How low can I go? AHI-Questions

[Salubrino]

Hello everyone!

New to the forum - my debut post!

I was diagnosed a month ago and got my machine and humidifier. No choice here in Sweden but it seems I got a good one - Resmed S9 VPAP + h5i with a Mirage Quattro FFM. Well I guess you can live with the lack of choice considering the total charge for me (including the doctors appointment was 25 USD).... Well the rest is on the taxes..... and they are high as you all know...


Anyway - I have some thoughts on what my goal AHI should be and what to expect. I read posts from people that are down to below 1...

My mean rate after a month (according to sleepyhead) is 5.89 with an intervall between 0,88 to 9,27... Is this OK? Can I expect it to lower further by just continuing to using it or should I take some further measures. I do feel a lot better but still tired some evenings.

OH - my sleep study results where AHI 46,4....so It´s a massive improvement compared to that. Any thoughts?

[trish6hundred]

Hi Salubrino,
WELCOME! to the forum.!
You got a good machine.
The further below 5 you can get, the better.
Hang in there for more suggestions and best of luck to you with your CPAP therapy.

[APAAW]

You've got a fine VPAP, and a good (my personal favorite) mask. No worries there.

I'd say your present main concern should be making sure leaks are under (or get under) control. Your AHI isn't optimum yet - but your average AHI is now very reasonable compared with your sleep study.

FWIW, my AHI with CPAP and BiPAP was averaging around 7 in 2013, was averaging 3 overall in 2014, and has been 2,4 in the past 3 months. My sleep physician would again remind me here of the limits of any machine's accuracy in scoring events, and the larger importance of enough sleep time, and so I will pass that valuable perspective along as well.

Severity and duration of apneas and hypopneas matter more as your AHI gets down to a lower range. I don't know where the "clinically significant" line happens to be drawn in Sweden. Certainly one individual might have an AHI of "only" 4 which represents serious apneas, yet another individual might have an AHI of 8 but suffer less from shorter events with more hypopneas and fewer apneas. In my view, there's nothing magic about an "single-number" AHI.

I wouldn't lose any sleep over your current AHI. It's the long-term trend that matters, along with how you are doing and feeling, and that merely takes time and patience. The folks on this board will be supportive of both for you.

[readyforsleep]

Welcome to the forum! What AAPAW said with an emphasis on patience. I also
read the posts (I am amazed at the experience and wealth of knowledge here)
You are off to a good start!

[Sleepster]

Hello everyone!

New to the forum - my debut post!

Hello and welcome!

I was diagnosed a month ago and got my machine and humidifier. No choice here in Sweden but it seems I got a good one - Resmed S9 VPAP + h5i with a Mirage Quattro FFM.

Your profile indicates you have a ResMed S9 Autoset, but you say you have the VPAP. Both of those are fine machines, but they have significant differences. There is also a VPAP Auto.

Anyway - I have some thoughts on what my goal AHI should be and what to expect. I read posts from people that are down to below 1...

There's really no consensus on that for a few reasons. First of all, you had an untreated AHI of 46.4, which translates to a diagnosis of severe sleep apnea. 15-30 is moderate, and 5-15 is mild. So below 5 is considered "normal" and accordingly that's the target we shoot for.

It's not some gold standard that you need to achieve. There are two hurdles to clear first.

1. Compliance. Are you using the machine every time you sleep, all the time you're sleeping. That's of primary importance and if you're doing that you should celebrate and consider yourself fortunate. Many people have a hard time clearing this hurdle.

2. Leaks. You need to check your leak rate and make sure it's acceptable. Getting the smiley face in the morning is the first step, but checking the leak rate with software is important, too.

3. AHI. Getting your AHI under 5 is the goal, but the AHI is the sum of three numbers and it's important to look at those three numbers and see how they're changing.

After that there are other things to be looked at such as flow limitation and snore, but that's nothing to worry about now.

Can I expect it to lower further by just continuing to using it or should I take some further measures. I do feel a lot better but still tired some evenings.

Both! I would not make any adjustments to the pressure settings until after you visit the doctor and have your results evaluated. When do you expect that to happen?

