how can I lower my AHI?

[melissa1974]

Hi-
I am still a newbie trying to figure this all out, and so many of you have already been helpful on my other posts in getting me started. I am finally getting a bit of control over my leak rate with my Liberty mask and would now like to see my AHI numbers come down. Last night, my leak was only .06L/s, which I was happy with, however my AHI was 15.9 and my AI was 0.9. Now, I have already been told that some forum members automatically cut the HI number in half to calculate a more realistic AHI when using Resmed machines, however, that still leaves me with an AHI of 7.5.
What else can I do to lower my AHI? I had been getting lower AHI and AI numbers when my leak rate was higher, actually, but as I read through forum posts, I learned that those numbers may or may not be reliable. So, now that I have the leak under control, I feel that these are the real numbers.
Oh, and just to clarify....for right now, I am only using the data available each morning from my machine. I haven't purchased a card reader yet to start working with software.

Thanks.

[Gerald]

Melissa......

The answer to your question is pretty well summed up in the last sentence of your message.

Get the software.....then, use experimentation, creativity, and good common sense to make your "lower AHI goal" happen.

You might also consider obtaining a recording Oximeter along with good software that will allow you to monitor your O2 saturation levels while sleeping. Keep in mind that a person can have a seemingly "just fine AHI score" while not actually keeping O2 levels where they should be.

Looking at the puzzle from two directions......CPAP software....and....Oximeter software....gives you the best indications on what you're doing right.

Gerald

[melissa1974]

Thanks, Gerald. Your comments about my O2 levels really make me wonder, because during my sleep study I was found to have and AHI of 96 and O2 levels below 70% for over 94% of the night and even on CPAP, they were unable to get my O2 levels where they should be. That's why my doc decided that I needed bipap. I came back to the sleep lab for a second night and on bipap my O2 levels were all over 95% once they figured out my correct pressures of 17 IPAP and 12 EPAP. Clearly, my OSA is quite severe and while I realize that the numbers I am getting now are a tremendous improvement over what was happening before my diagnosis, now that I "know" what is going on, I want to get them to be as good as possible.

Is there a time component in that perhaps my body might just need more time to heal? I have been approaching this from the perspective of tweaking mask fit and trying to see what I can to eliminate leak, in the hopes that once I did that, I would suddenly get perfect numbers because I was receiving the correct pressure. I guess I assumed that once I did that, I would stop having apneas and I would breathe "normally" during sleep. Is that an incorrect assumption? Is this something that might get better with time? I am not sure if I am working this clearly.....but I am wondering if it is just a mechanical thing where if the mask/machine/pressure are all correct then it should work, or if there is a component of needing time to actually recover from years of OSA?

Thanks to all for any clarification.

[Ms.Snuffleupagus]

Hi Melissa,
I have an APAP so my comments may not apply. I used to wear my mask before actually falling asleep. I would read in bed while wearing my mask, sometimes for an hour or so. I had turned off the ramp. One night I decided to check my AHI before I turned off the lights and to my surprise my AHI was close to 30..this while I was totally awake. This obviously had an effect on my AHI scoring in the morning.

So I decided to use the ramp feature when I was wearing my mask and reading in bed. The ramp does not count any obstructions while on. Well my morning AHI "improved" I think I was getting a truer reading.

This might not be your case, other things may be happening but is food for thought..

By the way, the Liberty mask is notorious for leaks. Even though your leak rate on your screen in the morning is within acceptable limits, you may be getting increase in leak rate during/prior to apneas. You may want to go to your DME and ask for a print-out and see what is happening. Definitely speak to your sleep doctor. Your AHI needs to be lower.

[ozij]

Hi Melissa,
I have an APAP so my comments may not apply. I used to wear my mask before actually falling asleep. I would read in bed while wearing my mask, sometimes for an hour or so. I had turned off the ramp. One night I decided to check my AHI before I turned off the lights and to my surprise my AHI was close to 30..this while I was totally awake. This obviously had an effect on my AHI scoring in the morning.

Great comment, and very applicable to any machine that reports data: the reporting gets really messed up when you're awake, since the machine assumes your breathing is regular, and treat the normal, wake breathing irregularities as though they were sleep disordered breathing with apneas and hypopneas.

So I decided to use the ramp feature when I was wearing my mask and reading in bed. The ramp does not count any obstructions while on. Well my morning AHI "improved" I think I was getting a truer reading.

And a very good idea.

I was wondering if you may be sleeping deeper now, and perhaps needing slightly more pressure because of that.
Maybe you doctor can instruct the DME to record overnight oximetry to see how you're doing?

[melissa1974]

My DME wants me to send in my "smart card" once I have three weeks worth of data and then they said they will see how I am doing and get in touch with me. Is that a typical plan for new users? Should I contact them sooner regarding these questions?

[Gerald]

Melissa......

From the way I understand it, simple Apnea is "airway obstruction" that produces suffocation.

