Looking for help getting AHI down

Hello everyone,

I have sleep apnea! I was diagnosed about 2 months ago, I got my CPAP machine about a month ago. First time CPAP user.

Equipment:

• Resmed Airsense 11
• Resmed N20 Nasal Mask
• Chin Strap

About me:

• 32 Male
• 6'
• 235 lbs (BMI 31.9)
• Medium length beard

When I was first diagnosed, I was diagnosed with an untreated AHI around 50, and supine (sleeping on my back) AHI around 60. Since my supine AHI was super high, I try to always sleep on my side. I don't really have a preference towards one or the other, and I tend to toss and turn in the night.

Anyway after I got the machine, my AHI was still somewhat high (around 10-15), so I've been trying to get my AHI down. I read this forum and some other resources, which told me I should increased the pressure. So I did.

After some tinkering, I found that the following setting worked reasonably well:

• Min pressure - 13
• Max pressure - 18
• EPR Level - 2
• Everything else factory defaults

Note: I found that really high pressures tend to cause a lot of leaks, which is why I had set the max pressure to 18. Looking in OSCAR, occasionally the CPAP machine will hit 18 while trying to treat an apnea event, but in doing so it would blow the mask off my face and wake me up. So my quality of sleep is a lot lower with the higher pressure. Additionally my wife hates the higher pressure because she can hear it blowing and it keeps her awake.

Anyway, after all my tinkering my AHI is still somewhat high. Here's a list of AHIs over time:

• Jan 3rd - 3.00
• Jan 4th - 3.54
• Jan 5th - 3.28
• Jan 6th - 8.26
• Jan 7th - 8.37 (see the image jan7.png)

I had an appointment with my Doctor yesterday, who wasn't happy with my "treated" AHI being over 5. And told me I should increase the pressure. They also mentioned that if my AHI is still too high at our next appointment, that they would want me to do a sleep study at a lab, which I really don't want to do.

My doctor was able to change the settings, and changed the settings to:

• Min pressure - 18
• Max pressure - 20

However, this still had me with an AHI of 5.82 (see the image jan8.png). So while my AHI did drop compared to the last 2 days, it's still higher than the I've seen with the previous settings. Additionally I slept very poorly yesterday, since the higher pressure kept me awake. Plus I had a lot of leaks (23.6% over leak redline).

So increasing the pressure a lot seems to cause other problems, and doesn't even fully treat my sleep apnea fully. I'm thinking I should try something else.

Other things I've tried:

• Putting pillow behind my back to prevent me from rolling onto my back - Worked well
• Pregnancy Pillow - Meant to keep you sleeping on your side (I guess pregnant women are supposed to sleep on their side, hence the name). However the one I bought contorted my neck in a weird way, and it didn't seem to get my AHI down, if anything it made it worse
• Mouth tape - I have a chin strap, so that should prevent my jaw from dropping and having me breathe through my mouth to some extent. However, even with the chin strap, my wife reported that I would "blow bubbles" when I was sleeping, so I guess some air still comes through my mouth. I got some mouth tape and it worked reasonably well but not 100%. Eventually my mouth would get too wet and the tape would come off.

On Jan 7th and the days before, I used the pregnancy pillow and the mouth tape. Jan 8th I didn't use mouth tape and just used regular pillows.

Wondering if any of you sleep wizards could do some analysis and give me some pointers?

Welcome! A couple of thoughts.

Many of your OAs are clustered, which can mean you're having a positional problem. The clusters might reflect you sleeping on your back, despite your efforts to stay on your sides, or they might indicate chin-tucking. That's when you sleep with your chin down near your chest, and it can slightly narrow your airway, making OAs more likely.

Maybe your wife can tell you whether you're sleeping on your back. (You seem to be doing some snoring during some of those periods of clustered OAs.) And if you're using a high pillow, or several pillows, you might try using a single low and firm one. Finally, you might experiment with a soft cervical collar (which will also help to keep your jaw up). More about positional apnea and collars here:

https://www.apneaboard.com/wiki/index.p ... onal_Apnea

You might try curling your lips inward a little bit before you put your tape on. That can help with the saliva problem. If the tape loosens in particular places, you might try buttressing with some extra tape.

If your sleep doctor suggests an in-lab test, I urge you to do it. It can provide more information than a home test about what's going on with your sleep. Find out whether it would be a split test, with no PAP machine for part of the night and a PAP machine for part of the night. Ask whether you should try to go without PAP at home for a few nights before the test, and ask whether you could try using a sleep aid for the night of the test.

Oh, and next time you post a chart, please provide only these graphs:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

If you turn off the calendar, you can still probably get a lot of the left panel into your screen shot.

Miss Emerita wrote: ↑

Thu Jan 09, 2025 6:31 pm

Welcome! A couple of thoughts.

Many of your OAs are clustered, which can mean you're having a positional problem. The clusters might reflect you sleeping on your back, despite your efforts to stay on your sides, or they might indicate chin-tucking. That's when you sleep with your chin down near your chest, and it can slightly narrow your airway, making OAs more likely.

Maybe your wife can tell you whether you're sleeping on your back. (You seem to be doing some snoring during some of those periods of clustered OAs.) And if you're using a high pillow, or several pillows, you might try using a single low and firm one. Finally, you might experiment with a soft cervical collar (which will also help to keep your jaw up). More about positional apnea and collars here:

https://www.apneaboard.com/wiki/index.p ... onal_Apnea

Thanks for your response!

I bought a soft cerivical collar. The last night it seemed to work well, it seems to affect my leak rate more than my AHI. It got my leak rate down to almost never being over the redline.

Miss Emerita wrote: ↑

Thu Jan 09, 2025 6:31 pm

You might try curling your lips inward a little bit before you put your tape on. That can help with the saliva problem. If the tape loosens in particular places, you might try buttressing with some extra tape.

This worked well as well. I also tried putting a smaller strip of tape on as well. The single piece of tape stayed on the whole night.

Miss Emerita wrote: ↑

Thu Jan 09, 2025 6:31 pm

Oh, and next time you post a chart, please provide only these graphs:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

If you turn off the calendar, you can still probably get a lot of the left panel into your screen shot.

Done. Although I'm not sure why I would want to hide the calendar in the top left, the only thing that would show is the Session Information which just has the start time and end time.

I am still getting some OA clusters though unfortunately, so I think I still need to change something else.
With the exception of the cluster around midnight, most of my apneas seem to come after a low period pressure. So I believe that means the machine is compensating to treat an apnea. So potentially I should increase the min pressure?

Do you know whether you're rolling onto your back during the night? And just to double-check: are you using a single, fairly low, fairly firm pillow?

I'd suggest you raise your minimum pressure to 16, which is your current median pressure, and your maximum to 20. Let's see how that goes before considering other edits to your settings.