[Diagnosis] AHI going up throughout the months

[Sleeprider]

Nothing in the graphs or summary above suggests CA is a problem for the O.P. Thibaultib. Arc0509, I think you should start a new thread where we can discuss your apnea or charts. It will get very confusing if you start a discussion not related to the original poster, and is sounds to me like you could use some help.

[arc0509]

Actually i was answering one of his question about the effect of increasing minimum pressure he asked in a previous post on this thread.. Couldn't quote it properly though. feel free to delete that post. Rest of my experience is relevant for him cause our physiology and family history seems similar. Hoping to see what comes out of it for him. It may end up helping me too.

[thibaulthib]

Hi all,

Bad news this morning, my AHI really increased even more, now 6.11. 

My new settings are:
- min pressure: 7.0
- max pressure: 11.0
- CFlex: On

Here is the screenshot.

I have also attached a screenshot from june, just to compare the AHI with my last night.

I can see that I am doing much more Central Apneas since I increased the pressure.

I am a bit confused now... Any ideas?

[Walla Walla]

Wait a couple of days. One night could just be a bad night. Wait a few days and see what the trend is.

[thibaulthib]

Wait a couple of days. One night could just be a bad night. Wait a few days and see what the trend is.

I hope so... 

Rather than the Aflex being supposedly more pleasurable than the CFlex, can the AFlex have a positive impact in lowering the AHI, even though it also plays some "tricks" on the inspiratory side as well ?

(I suspect CFlex should be more relevant than AFlex since it only plays a role on the expiratory, but...)

[Walla Walla]

The advice was good about about CFlex. The problem is Dreamstation's use flex instead of EPR. EPR acts like a mini bilevel and is usually very helpful with hypopnea's.
Flex doesn't work the same way. It can help a little but not always. I'd give it another night and if it's not helping than shut the flex off and just go with the pressures you have set.

[thibaulthib]

I can see my 90% pressure is now 9, Shall I increase the minimum to 8 and keep Cflex 1 ?

Also I forgot to mention: I only sleep on my tummy (never on supine nor on the side).

[Walla Walla]

Really it's up to you. I'd probably try do that though and if that didn't help I'd shut off the flex and see if that helped. The main thing is not to change more than one thing at a time so you can figure out what works and what doesn't.

[thibaulthib]

Really it's up to you. I'd probably try do that though and if that didn't help I'd shut off the flex and see if that helped. The main thing is not to change more than one thing at a time so you can figure out what works and what doesn't.

Thanks Walla Walla!

What I noticed is the following:
- My AHI was 1.5 - 2.0 when my min pressure = 5.0, 5.5, 6.0 and AFlex 1 ON
- My AHI jumped to 3.0 - 5.0 since my min pressure = 6.0 and AFlex/CFlex OFF
- My AHI was 6.0 last night with min pressure = 7.0 and CFlex 1 ON

I also noticed thanks to the charts that at the exhalation, AFlex 1 EPAP << CFlex 1 EPAP.

I guess tonight, I will try min pressure = 7.0 and AFlex 1 back ON.

Some more questions, sorry guys but I am really interested since it directly affects me:
1) Do you know if pressure relief (EPAP) wise, AFlex 1 = CFlex 2 ?
2) Does the body get used to a certain pressure if too much time is spent at that given pressure?
For instance, let's say with a Resmed, I would need 4-10, and Resmed will react very quickly to OA or hypopnea. So I would not spend to much time at a high pressure, but only when it is really needed.
Since PR is slow to respond, and the pressure settings need to be 7-10, by sleeping all my nights with a minimum pressure of 7, does it "effect" the airway somehow, because the body get used to it, and that could be the reason why the minimum pressure required keep increasing?
Sorry if the question is really stupid, but I can't find the answer on the web... lol

Thibault

[Sleeprider]

Pressure is relative, and individual.  My pressure begins at 13/9 IPAP/EPAP.  Many forum members experience starting pressures above 15 or 16 and hit 20 routinely.  Others may find full treatment at 4-6 cm.  There is no rule except for what your particular needs are, and the pressure you need has no relationship to the results of your diagnostic test.  One thing to keep in mind is that as you adapt to CPAP pressure, your needs and results often change.  This is why I think most titration tests are basically flawed in the assumption that they find your optimum pressure.  What they do is find the best pressure at that time and situation.  Everyone should have auto CPAP and become educated in making effective changes.

To make good decisions, you need to understand your data and work within the limits of the equipment you have.  For CPAP, the titration protocol is more limited than BiPAP because you only have one pressure to work with.  Your Dreamstation is a CPAP, even with Flex.  The Resmed Airsense 10 is a bilevel limited to 3-cm, and that is why we work with EPR in a therapy context.  Putting that aside, this is your decision matrix: