TWEAK OR NOT TO TWEAK

[codger]

I have suffered from Sleep Apnea for 30 years and have undergone CPAP therapy for 12 years. Recently I switched to APAP and I now have access to nightly sleep reports via Sleepy Head software.

My latest sleep study (four years ago) resulted in a CPAP setting of 14. That setting was too high and produced too many mask leaks. I soon learned how to reset the pressure myself, and I reset the pressure to 12, which was more comfortable. The new APAP has its pressure set at 8>12 with a ramp up from 6. Mask leak problems have diminished with the lower pressures delivered with the APAP.

Sleepy Head reports an AHI reading of 6.60 for the last 30 days. The daily reading has varied from 2.85 to 12.83. The readings tend to run in cycles with lower readings for a few days followed by higher readings. 29 out of 39 days have AHI readings >5.

The average pressure over the last month has been 8.44 with a 95% reading of 11.00. The reports show a dramatic AHI increase around 5:00 to 6:00 A:M, the time I wake up and call it a night.

My machine has exhale flex ability which is turned off. I can adapt to a continuos tube airflow noise, but the variable noise of the exhale flex bothers me.

I suppose that I have a moderate sleep apnea currently being treated with APAP therapy that is reasonably successful, but is not quite effective in reducing AHI to less than 5 (now 6.60). I read about many posters reducing AHI to 2 or less. Is there a way to similarly reduce my own AHI ?

Some possibilities are to change APAP pressure settings or go to CPAP since the average pressure and 95% readings are close (8.44 avg vs. 11.00). I could also tweak around with the flex features on my machine.
Or, since I am a long term sleep apnea sufferer, maybe my sleep habits are so ingrained that change is not possible. Maybe feeling a little tired is normal for me. After all, I am 71 years old.

Does anyone see anything in my litany of woes that stands out as a probable way to lower my 6.60 AHI reading, or should I just suck it up and be thankful that my apnea is not worse?

Codger

[jfmusil]

When you checnge things you have to give it a few weeks to see if the change does anything. I would leave the pressure where it is and turn the c flex on.

[PaulaO2]

What are you leak rates? High leak rates can skew the AHI data.

According to the numbers, you are not going over the 12 but still having events. You could try going to straight CPAP of 12 for a week or so and see how the data does. The AHI might settle down.

Interesting that you have so many events the last hour of sleep. Is anything else going on at the time? Like someone else is getting up and making noise? If your sleep is shallower or broken up, that would also result in wonky data.

The inhale/exhale relief pressure is a comfort feature. Some people report lower AHI with it off, others are the opposite.

So you have a few choices. It's good you have 30 days of data to go by.

1 set it to straight CPAP at 11 or 12
2 leave the pressure where it is and turn on the flex
3 ....I had a third but forgot it. Dang.

Whatever you do, set it and leave it for at least two weeks. No need for another 30 days unless the change is so good.

Consider keeping a sleep diary. Note the change you make, how you felt when you went to sleep (kind of day, caffeine difference, etc), how you felt when you woke up, and how you were during the day.

[JudgeMental]

Things to ponder: The pressure setting of 14, that was recommended by the sleep study, was obtained by the> "lowest pressure that eliminated all or nearly all apnea events". <

Perhaps a change in a mask would allow you to use a higher pressure more nearly aligned with the pressure of 14 as established by the study. That might help reduce your AHI. If your 95% is @ 12 then you don;t know where the remaining 5% is. Could be up around 14, plus your low ramp of 6 is allowing perhaps a number of Aeneas to occur before you reach a pressure of 12, therefore the higher AHI figures.

I am older then your 71 and don;t consider tiredness to be an "acceptable" senior malady. Though, we are all built different.

I, also, get most of my disturbances (periodic breathing and rema's) in the early hours (6-8am).

With your automatic XPAP, a bit higher pressure, eliminating the ramp pressure and make some adjustments to the mask situation, I think you could get your AHI down to a more reasonable number that will give you better therapeutic XPAP treatment.

[Dawei]

codger--Two ways to look at the pressure question. One is as you stated that you found that at 14cm you had too many leaks. So, you reduced the pressure. The other view is that at 14 you were having mask leaks. So, that means you need to fix those leaks but not touch the pressure setting. I've found that reducing leaks has really helped me get the AHI below 5, since excessive leaking makes for inaccurate data from the machine. Paula's question about your leak rates is therefore important. As judgemental mentioned, a change in masks might help the leaking problem, or the solution I got from another board member of using silicone on the leak areas of the mask seal works great for me.
I believe judgemental's question about your 95 percentile leak being 11cm, but where is that remaining 5% pressure is a good one. One possibility is that on the remaining 5 percentile, your machine's pressure is smack against the ceiling of 12cm, not being able to go higher. Personally, I don't consider pressures of 8.4 and 11 really close when it comes to xPAP. When docs make a change in a pt. pressure, they often make it in steps no greater than 1cm at one time.
Finally, like judgemental, I too often see higher or highest AHI events about an hour or so before waking in the morning. So, that may not be a special issue.

[zonk]

The reports show a dramatic AHI increase around 5:00 to 6:00 A:M, the time I wake up and call it a night.

maybe aliens .... rem sleep .... sleeping on your back .... high leak ... stuffy nose .... or something else

[archangle]

As long as you're looking at your results, tinker slowly and see what happens.

[codger]

I appreciate the informative postings in response to my inquiry.

So a rise in AHI activity near wake up time is not uncommon. And a temporary increase in the max APAP pressure may reveal whether or not I am having events not being controlled within the 95%
max pressure limit of 12, i.e., possibly a change in the max pressure will catch some more events and thereby lower average AHI. And maybe I should experiment with the flex option (the machine has 3 flex stages).

Maybe a straight CPAP setting will help. A ramp up starting at 6 (or as high as I can be comfortable with) going up to 12 (or higher) might prove beneficial.

Mask Leak Issues: My average leak rate is 48, 95% leak rate is 71 according to Sleepy Head. I found a posting on this site showing than the manufacturer's expected leak rate for the Resp Quattro Full face mask at a CPAP setting of 12 is 41. So the average leak rate of 48 is above manufacturer's specifications. I am not surprised by this because I flip from side to side during the night and the full face mask is subjected to various torquing pressures.

Maybe a different mask? I have always been a mouth breather due to nasal constrictions, so I need a full face mask. I have been using the Quattro FF for 4 years. I hesitate to commence the blind purchase of other FF masks......I wonder what other FF masks are to be recommended and whether masks can be rented for a tryout period?

Paula's idea about keeping a journal makes sense. I already spend a little time each day in reviewing the Sleepy Head data, so a minute or so with a journal takes little effort.

It will be interesting to see how my apnea responds to tweaks in the APAP settings and to various masks that I try.

[PaulaO2]

Have you tried a chin strap?

Leaks and full face masks are close friends and insist on partying together.

[codger]

Paula,

A chin strap is an interesting idea. I am a mouth breather because one side of my nose is constricted, but I can breathe through my nose when I want to and it seems like it would be easier still under CPAP/APAP pressure. I have an Rx for flucticasone (Flonaise) which keeps my nasal passages clear at night.

My first use of CPAP was before FF masks were common. At that time I had the usual mask, and as a general rule it worked for hours at a time (until I opened my mouth and lost CPAP pressure). I also complained of dry nasal passages, hence the flonaise Rx.

I wish that I had my old mask to try. Maybe it is worth it to buy another mask and chin strap.

Thanks for the suggestion.