[Treatment] AHI at 24 while using APAP 8-12mbar

[Exodus]

---

AHI from Clinic: 55
AHI form Clinic while on APAP 8-12mbar: 24

I Cranked the APAP up to 12-18 mbar

I Am 1 Year in and still feel really tired all the time. I Never feel well rested and need 10-14h Sleep a day. Can't work because of that and gained lots of weight.

Have Morbus Scheuermann, Insuline Resistance, Acne Inversa and OSAS

Please help me Guys

[Dormeo]

Welcome! Your AHI is excellent, if this chart is typical. You are having some large leaks, that is, leaks that are large enough potentially to make it impossible for your machine to compensate. Do you think the leaks are coming from your mouth? Or are they coming from your mask? Or maybe some of each?

What is striking in your chart is the flow limitations. Could you zoom in on about 1.5 minutes where we're seeing a lot of those FL markers? I'd like to see what your flow rate looks like. No need to provide all three charts -- just the left-most one (labeled 3.png).

I also wonder whether your doctor has evaluated you for other conditions that might be interfering with your ability to feel adequately rested. Possible areas for testing: testosterone, thyroid, vitamin D, B vitamins, autoimmune disease, especially in the connective-tissue-disease family, iron. Any chance you have long covid or Lyme disease?

[staceyburke]

I have not seen flow limits that large... I think you need to rule out positional apnea.  Positional Apnea is when you sleep in a position where you cut off your own airway.  It is also known as chin tucking where your chin is dropping down to your sternum cutting off your own airway.  There is NO adjustments you can make on a pap machine to help this type of apnea.  The only way is not to sleep in that position.  

Sleeping on your back or using to high of pillows can be the cause and just changing that can help control it.  BUT if it does not you will need a collar.  I have a link for collars in my signature (at the bottom of this post).  Please take a look at it.

[Deborah K.]

Yes, your flow limits are extremely high.  Do you have Prisma's version of EPR in use?  If not, set it to its highest setting.  Even then I doubt that yours can be lowered enough to help much.  

You may need to obtain a bilevel machine.  The bilevel most of us think is the best is the ResMed AirCurve 10 Vauto.  Even if your machine is not old, if your doctor (any kind of doctor, even NPs, LPNs, dentists, etc.) prescribes a bilevel, your insurance should still cover it because it is a different type of machine.  If you want the specific machine I mentioned, ask your Dr. to prescribe it by name, with a note that nothing is to be substituted.

[Jay51]

Here are some tips from our Wiki on how to optimize your Lowenstein:    Lowenstein PrismaLine optimization

[Exodus]

Welcome!  Your AHI is excellent, if this chart is typical.  You are having some large leaks, that is, leaks that are large enough potentially to make it impossible for your machine to compensate.  Do you think the leaks are coming from your mouth?  Or are they coming from your mask?  Or maybe some of each?  

What is striking in your chart is the flow limitations.  Could you zoom in on about 1.5 minutes where we're seeing a lot of those FL markers?  I'd like to see what your flow rate looks like.  No need to provide all three charts -- just the left-most one (labeled 3.png).

I also wonder whether your doctor has evaluated you for other conditions that might be interfering with your ability to feel adequately rested.  Possible areas for testing:  testosterone, thyroid, vitamin D, B vitamins, autoimmune disease, especially in the connective-tissue-disease family, iron.  Any chance you have long covid or Lyme disease?

I Think the CPAP machine will NOT state my Hypopnia. i Mostly suffer from Hypopnias. Sometimes i Have a mouth leak, if my Headband doesn't stay where it should, but i wake up pretty fast from it.
I gave 24h Urine to see if i had Morbus Addison or Cushing syndroms, but my Urine was fine.
I was seeing a Neurologist, Endocrinologist, Psychiatrist, Psychotherapist, Main Docs etc. etc. I Even had a gastrocopy and conoloscopy. I had a Ultrasound of the Heart, MRI of lower Back and Head.

I think they would have seen the Lyme disease on the MRI right?

Except the Inuslinresistance nothing was found. I was prescripted Metformin, but had to lay it off after 14 days of diarrhea. in this time my depression came back really hard and i had to cope with anxiety.
i Also suffer from random puking, but some of my docs think it's coming from not beeing able to sleep right, so the sympathicus is always active and its too much for it. Diarrhea is a problem too

I zoomed in on the Flow Rate chart, if i understood what you meant

I have not seen flow limits that large... I think you need to rule out positional apnea.  Positional Apnea is when you sleep in a position where you cut off your own airway.  It is also known as chin tucking where your chin is dropping down to your sternum cutting off your own airway.  There is NO adjustments you can make on a pap machine to help this type of apnea.  The only way is not to sleep in that position.  

