Struggling to Lower AHI Below 5

[terumi]

Hi everyone,

I’ve been having some challenges keeping my AHI below 5, and I’m looking for advice. My doctor recently adjusted my pressure remotely, increasing it from 4-14 cmH2O to 4-17 cmH2O. Despite the change, my AHI hasn’t improved much, and it remains stubbornly high.

Based on my OSCAR data, I’ve noticed that my pressure frequently sits at 17 cmH2O for extended periods, even though I’m not having apneas during that time. My apneas are mostly positional, occurring when I’m on my back. However, due to my ankylosing spondylitis, I can’t really do positional therapy, which complicates things.

I use an F20 mask, and although it’s generally fine, I’m having to press it tightly to avoid leaks, especially at the higher pressures.
I’ve activated the mask-fit function on my AirSense 10, and it only shows no leaks when I press the mask hard, which causes some red marks and discomfort.

I’m curious if others have had similar experiences where high pressure didn’t seem to fully address their AHI or if there’s another approach I should consider.
Since positional therapy is not an option for me, should I explore other settings or alternatives?

Thanks in advance for any help!


   
   
   

[G. Szabo]

To address your issues, we would like to see your full chart organized according to Wikipedia. Most importantly, the "Details" area, which includes your AHI and the instrument settings, is missing, among other things. You can turn the "Daily Sidebar" on in the "Wiew" menu. Also, turn the calendar off. Ensure that you post all the details below up to the bottom part.

[terumi]

Sorry about that...


   

[G. Szabo]

Your flow limit is high, and your minimum pressure setting is for kids.
I suggest setting EPR=3 to reduce flow limits and increasing the minimum pressure to 10 as a first step. A further increase is probably advisable.
Increase your maximum pressure to 18 because you are hitting the pressure ceiling.
Turn the ramp off because you have no treatment during the ramp period.

I agree that increasing pressure cannot resolve your position apnea issue. However, the above alterations can improve your treatment efficiency.

[Deborah K.]

Your pressure settings are way off.  Your median pressure is 12.44 and you are bumping far too often against your upper limit.  I suggest you set your pressure range at 12 to 20.

You have very high flow limits.  Raise your EPR to 3.  Even that may not be enough, but try that for now.

I think you are truly air-starved while using ramp.  You get no therapy during ramp, and if you get out of bed for any reason, when you return ramp starts again, robbing you of therapy.

Try these changes, and let us know how you feel.

Best of luck with your new therapy!  

[terumi]

I will try it but right now, even with erp set on 3 , the pressure of 17 is giving me hard time to exhale (I can, but I have to push hard).
Do you think it would be ok?

Should I disable the ramp on my device?

[Deborah K.]

If you are unable to wear a soft cervical collar, there is another solution.  I'm a back sleeper because of back pain.  I used collars for a while but decided to try something else.  I bought a child-size pillow, as they are smaller and flatter than regular pillows.  Mine has a raised front and back, and I sleep with the higher part at my neck.  This tips my head back just a little and solves the positional apnea completely. My pillow is no longer made, but I've seen some on Amazon that look like they might work.  In case you are interested, here's a link:

https://www.amazon.com/MLILY-Adjustable-...r=8-5&th=1

[terumi]

I will try and report back!
Thank you!

[Deborah K.]

Your EPR setting is 2 right now.  Raising it to 3 should make exhaling a little easier.  See how that goes tonight, and let us know if exhaling is good or still difficult.  If it's still difficult, you may need a different machine.

Yes, go ahead and turn ramp off.

[Dodies]

Are you a mouth or nose breather (or both?)

I was using the F20 face mask and my pressure was going up to 20 every night, the mask was somehow making it difficult to nose breathe, so i bought a nose pillow and now my pressure is between 10-12 through the night. It made a huge difference for me.

I also now sleep on my back using a travel pillow, which I turn 90 degrees, so that it tilts my head back and keeps my chin from tucking. My AHI is always way under 5 now.

But I do seem to still wake up in the night - usually once, sometimes I get back to sleep, sometimes not, but I never feel sleepy in the day now, even if I have had only 5 hours sleep.

So generally a load better since getting rid of the facemask.