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How long to see improvement?

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New2SleepApnea +0 points · about 1 month ago Original Poster

Hi All,

I recently got my CPAP machine and have been using it for the last 4 nights but my AHI number doesnt seem to be getting better. During my sleep study I had an AHI of 11 ( zero centrals, 1 osa and the rest hypopneas). Using my CPAP machine I have an AHI of 8 mostly made up of centrals and hypopneas. Should I be concerned that this seems to be increasing the centrals? I've not noticed an improvement in tiredness symptoms. I've included my readings in the iamge attached.

Should I stay the course or go back to the doctor?

Thanks!

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Biguglygremlin +0 points · about 1 month ago Sleep Commentator

Hi New2SleepApnea

If I were in your circumstances I would be concerned enough to ring whoever set up the machine for you and ask them to review the results so far.

I would even go so far as to request that they put a reasonable limit on the pressure maximum if the machine is running on auto.

Personally I run my machine on a fixed pressure with no ramp but that's probably just my distrust of devices. :)

In the meantime if you had an AHI of 11 beforehand you might be better off without the machine until you can get it sorted.

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Sierra +0 points · about 1 month ago Sleep Innovater

What brand and model of a machine do you have? Is it in Auto pressure mode? If so, what are the minimum and maximum pressures set at? Are you using EPR or Flex? If so what is it set at?

A reduction from an AHI of 11 to 8 is not a great improvement, and does not meet the general guidelines to be under 5. I noticed from an earlier post your sleep study indicated your obstructive index was 1 and the hypopnea index was 10. The issue with hypopnea is that they are almost always assumed to be obstructive, but they can actually be central or clear airway in nature. CPAP pressure does not help with clear airway events, and it may in fact make it worse.

I would go back to your doctor to report your results, and ask if the maximum pressure can be reduced to see if that helps, or ask if your machine can be set to a fixed pressure significantly lower than what your machine is currently going to.

If you have a compatible machine you could view your results on a PC or a Mac using a SD card reader to transfer the data to SleepyHead. That would be very revealing as to what is going on. This version of SleepyHead is no longer being developed, but it still works.

EDIT: I believe that image you posted is from DreamMapper and suggests you have a DreamStation machine. Is it an Auto version, and again what are the pressure and Flex settings?

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New2SleepApnea +0 points · about 1 month ago Original Poster

Thanks for the responses.

I have a DreamStation auto. The min is set to 7 and the max 13. I do not know what the flex setting is?, how do I find this out?

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Sierra +0 points · about 1 month ago Sleep Innovater

Flex provides a smoother transition from inhale to exhale. The effect is rather minor compared to the EPR on a ResMed. However, I would adjust it to minimum or turn it off if that is a choice. See page 4-15 in this Service Manual.

My thoughts are that your machine in Auto may be chasing the hypopnea events which could be central in nature. This results in a higher pressure and can cause centrals and more central hypopnea. Simply setting the machine into fixed CPAP mode and running it at 7 cm would be worth a try. The other choice would be to set the minimum at 6 cm and max at 7 cm. Obstructive apnea does not seem to be a big problem for you, and it may take very little pressure to control the obstructive part. Avoiding high pressure would help too. SleepyHead would allow you to display the pressure record for the whole night and see where the machine is taking it.

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Biguglygremlin +0 points · about 1 month ago Sleep Commentator

It surprises me that a max of 13 could be the cause of so many central events.

It seems like we are missing a piece of the puzzle.

Taking the machine back to whoever set it up would be a sensible move.

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Sierra +0 points · 30 days ago Sleep Innovater

It is possible that obstructive apnea is not a problem at all. The AHI due to obstructive apnea was only 1 at diagnosis. That usually does not take much pressure to correct.

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New2SleepApnea +0 points · 29 days ago Original Poster

Emailed my doctor yesterday so I'll update when I hear back. I am using a nasal pillow and have woken up a few times throughout the night and noticed that I was breathing through my mouth, could that be affecting the results?

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Sierra +0 points · 29 days ago Sleep Innovater

Breathing through the mouth is a common issue. Some solve it by wearing a chin strap, others by using mouth taping, and other by going to a full face mask. It is not real conclusive as to whether or not it affects the AHI. Resmed says that they stop reporting and responding to events when the leak rate is high. So, potentially events are missed. But, the also say because the machine does not respond to these events pressure can be too low when the leak rate is lowered and you can get a bunch of events. You can see all of that detail with SleepyHead.

In your case, I doubt that is the source of your high AHI though. I would ask the doctor about reducing the maximum pressure, or going to a lower fixed pressure, like about 8 cm to see what that does. If it lower the number of central events, and hypopnea events then too much pressure is likely your problem.

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