[Diagnosis] High AHI (16) and wake several times

[Linnea]

After CPAP for 16 days, I feel so much better than before. The problems: AHI is 16 (was 45 in home sleep study) and I wake multiple times a night. I don't feel as good as I did the first night when AHI was 8. Part of the graph is me lying awake and breathing normally after waking up several times - I didn’t stop the CPAP most of the time.

 
In this first month trial, should the DME make any changes? Should I wait 30 days? I don’t have a sleep doctor.
I am posting the overview, statistics, and first and latest daily (closeup of latest daily)






First night


Last night

[Sleeprider]

Your events are primarily obstructive and the Philips Dreamstation is very slow to respond to obstruction when the minimum pressure is too low. In your case our correct minimum pressure is about 9.0 cm, so your machine is taking a long time to get where it needs to be while you suffer obstructive apnea, then drops pressure below your therapeutic need and you have hypopnea.

In addition to pressure, your obstructive events seem to occur in strong clusters which suggest a positional component. May forum users have resolved this problem and ended up with lower pressures by using a soft cervical collar. The collar is fitted to be comfortable, while it provides support to keep the neck and head aligned preventing obstruction of the airway. If you sit in a chair and let your chin droop towards your chest, you may feel your airway become increasingly restricted as your chin drops. The same thing can happen at night when your head is propped on a pillow or you just turn in a way that your airway is occluded. Most people find the soft cervical collar comfortable and very effective, and I think you probably need to give it a try.

Between an increase in your minimum pressure to 9.0 and the use of positional therapy, I think you will see a dramatic reduction in AHI and get more comfortable restorative sleep.

[Linnea]

Thank you so much. I'll get that cervical collar ASAP and change the pressure.

[Ron AKA]

That last zoomed in chart is interesting. You can see the machine responding to the obstructive events and increasing pressure up to about 11 cm. Then for reasons I don't understand the machine reduces pressure to 9 cm but the obstructive events keep coming. By my count about 17 more events and no response from the machine. Strange!

Increasing the minimum pressure to 9 cm is a good start. But based on that chart it probably will have to go higher still. See what you get with 9 cm and post again.

Edit:
I noticed that you said you were in a 1 month trial at the DME. Does that mean you may have the opportunity to change machines? If so you should ask to try a ResMed AirSense 10 AutoSet For Her. I think it could respond better to your apnea events than the Dreamstation is.

[Linnea]

Thank you. I will ask about that Monday. I'll be posting tomorrow on the first night of min 9 pressure. Cervical color on the way.

[Walla Walla]

When the machine sees CA events it backs off the pressure. I also agree with sleeprider about the collar. Your pressure at 9cm should be more than enough after you start using the collar.

[Ron AKA]

When the machine sees CA events it backs off the pressure. I also agree with sleeprider about the collar. Your pressure at 9cm should be more than enough after you start using the collar.

The last CA event I can see in that string was when the pressure was still ramping up. Once it got to 11 cm and while it sat there a bit, there were no more CA events, only OA, and then it decides to ramp back down to 9 cm?? I would not be happy with a machine that acts like that.

[Linnea]

I’m going to see if I can get a ResMed as suggested.

[Sleeprider]

Since this is a trial, it's fortunate if you can change. The Resmed is much more responsive to these events, even when not fully optimized. It also can achieve control of hypopnea at lower pressures due to the way exhale pressure relief is implemented. By all means if you can get a Resmed Airsense 10 Autoset machine, that is your better option. Avoid a fixed pressure CPAP machine and get the Auto.

[Linnea]

Here is the first night with 9 minimum pressure. It took a long time to get to sleep. I woke up a couple times. Is this something the ResMed CPAP would help?