Need Help to Lower AHI

[ftrgreen]

I recently has a home sleep study ans was diagnosed with severe sleep apnea with 46.4 events per hour. I attempted to attach my sleep study but the PDF file is too large (1.54MB).  My lowest SpO2 was 71% and the average was 89%.  I purchased a Resmed Airsense10 autoset and set it a a range of 6-20 and EPR 2. My AHI the first night was 8.62. Because of the clustering of QAs I purchased a soft cervical collar. I also increased the min pressure to 8. In the subsequent 5 nights my AHI readings were between 4 and 5.8. In spite of the use of the cervical collar most of my OAs are still clustered. I would like to get my AHI consistently below 5 but am not sure where to go from here. Any help will be appreciated
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[Gideon]

You have up to about 25% Centrals, this means that we want to keep your max pressures down. I'm going to suggest a max of 14 possibly 13 later and see how that affectes them over all. In your case it is about finding a sweet spot that balances between central and obstructive apneas.

[ftrgreen]

Thanks for your response. Does use of EPR cause or prevent centrals? My current EPR setting is 2. Also, my wife says I change positions frequently while sleeping. What influence does that have on events?

[Gideon]

There is no absolute answer but EPR tends to increase Central Apneas.  

With CPAP Centrals tend to increase with higher pressure and higher range of pressure including EPR.  
Also, results frequently are consistently inconsistent meaning AHI tends to be all over the place.  CPAP (APAP) is not intended to treat Central/Complex/Mixed apneas.

Most of your Centrals are occurring near the peaks of pressure so we see how the balance looks after lowering pressure a bit and look for the sweet spot balancing between Obstructive and Central.

[ftrgreen]

I lowered the max pressure to 14 per your recommendation and my AHI increased to 7.2 last night per the readout on the machine. I can't post the graph now.

I have attached my sleep study. Hopefully that will be helpful.


  frank Sleep Srudy.pdf (Size: 299.03 KB / Downloads: 40)

[ftrgreen]

I kept my max presure at 14 and EPR at 2. I seem to be doing better but as you predicted, the results are inconsistent. I'm wondering if this is the best I can do with this machine. Do you have have any further suggestions. Here are some recent graphs. I'm quite comfortable with the pressure and don't think reducing EPR will bother me if that will help. I do feel much better than I did before getting this machine.

[Gideon]

I think you are doing well 3 of the 4 nights with almost no Centrals and 3.4 AHI if you discount the Centrals.
And most importantly you are feeling good.

I would leave the settings alone but if you want to try something increase EPR to 3. If you get multiple days like your 7.42 with plenty of Centrals drop it to 2 which is working well. The increase may increase the Centrals but the other impact is that it could reduce Hypopneas and Flow Limits which would decrease your AHI without the Centrals. Like I said it is about creating a balance.