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Looking for help with lowering my AHI
#1
Looking for help with lowering my AHI
Hello,

I have been using a CPAP machine for the past 8 years. Up until yesterday, I've been using an Airsense 10 (just got an Airsense 11).  I've never adjusted any settings so I'm curious if I might benefit from any changes. Most days I feel tired and I haven't experienced any significant improvements with energy levels with my CPAP machine. The biggest benefit I get is the elimination of snoring. I was diagnosed with mild OSAS in 2015.

Attached are some screenshots from OSCAR.

Any help would be greatly appreciated!

-Jack


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#2
RE: Looking for help with lowering my AHI
I raised the min pressure from 4 to 6 (since that seemed like a common suggestion on this board) and my AHI went up to 7.7!

I also lowered my ramp time from 30 to 15 minutes. 

I’m thinking I’ll change everything back to what it was originally unless someone suggests otherwise.
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#3
RE: Looking for help with lowering my AHI
Help? Anyone?
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#4
RE: Looking for help with lowering my AHI
Bumping with some additional screenshots from the past few nights.


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#5
RE: Looking for help with lowering my AHI
Your events are mainly obstructive and your minimum pressure isn't doing you any good at 4 cm. Likewise, the EPR setting of 3 cm does nothing for you since the lowest pressure the machine can provide is 4 cm. 

You might try raising your minimum pressure to at least 8 cm. You can see on your OSCAR statistics that your machine is trying to go much higher to treat your apnea. Your 95% pressure was almost 10 in this screenshot. I would also turn off ramp as at this low pressure, you probably won't miss it. Try an EPR of 2 cm and this may resolve a few of the centrals. 

Give these settings a couple of nights and post back with new charts to let us know if any improvement was seen. 
Hopefully, some of the more experienced experts will chime in if I missed anything.
My get-up-and-go musta got up and went.  Cool

Download OSCAR for your sleep data.  
https://www.sleepfiles.com/OSCAR


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#6
RE: Looking for help with lowering my AHI
Thanks for the response upsman!  A couple of follow-up questions:

1. So the EPR will only be able to go to whatever the minimum pressure is? If that's the case, then won't setting the EPR to 2 and the minimum pressure to 8cm result in the same problem? 

2. If my max is set to 16, why is my machine trying to go higher? Doesn't it have free reign to go as high as 16?
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#7
RE: Looking for help with lowering my AHI
EPR reduces your EPAP or exhale pressure by whatever you set it to...up to 3 cm. So, if your minimum pressure is 4 cm and EPR is 3 cm, there is no room for it to work properly. Minimum pressure of 8 and EPR of 2 results in an exhale pressure of 6 cm.

If your max pressure is 16 cm, the machine will go no higher than that. The chart you posted shows it never went any higher than about 12, so leaving it at 16 is fine. The max pressure setting is more or less just a cap to make sure the machine doesn't run away with pressure. It's available if the machine decides you need it. 

I think you'll find that increasing your minimum pressure will make your therapy much more comfortable and effective.
My get-up-and-go musta got up and went.  Cool

Download OSCAR for your sleep data.  
https://www.sleepfiles.com/OSCAR


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#8
RE: Looking for help with lowering my AHI
I had a few good nights in a row, but then last night the AHI went up a bit. Attaching screenshots below.

Are there any additional changes I should consider?


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#9
RE: Looking for help with lowering my AHI
Update: My AHI has remained high, despite the suggested changes. I will be doing a sleep study tonight in hopes that they are able to determine if any additional changes are needed. 

Attaching the summary section in case anyone has any recommendations.


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#10
RE: Looking for help with lowering my AHI
You are having some of positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  There are not a huge amount but getting rid of as many as you can will lower your AHI.

Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…  I think you can easily control it with paying attention to your sleep position but... 


IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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