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I've been on CPAP for over 7 years. My AHI average over the last year was 3.81, but over the last few months it seems to be creeping up and my monthly average is 6.03. I thought an AHI of 3.81 was ok since it was under 5, but I am still tired all the time (but much better than before CPAP). Throughout this process I've never had a doctor or anyone to help me manage it, they just give me a CPAP and send me on my way. I'm so jealous of all of you posting charts with AHI < 1.
I've had many sleep studies over the years showing AHIs of 9.8, 35.8, 21.7, 22.5 and 5.3. Every test shows they are much worse in the supine position. I am a side sleeper but every test had shown I'm in the supine position for a while even though I didn't know I was.
I'm 56M, 6'0" 180lbs. I have asthma, anxiety and my nose is frequently clogged so I'm forced to use a full face mask and mouth breath. I sleep on an adjustable bed with my head slightly raised. I have not gained weight lately.
I used a Resmed Airsense 10 Autoset for 7 years and got an Airsense 11 about a month ago. On the 10, I used an F10 mask and now on the 11 I'm trying a F31i, both full face.
I've asked everyone through the process of getting my new CPAP who can review my SD card data and help me improve my therapy but no one seems to be able to help, so I'm turning to the experts here.
The 3 screen shots are from last night, first the full night, then zoomed in on the first cluster of events and then zoomed in to around 3 minutes of that cluster.
10-07-2023, 11:53 AM (This post was last modified: 10-07-2023, 11:58 AM by staceyburke.)
RE: Need help lowering my AHI
You are having some of positional apnea. You can see positional apnea where either H or Oa events are clustered together. 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 (you already said that sleeping on your back gives you higher AHI). Have you changed your sleep position? Sleeping on your back (yes)? 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…
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.
Although the Positional Apnea is the most important there is another thing you can do to improve your therapy. Now you have EPR set to 3 and your min is at 5. So it is really only doing a EPR of 1. Let me quickly explain, the absolute lowest any cpap machine can go is 4. EPR is exhale pressure relief and it subtracts the EPR from the min to give you a lower exhale pressure (hence the name Exhale Pressure Relief). But if you are at a min of 5 and you try to subtract EPR of 3 is should be exhale of 2 BUT it can't go that low - it can only go to 4 the absolute lowest the cpap can go.
So I would raise the min to 7 minus the EPR 3 would give you the same min exhale of 4.
Thanks for your help. I first tried raising my minimum pressure from 5 to 7. I've been using it that way for about a week and my average AHI does seem to be a little lower, from an average around 6 to 4. I do sleep on a fairly flat pillow and I am a side sleeper, though my sleep tests indicate I am on my back some which is weird because I never remember being on my back. Anytime I wake up I'm still on my side. For reference I attached some screenshots from this week. I picked a very low AHI night for me, a high one and a medium one so you can see the results of just changing the pressure.
I also picked up a cervical collar. I just grabbed the only one they had at a local Walgreens. It's not very comfortable, but I'm hoping it will be good enough to try it out. I may need to do the measurements and try to find something else elsewhere. I'll report back after I've tried it for a while.
I picked up a few cervical collars to try to help the positional OAs. It took me a long time before I could sleep with one on, but I finally have been able to sleep with it on for 2 weeks. Based on my Oscar charts, it does seem like the collar has helped reduce the OAs significantly. However, my AHI is still high. I've looked over my Oscar data and it seems that I have always been having a pretty high number of CAs most nights. Now that the OAs are under control, the CAs seem to be the main problem. So I need help figuring out if there is something I can do with my CPAP to reduce these, or if I need to move to an ASV or something. I hope not, as I just got a new CPAP.
The first chart has almost no OAs, but lots of CA. This is the biggest CA vs. OA day I've had.
The second screenshot is a zoom in on some of the CAs.
The third attachment is the Overview from all the data on my SD cards. The bottom purple portion of the lines is the CAs in the top row.
I'm glade you have the Oa under better control. The Centals are a different problem. They can be what we call treatment emergent. Meaning that once you get use to the therapy they will lessen. Most of the time if you turn the EPR down to 1 or even off, it cuts the central apnea. But the problem with that is that if you don't have EPR your flow limits will probably go up. To see if it helps your centrals try EPR 1 and see how that does and post again tomorrow
OK, I changed my ERP from 3 to 1 last night. My CAs were lower so hopefully that will continue. I did get to sleep fine but when I woke up I wasn't able to get back to sleep but it looks like that was at 6:30 in the graph so that's not too bad a night. I do see that I started having leaks last night. I have had to keep my mask super tight to eliminate the leaks and tried loosening it just a hair last night but it looks like I need to tighten it back up again.
Last night's data attached, let me know what you think.
Like I said EPR does cause centrals while you get use to the therapy but turning down EPR gives more flow limits. The Resmed increases higher pressure when it has to.
I would try lowering the max pressure from 15 to 10. That should help your mask leaks. Give it a try and post tomorrow or give it 2 days to see how that helps or not.
On mask tightening- over tightening is just as bad for leaks as is to loose. With the lower max pressure try a little looser.
Before considering changing the pressure, I decided to tighten the mask back up the way it used to be when it wasn't leaking. I have also noticed in my Oscar charts that the pressure would often be up in the 11-15 range so I suspect I need that pressure to resolve the OAs. On my old CPAP when I found out about Oscar I looked at my charts and they had set my max pressure at 10 and it would often be pegged at 10, so it wanted to go higher but couldn't.
Anyway, here are a few of my best days this week where there were no leaks. I don't know how to read the flow limits yet, so want advice on if those are OK or if I should consider further adjustment. One way or another, lowering EPR has given me my best numbers in a long time, probably ever.
Take a look at your Flow Limits and compare them with your pressure graph. Notice whenever your FL go up your pressure goes up. That is how Resmed is programed to stop the FL from becoming larger Apneas. With the added pressure you have more leaks and more chance of waking up. EPR helps with the FL and pressures will not rise as they are now. You tried 3 and it did not work well and you went down to 1. I would try a night or 2 with EPR at 2 and see how that does for you.
Remember that the CA will go down as you get use to therapy. Going to 2 for a few weeks and getting use to it then go to 3. You need EPR at 3 but probably need to move up slowly...
Also, I wanted to make sure it's clear that I've been on CPAP for over 7 years. EPR was set to 3 on both my previous Resmed 10 and my new Resmed 11 I got in September initially. It wasn't until last year when I discovered Oscar that I learned my treatment wasn't as good as it could be, so I started an effort to optimize it. So the CAs are not something that just started. I don't have Oscar data back beyond April of 2022, but I suspect I've always been having some level of CAs.