Sleeping on your back or using to high of pillows can be the cause and just changing that can help control it.  BUT if it does not you will need a collar.  I have a link for collars in my signature (at the bottom of this post).  Please take a look at it.

As the Report of the Sleep-Lab says, i have Hypopnias on every position.
I was at a Privat clinic where they 3-D scanned my head and they told me when laying down on the back even when i am awake, my airway in the throat is only about 40mm^2 wide when it should be over 150mm^2 (squaremillimeter)

But they also wanted me to pay 40.000€ for a Surgery, where my jaws get cut off from the head, get rotated, made wider and go up front.

These kind of clinics are only "private" so i would have to pay for it myself, as the public insurance companies in Germany won't pay for it. My jaws would be sawn shut for 9 weeks also.

I don't know if the 3-D scan of my head should be noted, as they would like to make some money.

Yes, your flow limits are extremely high.  Do you have Prisma's version of EPR in use?  If not, set it to its highest setting.  Even then I doubt that yours can be lowered enough to help much.  

You may need to obtain a bilevel machine.  The bilevel most of us think is the best is the ResMed AirCurve 10 Vauto.  Even if your machine is not old, if your doctor (any kind of doctor, even NPs, LPNs, dentists, etc.) prescribes a bilevel, your insurance should still cover it because it is a different type of machine.  If you want the specific machine I mentioned, ask your Dr. to prescribe it by name, with a note that nothing is to be substituted.

I have the EPR at the highest level, i feel it to be extremely uncomfortable to exhale without it, i even get the feeling of suffocating while EXHALING when not using it.

My Professor won't describe a BiPap. He send me to a clinic, in which i only got a Appointment in July of 2025 - welcome to the german Public Health insurance Company

Here are some tips from our Wiki on how to optimize your Lowenstein:   

Thanks to Jay, Deborah, Stacey and Dormeo!

I Plan to find a Doc wich will do a Sleep-Endoscopy of my upper Airways. This would be real and True Diagnostics - There you get put to sleep and they go in and look at your Airways to see what the real cause is.

[Dormeo]

Thanks for the zoomed-in view. There's nothing outre there that I could see, like palatal prolapse, but the flattened inhalation traces seem to me to be cousins of hypopneas. (Your machine does report Hs, though no PAP machine can report Hs very accurately, since the definition of "hypopnea" involves drops in O2 and/or arousals detected by EEG.)

I think it'd be wonderful if you could get a sleep endoscopy. If you do, ask ahead of time whether you can or should stop using your CPAP machine ahead of time and also whether you should use a prescription sleep aid the night of the endoscopy.

[Exodus]

Hello Guys,

I've been to another Sleep-Doctor about 50 Miles Away from my Home(Munich). These Doctors are Specifically ONLY Sleep-Researchers. The other Doc who prescribed my CPAP were mostly ENT Phsysicians.

(There is another Doc in my Hometown, a Pulmonologist, which also does sleep research. But they won't take any Patients over 280lb - what a shame!)

The new Doc looked at my Sleep-Studies from the First Sleep-Research and asked if they also measured CO2 in sleep. I Said no, she replied those ENT docs who also do sleep exams mostly do not have that big of a Knowledge about Sleep Exams.

She also looked at the Graphs of my OSCAR data and replied that my AHI is under 1 on these. I told her my CPAP machines aren't really capable to diagnose the Hypopnias which mostly occur for me. I said to her she has to look on the Flow Limit graphs, as she replied she doesn't really know these kinds of Graphs but they do seem off.

Long story short: She wants me to sleep there and to introduce BiPAP. I will sleep there a night in the end of Feburary and will get my BiPap machine afterwards.

I also told her i even tried CPAP with 16 or even 18 cmH20, but she said for CPAP the Max what they do is 14 because it will get too hard to Exhale.

I felt really understood and i greatly look forward to using BiPAP. I know i have to loose a lot of weight, because i cant live like this anymore. But to have more energy troughout the day will help me do that.

I thank you guys for your posts! I greatly appreciate your help!

I will keep you updated.
I wish you great holidays and a good start to the new year!

[Dormeo]

It's such good news to hear that you've seen a doctor you feel you can trust. That really makes a difference, doesn't it! I hope you can get a ResMed Aircurve 10 VAuto machine, as Deborah K mentioned. (I have one, and it's great, plus you'll get excellent data from it for Oscar.)

Please do keep us updated; I hope 2025 will be the year you start sleeping well!