Getting AHI lower

[mgundy]

Hello,

I'm really having difficulty lowering my AHI below 10 with my apap. I currently use a philips respironics dreamstation with a dreamwear mask (w/ nasal cushion) and A-flex of 2. I originally had my minimum pressure set to 8 cmH2O and max at 16 cmH2O. My 90% pressure ranged anywhere from 10 to 13, with most nights right at 11. After reading some of the posts here with the same issue I tried to increase my minimum pressure to 9 cmH2O. This resulted in my AHI increasing to 16... It caused everything to increase (clear airway apneas, obstructive apneas, and hypopneas).

I have Sleepyhead but don't really know how to look at the data. I was hoping some kind soul would take pity on me and offer some suggestions. What charts should I post for analysis?

Thank you for reading!

[jnk...]

You may find numbers 3 and 4 to be of particular help to you when you click on the following link:

viewtopic/t172378/Sticky--Newbies-PLEAS ... STING.html

[jimbud]

Hello,

I'm really having difficulty lowering my AHI below 10 with my apap. I currently use a philips respironics dreamstation with a dreamwear mask (w/ nasal cushion) and A-flex of 2. I originally had my minimum pressure set to 8 cmH2O and max at 16 cmH2O. My 90% pressure ranged anywhere from 10 to 13, with most nights right at 11. After reading some of the posts here with the same issue I tried to increase my minimum pressure to 9 cmH2O. This resulted in my AHI increasing to 16... It caused everything to increase (clear airway apneas, obstructive apneas, and hypopneas).

I have Sleepyhead but don't really know how to look at the data. I was hoping some kind soul would take pity on me and offer some suggestions. What charts should I post for analysis?

Thank you for reading!

Read this:

Sticky: Newbies PLEASE READ BEFORE POSTING
Post by Pugsy » Fri Jul 27, 2018 4:36 am

It is on the Home Page.
It is the first announcement.
Below the big orange Post a New Topic (with a down pointing arrow) sign.

That should get you started.

JPB

[mgundy]

Hi all,

Thank you! I've attached a screen shot from sleepyhead from before and after I raised my min pressure from 8 to 9. Hope someone has a few insights!

min pressure 9

screenshot-20200127-141837.png (307.81 KiB) Viewed 13099 times

min pressure 8

screenshot-20200127-142114.png (295.49 KiB) Viewed 13099 times

[Jas_williams]

Your machine is not raising pressure correctly can you make sure you have optistart set to off

[mgundy]

I just verified that Optistart was set to ON. I turned it OFF. I will try this setup for a few nights and report back.

Thank you!

[Pugsy]

Make sure you aren't using EZStart either.

[mgundy]

I verified both optistart and ezstart were off. The AHI was the same, but the pressures certainly changed a lot. Does my pressure plot look normal now at least?

screenshot-20200128-085156.png (983.51 KiB) Viewed 13011 times

[Dog Slobber]

Yes, your pressure charts are now representing the range of your min/max settings.

Your minimum pressure is low. As soon your therapy starts, it climbs. Rarely below 10.

I would set it 10, perhaps a little more depending on your comfort level and see how things go for a few days.

Your machine hit your maximum (16) a few times. You may want to just set it to 20, it will only go there if it needs to.

[Pugsy]

Did you actually fall asleep that first 90 minutes or so and turn the machine off?
or did you have a lot of trouble falling asleep?

If the answer is yes you were asleep....definitely need more minimum pressure.

Probably at least 10 cm minimum but that's quite a jump to start with from the 6.5 cm you are starting with now.
So if you can't handle that big of a jump then do it in 1 cm increments over a new days.
Some people can handle big jumps rather easily and some can barely handle 1 cm increases. I don't know which one you are.

[mgundy]

Did you actually fall asleep that first 90 minutes or so and turn the machine off?
or did you have a lot of trouble falling asleep?

If the answer is yes you were asleep....definitely need more minimum pressure.

Probably at least 10 cm minimum but that's quite a jump to start with from the 6.5 cm you are starting with now.
So if you can't handle that big of a jump then do it in 1 cm increments over a new days.
Some people can handle big jumps rather easily and some can barely handle 1 cm increases. I don't know which one you are.

I did fall asleep the first 90 minutes and then woke up. I turn the machine off when I get up to go to the bathroom and that's what I did.

Thank you both! I'll try 8 tonight with the plan to increase to 10 over the next few nights. *fingers crossed*

[palerider]

I'd do a minimum of 12 *tonight* with a max of 20, all you're doing by setting the min to 8 is causing more ineffective treatment as the machine spends the night trying to get back to that min pressure, which you can see is too low.

If you have trouble getting to sleep with that pressure, use the ramp.

[mgundy]

I've upped my min pressure to 12 for the last few nights. Still no luck... I'm getting a little worried that this is the best I can expect

A minor thing is I've noticed dry mouth/throat that is causing me to cough later in the evening from the higher pressure (I'm guessing). I have the humidifier all the way up and the heated tube setting at 3. I don't think my mouth is opening during the night.

screenshot-20200131-060550.png (887.41 KiB) Viewed 12901 times

[Pugsy]

Try minimum of 14...use ramp if you need to. We don't give up....we keep trying more pressure until you can't go higher with this machine and then we switch machines that will go higher if we have to.

Dry mouth happens more easily to some people than others and we don't know why and it isn't always mouth breathing but of course mouth breathing is a well known culprit.
It doesn't take a lot of mouth breathing either for some people....as little as 10 minutes of mouth breathing (even with a full face mask and humidity maxed out) to develop dry mouth.

The humidifier was never really designed to crank out enough moisture to rehydrate the oral cavity...it was designed for the much smaller nasal cavity.
Maybe someone takes some meds that accelerate the mouth drying or maybe they have other health issues that might accelerate mouth drying or maybe they are just unlucky.

Dry mouth even with a full face mask and humidifier set to max....still happens a lot and is a common complaint.
Those people add some sort of mouth hydrating agent at bedtime...to help keep the mouth moister.

[mgundy]

Will do! I’ll give 14 a shot. I’ve read a full face mask can help with dry mouth. What’s your opinion on that?