*** him off by Fiddling with my prescription  this early in our relationship!). Certainly I can try out the cervical collar. Also, it’s possible that my settings will be adjusted as a result of this Sunday’s sleep study. I’ll be curious to see  if they  do what you are suggesting. 

 I really hope the solution is this simple.   I really don’t want to have to buy an ASV machine. They’re hugely expensive. Also, in my enthusiasm to embrace CPAP, I got an AirMini for travelling. It would be a real drag if that machine was of no use.

[Sleeprider]

The clusters of OA could be a positional issue that resolve for the most part with the soft cervical collar. It is a worthwhile first step that is inexpensive and won't interfere with your doctor's directions.

[allanri]

Do you think a cervical pillow would do the same thing as a cervical collar?

[gwc2795]

Welcome to the forum allanri.
I am sure you will find excellent guidance on the forum. It has been a game changer for me.

[Sleeprider]

Allan, it only works if you cannot tuck your chin into your chest. Any padding that does that will most likely work, but I have seen mixed results with ergonomic pillows as people tend to move as they sleep. The soft collars also come up under the jaw and help with mask leaks and actually may help keep the jaw forward which will help with obstruction. I know many members have used a collar successfully, and I have heard of a few using a neck roll. YMMV. If it was me, I would find a comfortable fitting collar. One brand I have heard mentioned more than once is the Caldera Releaf Neck Rest. Nine Max has a shorter profile and longer length for larger necks like mine.

[allanri]

Thanks!  I’m already seeing how helpful it will be!