Using that simple definition, it's easy to see that one doesn't "heal" when it comes to apnea problems. I find that I have more problems when my weight goes "up"....and when I have more sinus drainage.

So....if we drop the weight....that might help......and if we make sure that we're using good filters on the CPAP machine (meaning that our allergy problems get better because we're breathing cleaner air at night)....we can max out the help we get from the increased air pressure in our breathing passageways.

The CPAP machine is simply a "Stent" that pushes excess tissues aside and opens up our airways. It doesn't "heal" those excess tissues....it just pushes them aside.

Gerald

[jmelby]

Hi Melissa,
I have an APAP so my comments may not apply. I used to wear my mask before actually falling asleep. I would read in bed while wearing my mask, sometimes for an hour or so. I had turned off the ramp. One night I decided to check my AHI before I turned off the lights and to my surprise my AHI was close to 30..this while I was totally awake. This obviously had an effect on my AHI scoring in the morning.

So I decided to use the ramp feature when I was wearing my mask and reading in bed. The ramp does not count any obstructions while on. Well my morning AHI "improved" I think I was getting a truer reading.

This is interesting... as I have noticed a similar trend that the number of counted hypopnea events is highest when I'm awake. What I didn't realize is that the ramp (called settling in APAP mode I think) will not count these. I typically wake up once or twice a night to use the bathroom, and I see the same pattern as when going to bed. I'm going to try enabling settling tonight and see if it makes a difference in my overall AHI numbers.

[AirBreather]

I have had an increasing problem with insomnia as I have grown older. Sometimes I have difficulty initially going to sleep, but more commonly I am unable to go back to sleep after waking in the night. I have noticed that my HI generally tends to be much higher while awake than while sleeping, so if I wake up in the middle of the night and then stay in bed awake with my mask on the remaining half-night, I will have a high HI, and consequently high AHI for the night. However, since more than half the hypopneas didn't occur while I was sleeping both the AI and AHI are misleading with respect to the period of sleep.

[terrydk]

Hi-
I am still a newbie trying to figure this all out, and so many of you have already been helpful on my other posts in getting me started. I am finally getting a bit of control over my leak rate with my Liberty mask and would now like to see my AHI numbers come down. Last night, my leak was only .06L/s, which I was happy with, however my AHI was 15.9 and my AI was 0.9. Now, I have already been told that some forum members automatically cut the HI number in half to calculate a more realistic AHI when using Resmed machines, however, that still leaves me with an AHI of 7.5.
What else can I do to lower my AHI? I had been getting lower AHI and AI numbers when my leak rate was higher, actually, but as I read through forum posts, I learned that those numbers may or may not be reliable. So, now that I have the leak under control, I feel that these are the real numbers.
Oh, and just to clarify....for right now, I am only using the data available each morning from my machine. I haven't purchased a card reader yet to start working with software.

Thanks.

The ResScan software is invaluable and such a great tool. It's a shame that its not easily available to anyone that can work a computer and wants to know what is going on with their therapy. The first thing I do every morning is check my numbers and if something looks out of whack I download the info and look at it in the software, you can't get any details any other way. For instance this morning my AI was 2.8, HI = 7.8 for an AHI of 10.6 & 6:45 of usage. These were not like the numbers I had been seeing the previous 25 days. My previous 25 day averages were AI= .4, HI= 6.1, AHI= 6.5 & average use time of 6:50. When I looked at the detailed information for last night I found that I had 13 AI's in a 16 min span of time. I also had 5 other AI's scattered throughout the night. Now exactly why I had those 13 apnea's all within a very short period of time I don't know for sure but it is something that I will continue to watch for and evaluate.

[katztoy]

This is very interesting information. I was unaware that the "wake" time would register any differently (or that breathing was really any different wake or sleep) I have been having trouble with my ahi again in the last few weeks but I have had horrible insomnia. Though I am still getting over bronchitis as well so I was thinking it was that. I wonder now if it's the fact that i'm awake for so much longer.

I'm waiting on my card reader now so hopefully I can see what's actually going on!

[melissa1974]

Thanks so much for all of the thoughtful answers. I do spend some time trying to fall back to sleep, so the awake breathing may be contributing to my numbers a bit. I also really do need to purchase a card reader. Money is tight (isn't it always?) and I have checked around it seems that I can't get one for less than about $70. Is that accurate?

I have the software, so I guess I just need the reader and a card, since the card that came with my machine has to be sent back to my DME in a week or so. Is that all I need?

Thanks.

[dtsm]

Money is tight (isn't it always?) and I have checked around it seems that I can't get one for less than about $70. Is that accurate?

I have the software, so I guess I just need the reader and a card, since the card that came with my machine has to be sent back to my DME in a week or so. Is that all I need?

Thanks.

Usually the card is then sent by DME to your doctor. I would ask them to then return to you - as the rightful owner.

[SleepingUgly]

Will the events not be counted during ramp on the PR System One?

The ramp does not count any obstructions while on.