Next step(s) after getting AHI <5

[Roy289]

New APAP user (in third week)

History:
PSG gave AHI of 57
started with 7-14

Noticed that many CA'S clustered when transitioning out of and into sleep. My habit was to stay in bed snoozing after waking but now get out of bed when awake. This change alone seems to bring the AHI below 5.

While on APAP only getting up once per night for bathroom which is big improvement as Type II Diabetic and though 2 or 3 times would be my norm.

Last night AHI was 1.99 with 1-OA /3-H/10-CA

Using Autostart and pressure at 5 until asleep. Typically within 5 - 10 min.

A10 ramps quickly (about 5 min) to mid 10 range and then cycles through pressure (up/down) in response to Flow Limitations.

Channel Min Med 95% Max
PressureTherapy Pressure (cmH2O)
W-Avg: 9.60 5.00 10.02 10.72 11.32
EPAPExpiratory Pressure (cmH2O)
W-Avg: 6.86 4.08 7.08 7.72 8.32

Next steps
1. Should the low range be increased to 9 from 7?
2. EPR is set to 3, should this be decreased to 1 or 2?

Still struggling with mask leakage and fitting (sore on bridge of nose) but think this is typical in adjusting to CPAP.

[Sleepster]

Still struggling with mask leakage and fitting (sore on bridge of nose) but think this is typical in adjusting to CPAP.

You'll need to get that under control before worrying about the AHI and the pressure range, although it appears that lowering the EPR or the pressure, or both, might lower the number of central apneas.

A sore on your nose indicates a poor mask fit, as does the leaks. Contact your equipment provider and get a different mask. This is normal. Putting up with a poor-fitting mask is not!

[PoolQ]

You seem to be treated well where you are. Are you having problems sleeping? do you want to feel more rested the next day? From just what you have said I am not sure why you feel the need to change any settings, as far as treatment goes, your setting are fine.

Regardless of what the numbers say, if most of the apneas are happening when entering or exiting sleep, this is known as sleep/wake junk and are not really considered apneas by most.

You change the low range and/or EPR settings if you are having problems, on their own there is nothing wrong with the settings you have.

What is your goal?

[tmoody]

Looks like you've done well. I don't know that you need to tweak the pressure settings anymore, if your AHI stays that low. You might experiment with the EPR. I don't know much about that, but from what I've read here, some people see a change in AHI, for better or worse, when they change the EPR setting. EPR is a "comfort" setting that provides a short "ramp" to full EPAP pressure when you exhale, as I understand it (Expiratory Pressure Relief, no?). At 3, you're at the highest comfort setting. You might see if reducing it does anything to the centrals. And see if there's any noticeable difference in comfort.

[Roy289]

My goal is to feel more rested in the morning and less tired during the day. Since using APAP haven't had urge to nap so that's progress.

Three masks have been tried,
F&P Flexifit 405 (came with A10)
Resmed N10 (not able to lie on my side due to stiff mask frame shifting mask )
Amara View ffm - many issues with leaking and returned after 2 days

went back to the 405 and trying different pillow insert from Med to Large to reduce pressure on nose.

[BadGoodDeb]

Have you tried a nasal PILLOWS mask, at all? It's much smaller than a full face mask or a nasal mask. It just sits under your nose (and blocks some of your mouth). The only pressure points on mine are the nostrils and some days, the top lip (the philtrum, is that?) But you have to be able to keep your mouth closed -- you probably are doing that already, since you say you have a nasal mask. The AirSense P10 nasal pillows (google it for a picture) has soft straps going around your head, but no real frame beyond an inch from the nasal pillows.

[OpalRose]

I wouldn't change actual pressure settings right now, but lowering EPR from 3 to 2 may help with the centrals.

[PaytonA]

If you are struggling with leakage your AHI and pressure settings may not be very relevant. I agree with Sleepster. You need to get the leaks under control first. Depending on the size and type of leaks, the rest of your data *may* be suspect.

Best Regards,

PaytonA

[Roy289]

BadGoodDeb,
Not sure if I would tolerate pillow style of mask like Resmed P10. Certainly will try them if no success reducing leakage.

PaytonA,
Examining the leakage areas there doesn't appear to be apnea events nearby. Perhaps there is an impact on apneas but not sure. My goal is to reduce leakage to a minimum.

OpalRose,
May try reducing EPR to 2 as suggested

Thanks everyone for the comments

[trish6hundred]

Hi Roy289,
Sounds like you are doing well.
Keep up the good work.