How to attack persistent 3-10AHI?

[spacewrench]

I've been using my Philips Dreamstation for about 9-10 months, and I think I'm mostly through the "help I can't use this" phase.  I had managed to get occasional 1-3AHI days, but interspersed with terrible 10-20AHI days where I'd end up taking off the machine.

I had good luck switching to plain-ol CPAP (Philips' "auto" algorithm would wake me up) and can currently tolerate pressures of 8-9 or so.

At the beginning, I would see spates of events (mostly CA and hypopnea) with long quiet stretches (on a good day).  Now, I see a greater variety of events, more-or-less all night long, with fewer and shorter uninterrupted periods.  And I can't seem to get my AHI lower than about 3 (most days it's in the 5-6 range).

If I feel like I'm sleeping adequately well, should I just not worry about this?  Or is it worth trying to optimize some more?  (I can certainly "solve" the problem by just not downloading data to OSCAR or looking at it -- I'm not in the Sleep Olympics where I need to have sub-1.0 AHI!)  But if I could sleep more effectively, I'd be willing to exert a little effort to accomplish it.

   

   

[Gideon]

To do that you would have to increase the difference between exhale and inhale. Unfortunately, your machine cannot do that.

Switch to the ResMed AirSense 10 AutoSet or the bilevel ResMed AirCurve 19 VAuto. ResMed's EPR feature in the AutoSet or the BiLevel in the VAuto, either should put you on the right road.

Sorry,

[spacewrench]

To do that you would have to increase the difference between exhale and inhale.  Unfortunately, your machine cannot do that.

Philips' "Flex" is not enough, then, I guess.  But better than nothing?  I can turn it up to 3 (not to 11 ;-) ) while I watch Craigslist for a cheap ResMed.

Thanks!

[Gideon]

Flex behaves differently from EPR and is just not nearly as effective.

[spacewrench]

Flex behaves differently from EPR and is just not nearly as effective.

I found an AirSense 10 AutoSet for an affordable price, so I gave it a try.  You're right: the ResMed EPR is quite different from Philips.  At the same pressures, the ResMed feels a lot less like it's inflating my lungs, and the Auto mode looks more intelligent (and it doesn't wake me up).  Last night's traces from ResMed:
   
For comparison, this is from a few months ago when I tried Philips' Auto mode again.  Note the pressure-test "spikes" in the middle of otherwise uneventful breathing -- I think those were waking me up, which caused me to go back to CPAP mode after a day or two.
   
So...although my AHI generally seems somewhat lower on ResMed (after a few days), it's still in the 1-5 range.  What should I try next?

[Gideon]

Based on this chart your numbers are acceptable. How do you feel? what symptoms are you having?
I am guessing that the reason you have variability is because of varying central apnea. You can try reducing. slowly, EPR as this frequently decreases central apnea.

Again don't chase numbers.

[spacewrench]

Again don't chase numbers.

That sounds like the best approach!  I don't have significant sleep-deficit symptoms (as far as I know) so I'll just leave things as-is until I have a better reason to fiddle with it again.

Thanks!