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+--- Thread: [Treatment] How can my father improve his AHI? (/Thread-Treatment-How-can-my-father-improve-his-AHI)
How can my father improve his AHI? - azaz1994 - 08-19-2023
Hi everyone,
My father (60 yo) has recently been diagnosed with severe OSA. He's not overweight but the soft tissues in his upper airways are anatomically large and he's undergoing hypothyroidism treatment.
He's been using a ResMed AirSense 10 machine for almost a month starting with the default 4-20 cm pressure and full face Air Fit f20 mask and have been testing out different pressures. We have settled on 10-17 cm for over a week but his AHI jumps up and down every night. I looked at his OSCAR charts and the readings flag so many OA events on some nights that it's scary to look at.. and on another night there are much less. We began to worry if there are any positive results happening at all. How can his AHI be 14 on one day and 3 on the next? How do we make it more consistent? I will attach his OSCAR charts from the past couple of days.
He has also been complaining that the mask is blowing too much air that wakes him up every morning around the same time blowing up his cheeks and becoming unbearable. That's the reason why we lowered the pressure from 20 in the first place, yet it's still happening every morning.
RE: How can my father improve his AHI? - jwest - 08-19-2023
Makes these changes please:
1) Right click on the flowrate y-axis and then change the range to +70 and -70.
2) Right click on the leak rate y-axis and cap it at 50
then repost those images.
3) take two additional zoomed-in photos with ~1-minute window of flow rate where all of those "OAs" are occurring.
Your father looks like he's getting adequate therapy on lower pressures. I'll try to confirm that when you post the charts I've requested above. Although it's hard to see, it looks like the therapy is quite effective around the max 10cm pressure mark. All of the bad sleep is occurring at higher pressures, which might be pressure-emergent central apneas that are being wrongly classified as obstructive apnea. Alternatively, it could be positional. That is, he may have tucked his chin or moved into a position where his throat is closed. I'm leaning towards it being pressure-emergent, and that he doesn't need that high of pressure ever.
Although I would prefer to see the requested images first, what I would change is capping the max pressure to 12cm.
RE: How can my father improve his AHI? - staceyburke - 08-20-2023
As the first poster said it is hard to see what is going on with the settings you have to view OSCAR.
BUT he is having a lot of positional apnea. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
You can tell positional apnea when the events are grouped in the Oa and H events.
RE: How can my father improve his AHI? - azaz1994 - 08-20-2023
Thank you for your quick replies.
I have attached the requested screenshots.
We have discussed the option of getting a more suitable pillow to support my father's position so hopefully that can happen in the near future. He believes he's sleeping on his side for most of the night, but perhaps he's still tucking his chin.
If you do make out any more information from the new screenshots, I would really appreciate it!
[attachment=53394]2 more zoomed in images
RE: How can my father improve his AHI? - jwest - 08-20-2023
Sorry, I was a bit unclear. I meant a close up of the apneas that occur/start around 5am on the 18th.
I have a strong suspicion that the high pressure is causing issues, and I think capping the pressure max at 13-14cm is probably a good idea. The increased pressure coincides with increased leaks and horrendous waveforms. His breathing between 1am and 5am on the 18th is clean, minus again where the pressure changes are occurring. Now, the pressure changes could be reactive here, but the giveaway, in my opinion, is the 5am to 7am.
Let me know what you think.
RE: How can my father improve his AHI? - staceyburke - 08-20-2023
The problem is positional apnea - It is bad enough he needs a collar while sleeping if he can not stop from getting into the position that is causing it. You can chin tuck in any position - but more often on your back.
You can see periods of time where there is little or no apnea but others when the GROUPED Oa or H events are non stop for a good period. That shows positional apnea....
RE: How can my father improve his AHI? - Gideon - 08-20-2023
Positional apnea. Just reinforcing the opinion
RE: How can my father improve his AHI? - azaz1994 - 08-21-2023
Hello!
I am attaching the new screenshots of the close up of the OA's from the 18th Aug after 5 am just in case it can be more clear whether it is caused by high pressure or positional.
As Jwest suggested we will cap his pressure at 13-14 cm in case, to see any change.
Thank you StaceyBurke for suggesting the collar. I will I purchase it for him to try. I worry he will be a little intimidated by having to wear it to sleep, but looking at how this helped other people, I have good hopes he will change his mind!