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+--- Thread: [CPAP] High AHI but technician says all OK... (/Thread-CPAP-High-AHI-but-technician-says-all-OK)
RE: High AHI but technician says all OK... - Benzi - 05-06-2020
So last night I set EPR to Off. Took me a while to fall asleep, didn't feel comfortable. But my AHI was down to 3.2 ! Thanks!!
On the other hand, I woke up feeling drugged and my chest feels like it was working hard. Seems my body needs to get used to this mode of breathing. May take a while.
Thanks again for your help. Seeing that 3.2 was very encouraging.
RE: High AHI but technician says all OK... - Gideon - 05-06-2020
Did you set your min pressure to 6?. 4 is often too low for an adult.
And with pressures this low you have no need for a ramp.
Have you been using your CPAP consistently for the past 6 months?
how long were you using EPR?
EPR increased your breathing efficiency. This means you had better uptake of oxygen (good) and better clearing of CO2 (bad).
Your blood CO2 levels is the major driver to breath. When levels drop below your apneic threshold you stop breathing (Central apnea) until levels rise above your apneic threshold. Your body usually takes 2 to 3 months to reset this threshold but you stated 6 months thus the above questions.
This form of apnea is frequently called Treatment Emergent Central Apnea.
RE: High AHI but technician says all OK... - Benzi - 05-06-2020
Hi Fred
My previous responder suggested I start by turning EPR off, which I did. Are you saying I should turn it back on?
I have apparently always used a min pressure of 4. I just used what the technician did.
I used CPAP (with EPR) for about 5 months before I started seeing high AHI.
RE: High AHI but technician says all OK... - Gideon - 05-06-2020
No, but let's raise your min pressure to 6 for comfort, with the possibility of further increases. And make it a habit to post your nightly charts. It was mostly the charts that told me what was going on.
RE: High AHI but technician says all OK... - Benzi - 05-06-2020
Won't increasing the pressure be uncomfortable? It took me weeks in the beginning before the pressure stopped bothering me (and it even started feeling comfortable). If I understand correctly, the EPR is supposed to make it more comfortable. Won't turning off EPR + increasing pressure make it very uncomfortable? (I'm trying to avoid waking up feeling drugged again.)
RE: High AHI but technician says all OK... - Gideon - 05-06-2020
(05-06-2020, 12:01 AM)Benzi Wrote: So last night I set EPR to Off. Took me a while to fall asleep, didn't feel comfortable. But my AHI was down to 3.2 ! Thanks!!
On the other hand, I woke up feeling drugged and my chest feels like it was working hard. Seems my body needs to get used to this mode of breathing. May take a while.
Thanks again for your help. Seeing that 3.2 was very encouraging.
That is a very common statement for many, many people. Thus the increase to barely above your median pressure (5.76) to 6 for COMFORT, not therapy. Try it!
Also try an experiment for me,
Get a tall glass of water and a straw.
Put the straw to near the bottom of the glass,
Now make like a kid and blow bubbles!
Any issue/trouble? Didn't think so. That, assuming 8 inches of depth, is the maximium pressure your machine is capable of producing, 20 cmw, your 6 is 2.36. inches of water. We are dealing with very low pressures.
RE: High AHI but technician says all OK... - mesenteria - 05-06-2020
You have been using the device for some time, so you're not likely to suffer unduly by fiddling with some of the parameters. Your setting for minimum pressure, 4, is quite a bit problematic for almost everyone. I don't know why therapists start people off with that silly low pressure because it causes so many problems and anxiety with new patients to PAP therapy. As you have been counselled, you ought to up your minimum, going into your settings, to at least 6, and it may turn out that you end up higher when we've all agreed that you're doing about as well as can be hoped.
EPR is something else. It's the relief from the inspiration high setting. It should result in a 'maintenance' and 'comfort' level that is still above your minimum setting...which we hope you'll agree should be 6 for now. You have turned EPR off entirely and seen an 'apparent' improvement. We advise against taking any one night as proof of concept, in this case turning off your EPR. Usually a run of at least three or four nights will show if the results are just a random thing or if they indicate a real change.
RE: High AHI but technician says all OK... - Benzi - 05-07-2020
Last night was not a tremendous success. Started with EPR off and min pressure of 6 in stead of 4.
After a few hours my wife woke me to say that she couldn't sleep because of the noise. So I changed the min pressure from 6 back to 4 and went back to sleep. She said she heard air blowing and some kind of buzz. AHI 7.
Could be the mask was leaking because I raised the pressure? The mask is pretty tight as it is.
Attaching the screen shots.
RE: High AHI but technician says all OK... - Gideon - 05-07-2020
Based on your description, your mask is too tight. Please read the Mask Primer in my signature.
There was enough to see that EPR off is not impacting your centrals. This means that you have 3 options,
1. Ignore your centrals
2. Hope they go away over time.
3. Use a machine that relies on much higher pressures to treat your centrals, an ASV
RE: High AHI but technician says all OK... - OpalRose - 05-07-2020
Surprising that lowering the EPR didn't help at all, but one day does not make a trend. As stated above, you can ignore the CA's, but I know that I could never ignore that if it were me, especially if you wake up feeling like crap.
If you can't get control of the CA's, then you may need to talk to your doctor about using a ASV machine.
Also, do you realize that you are at a pressure of 8cm for most of the night? You can see this on your graph. You are sleeping and don't notice it.
In the meantime, you need to try for comfort. Is it possible your doctor is aware of the central apnea and is keeping the pressure low?
If this were me, I would keep the mode set to auto, but change the settings to 5-5. In other words, leave your machine in Auto Mode, but change the minimum to 5cm and your maximum to 5cm. Post another graph after a couple days.