The fact that you're feeling better is the most important thing of all, and should be celebrated. You will have good days and bad. Your body has to adjust to being able to breathe and sleep at the same time, which is something it hasn't been able to do in the past, likely for a very long time. As you adjust your AHI will drop and the way you feel will continue to improve. Another thing you'll notice is improved cognition.

[zonk]

AHI 5 or whereabouts considered the therapy is working, lower is better but the goal is good night sleep and feeling better

Your user profile point to 'Machine: Resmed S9 Autoset - CPAP Pressure: Auto-CPAP", which machine are you using, the AutoSet or VPAP?

As for Swedish health system vs US health system, I choose the Swedish system over the US system any day. According to Bloomberg report http://www.bloomberg.com/visual-data/bes...-countries , US ranked 46th in a list of 48 countries (behind Turkey and Iran) Australia 7th place, Sweden 10th place. Now the Australian government want us to follow the US model ... race to the bottom

[Salubrino]

Hi everyone!

Thanks for the warm welcome and the encouraging words.

I will try and not focus to much on the number issue and go for compliance instead. I am a competetive person in that sense and always wants to be the "best" - i.e. reaching a good number. But you are right that it´s better to focus on the overall picture - how I actually feel.

The limit for getting treatment at all here is an AHI of 10 as I understood it from the doc. So I´m well below that which is good. My next follow up will be in a year if I don´t experience problems. I have had one after two weeks where I changed the mask. They read the card but seemd to focus the most ojn the obstructive apnea part of the index and not the whole thing - and seemed content with the results.

When it comes to compliance I already think I´ve come a long way. ´ve only taken off the mask in my sleep 3 times or so over the month - usually around 4-5 hours in to the night taking it off because of itching and then falling a lseep again before putting back on. I had som issues with sores on my nose and dry skin the first ten days but changed my mask to the bigger Mirage Quattro (from Quattro Air) and that solved that issue. Felt like downgrade at first to get the older model but it works better for me...

And for the machine - I got the autoset. I think it´s just set on auto or did the clinic program a range you think? I cant access the settings menu (the clinic looked it) but I can read the card with sleepyhead. Didn´t realize that there was one that was named VPAP too - thought VPAP was the description for an autoset machine....sorry for the confusion.

I do think that the leak rate is ok but will look into that aspect a bit more (haven´t really looked on that part of the sleepyhead graphs yet) - thanks for the tip!

Oh btw - does anyone know if the sizing of the Quattro fx is similiar to that of the Mirage Quattro? It would be nize to get rid of the forehead support thing if possible...

[archangle]

Welcome aboard, salubrino.

What does it say next to the power button on your S9 unit? This will tell us what model you have.

Look at your events (apneas, hypopneas, etc.) in SleepyHead and see how long and severe they are. While AHI is useful, it's also good to get an idea of how long the apneas last, and how complete they are. You can also figure out things like if you have a long cluster of apneas close to each other.

You can figure out how to change your own settings if you need to by looking at the "Setup Manuals" link at the top of most pages on this board.

[zonk]

I do think that the leak rate is ok but will look into that aspect a bit more (haven´t really looked on that part of the sleepyhead graphs yet) - thanks for the tip!

Oh btw - does anyone know if the sizing of the Quattro fx is similiar to that of the Mirage Quattro? It would be nize to get rid of the forehead support thing if possible...

The number from screen sleep report is 95th percentile number means leak was at or below this number for 95% of the night. The leak graph in ResScan or SleepyHead shows stuff in details, 95th can on the high side but that does not mean leaks was that high all night

Mirage Quattro and Quattro FX sizes do not match, Quattro FX sizes slightly smaller and sit on the nose lower than Mirage Quattro

Check them out:
Mirage Quattro http://www.resmed.com/us/en/healthcare-p...attro.html
Quattro FX http://www.resmed.com/us/en/healthcare-p...ro-fx.html

[Salubrino]

Hi again!

My machine is the Autoset.... If I hade read next to the power button from the start that wouldn´t had been an issue...


Checked the leaks now in sleepyhead - the leak rate 95% is 4.53 over the last two weeks. This is good, right? It´s a lot better since i switched masks...

My med pressure is quite high - 12.6 and the 95% pressure is 16.80... would i benefit from tighteneing the auto cpap range that is nowfrom 4-20 to something tighter?