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+--- Thread: How can I lower my AHI? (/Thread-How-can-I-lower-my-AHI)
How can I lower my AHI? - jstro84 - 10-12-2023
Hi all!
New user here, thanks for being such an awesome community.
I've been using APAP for the last 2 weeks and have had a really uneven time of it. Sometimes I wake up and my AHI is less than 2 and I feel great, sometimes it's over 8 and I feel terrible. I know that like everything else, there are good days and bad days, but I was wondering if there was something in my Oscar charts that would clue me in to how to tweak my settings so there are more good days and fewer bad ones.
These are my settings:
Philips Respironics AutoCPAP (refurbished)
ResMed AirFit N20 nasal mask size S
Humidity off
Pressure: 10 - 20 cm H2O
A-Flex/EPR 2
Please let me know what you think. Thanks everyone!
RE: How can I lower my AHI? - gainerfull - 10-12-2023
1. Your minimum pressure combined with flex is not enough to keep your airway open consistently as evidenced by the prevalent obstructive events (light blue).
2. Your leak rate suggests you're opening your mouth at night and air is escaping causing leaks & impacting therapy. Look into mouth taping, a chin strap, or a full face mask.
If I were you I'd try the same exact settings aside from turning off flex and see if your results are any better. Once you find the minimum pressure that resolves your obstructive events then we can raise the pressure to accommodate flex.
RE: How can I lower my AHI? - staceyburke - 10-12-2023
Welcome. You are having some of positional apnea. You can see positional apnea where either H or Oa events are clustered together. There are not a huge amount but getting rid of as many as you can will lower your AHI.
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.
RE: How can I lower my AHI? - jstro84 - 10-12-2023
Thanks for the suggestions, gainerfull.
I noticed that I was still having a lot of obstructive events and raised the pressure to 11, and then to 13, (with flex at 3) but I got so gassy I couldn't tolerate it (TMI? lol) Probably I should have gradually increased the pressure over a couple of nights at least but I got impatient.
I've started taping my mouth over the last couple of days. It definitely improved my sleep so I'll continue doing that while I tweak the pressure. I guess I should also try a FFM but I am worried it will get nasty because I drool if my mouth is open.
I will try your suggestion of turning off the flex. I have had good results on 2 so I will try lowering it and see how it goes.
RE: How can I lower my AHI? - jstro84 - 10-12-2023
Thanks Stacey!
I have changed to a flatter pillow over the last few days after seeing your advice to others on the forum
I have some small Japanese-style buckwheat pillows that I can try to use under my chin to see if that helps, and will check out getting a collar.
I am a side sleeper and haven't changed positions, although I did wake up last night with an OA and found that I was on my back. I do toss and turn a lot so that may be the culprit.
RE: How can I lower my AHI? - jstro84 - 10-13-2023
I had a much better night last night! Slept almost 10 hours
AHI number is low, but I still feel that there are some issues - I am snoring a lot and still having quite a few events. Mouth taped, A-flex off, pressure set 10 - 20cm, wearing a soft collar.
For reference my user defined events are:
UF1 - 20% FR @ 5s
UF2 - 50% RR @ 5s
I know that that's technically less than the official definition of a hypopnea but it flags a lot of my messed up breathing patterns not counted by the machine as an event.
I'm feeling about average this morning. Not tired but not NOT tired.
Any more suggestions?
RE: How can I lower my AHI? - gainerfull - 10-13-2023
Wow - what a difference! We're on the right track - raise your minimum to 11cmH20 tonight and we should see even less events. Since you're on cpap / apap our goal is to eliminate all obstructive events and all snoring with pressure. Nice work!
RE: How can I lower my AHI? - jstro84 - 10-14-2023
Had a wonderful nap yesterday afternoon - .85 AHI and far fewer events overall!
Unfortunately I had kind of a restless night last night because I was anxious about waking up on time after going to bed late... I'll give 11cm another shot tonight or maybe bump it up to 12cm given that my Med was 13.5 and my max was 14.5.
Thanks for your help everyone
RE: How can I lower my AHI? - gainerfull - 10-14-2023
Glad to hear you're experiencing a positive result. I agree that your optimal pressure is somewhere in the 11-14cmH20 range considering. You'll know you're making progress once all of the VS1, VS2 & obstructive events disappear.
RE: How can I lower my AHI? - staceyburke - 10-14-2023
I don’t use the dreamstation but V1 and V2 are vibrations that can be just the hose rubbing. Most of the time most people don’t have Oscar even show them they are not obstruction events.