Hypopnea and Flow Limitation Problems

[Rooter]

I am using a Remstar auto biflex operating in the auto bilevel with biflex mode. The mask is quatro and the humidifier is F&P 150. My average numbers for the following 7 days are as follows:

Average No. of Hypopneas - 19
Average No. of Apneas - 1.4
Ipap Setting - 17
Epap Setting - 10
Pressure Support - 7
Maximum Ipap Average - 15.0
Epap Average - 10.1
Average Flow Limitations - 5.4
Average AHI - 3.0

I would appreciate any suggestions as to how I can lower my hypopnea and flow limitation numbers.

Thanks,

Rooter

[RipVW]

Rooter, I don't if this is a normal phenomenon or not, I'm sure some of our experts will chime in here, but, after using nasal masks intermittedly during the past month or so, I've found that my AHI is consistently lower with the nasal interface than with the FFM (typically 1.1-1.5 compared to my average 2.3 with my UMFF or Quattro). Wondering if this is typical, or if just my experience for some unknown reason.

Also, note that AHI less than 5 is optimal; I believe Bill Bolton says that there's really no significant difference/improvement once we are under 5.

[boynedoc]

Not certain I would necessarily agree with the statement that there isn't any significant difference/improvement once you hit that "magic" 5 AHI or less mark.

I haven't been hosing for that long - just over a month - but I feel significantly different when my AHI is under 2 as compared to being close to 3. It's almost night and day for me. For Bill, perhaps not. Isn't individuality a wonderful thing??

[betty303]

Ditto for me....if I can keep my numbers under 1.0, I feel better than if they get above 1.5+. Usually I can tell the difference when I get above 1.0 - probably about 80% of the time. If I get into the 3s and up - I feel a whole other level of deeper tiredness. I usually check my numbers at the end of the day, so can compare the results pretty objectively, because how I feel is already evident by the time I learn my numbers.

Even with my numbers at 1 or below, I still have some tiredness, so I am on the path of finding out more about the effect of RERAs and other possible causes - so maybe something else is going on and my AHI affects how much I my general state of tiredness is.

[Treesap]

[quote="boynedoc"]Not certain I would necessarily agree with the statement that there isn't any significant difference/improvement once you hit that "magic" 5 AHI or less mark.

I haven't been hosing for that long - just over a month - but I feel significantly different when my AHI is under 2 as compared to being close to 3. It's almost night and day for me. For Bill, perhaps not. Isn't individuality a wonderful thing??

[track]

I agree. I had an AHI of .1 once. If only I could get that again because I felt "normal" again. I feel better, but my AHI has been between 3-4. I could feel better.

I don't know that I would consider an AHI of .1 normal for anyone. That would be extremely low for even a person who does not have apnea...assuming anything under 5 is considered normal. That's less than one apnea the entire night assuming the person sleeps 8 hours or less.

I have been on cpap for over a year and I haven't even sniffed an AHI as low as 1 or 2. If I can get in the normal range..under 5... I consider it a very good night....not that I wouldn't like to eliminate all apneas....but to date I can't imagine that possibility.

[bigk]

I have very low mask leak and an APAP machine but I have never gotten below 3.3 - I am averaging 5. I can't even imagine how an AHI of <1 would even be possible.

[rested gal]

I know everyone's different, so I'll toss in how the AHI affects me. I feel exactly the same (well rested) each morning, whether the AHI is 0.0 (yes, I've gotten quite a few of those zeros) or is 4.0. Guess I'm lucky.

Had one night that the AHI was 6.3, which was odd. Nothing different had happened. Same mask as usual. Low leak rate like any other night. Still felt well rested all day. Next night, AHI was back down under 1.0.

The few times in the past 4 years that I did not use a machine (was experimenting with overnight recording pulse oximeter to see what my SpO2 was, with and without "cpap") I did feel groggy waking up and did need a long "cpap nap" by afternoon. Left no doubt that I do need "cpap", but apparently I do fine, and feel perfectly rested as long as my AHI is anything under 5.0.

I don't have any health problems, though, so perhaps additional health issues might factor into how other people feel.

[ozij]

I wonder if anyone has found a study showing that an AHI of 5 has far less impact on people's health than an AHI of 6. I would be very glad to read it.

"Normal" in statistical terms mean that in a "normal distribution" half the population has a number that is less than the norm(al).

It is also "normal" for a majority of human being to suffer from backaches - which does not make a "normal backache" something to aim for.

I have only found an AHI of 5 in financial definitions - and, IIRC, there was no explanation of why that number was chosen. Perhaps in world of limited financial funds that's a good cut off point, I would love to know the medical rationale for that number.

Sleep techs running titrations aim for a pressure that results in 0 apneas and 0 hypopneas. They may not achieve it, but they do aim for it.

I feel disticntly worse when my AHI scratches 3 from below.

O.

[boynedoc]

O,

I have zero knowledge of a study showing that AHI of 5 is significant in any way over say, an AHI of 6.

I think you are SPOT ON that an AHI of 5 is a financial consideration rather than one of health and well-being. Insurance companies pick arbitrary numbers not out of concern for our best interest but for their bottom line. It's been a proven fact for many years - and one we are forced to live with.

[krousseau]

My lowest numbers have not always meant that I feel well in the AM. I have at times thought that when I get the lowest numbers that I may not have slept as well either....


And the times AHI is staying under 5 but still feel tired-I look at the FL and snores

[Snoredog]

don't really see it as being a "problem" based upon the results, but if you want to lower the obstructive events you increase pressure.

probably the least noticeable would be increasing epap minimum to 11, result should also be a lower ipap found by the machine.

[sleepie]

I don't if this is a normal phenomenon or not, I'm sure some of our experts will chime in here, but, after using nasal masks intermittedly during the past month or so, I've found that my AHI is consistently lower with the nasal interface than with the FFM (typically 1.1-1.5 compared to my average 2.3 with my UMFF or Quattro). Wondering if this is typical, or if just my experience for some unknown reason.

rip---- i have the same thing go on with me--nasel mask always below 1.0---fullface mask and i have tried 4 different ones--then ahi is---4.7----to --7.7--i still can't figure out why---sleep dr says i must be having leaks--but the software says no difference on the leak averages----maybe someone can answer this---i wanted to wear a ff mask to stop the ocasional mouth drop---but the dr says if the # are less than 1.0 with the nasel even with the mouth drops then stick with that-------