Reducing AHI's by increasing mask pressure

I have been on CPAP treatment for Sleep Apnea for about one year and the results have been dramatic: the AHI's went down from about 40+ per hour to about 0.50 avg, with no OA’s, mostly brief hypopneas and occasional RERAS. The results have improved even more after my doctor has recently increased the mask pressure to 12-16 H2O, with an option to increase it to 14-16 if needed. I believe my sleep it is not yet optimal , though, as l still experience some sweating and back aches at wake up, albeit not regularly and i wonder if further increasing the mask pressure would help to further reduce hypopneas and RERAS and, generally, improve my sleep. In fact, contrary to what I expected given the severity of my disorder, I never felt subjectively any changes or improvement in my sleep quality after starting treatment, none of those …AHA ! feelings of relief many people report after their sleep dramatically improves by undergoing treatment. The only tangible difference is that I no longer need to wake up several times to relief the bladder. A big relief, but perhaps I still have some way to go, even though at 79 I cannot expect the same quality of sleep as when I was younger. I know that, in the end only a doctor can make recommendations on this, but I was wondering if there are people who have noticed reduced hypoapneas or RERAs after increasing the pressure.

Thanks

Ittiandro

Apap machines are a wonderful mode of treatment as they can be set in a range of 4 cm to 20 cm and anything in between. You are correct in saying the doctor is the only one who can prescribe the pressure setting. I was in Sleep medicine for nearly 25 years and patient support was my forte. I can tell you this, your AHI is not the only factor to look at. An AHI is a index of all your apnea activity so if your index went from 40 to 0.5 I’m certain your hypopneas are treated also. Your oxygen level is also very important. If that is coming up to normal and your leak is acceptable and it sounds , from what you stated ,your AHI is down and your compliance is good, then your on a good path. Your not waking as often which is probably indicative of getting through your REM stages. All seems like a perfect remediation with only a suggestion and that is to let you pressure range end at 20. It won’t reach it if you don’t need it but on the other hand if you set the max too low it can’t go above that pressure.

Not everyone feels the WOW! You should however see improvements in small ways, no snoring, wake up much less tired, less naps or none at lol, and if for some reason you could not use the mask for a couple of days I’m sure you would notice a difference from the nights you do sleep with it. All in all it sounds like you’re very happy with your progress. Kudos and keep up the good work.

I was diagnosed with an AHI of 37 and with CPAP it has been reduced to under 3 or so. I never had any big AhHa moment. My wife likes that I don't snore any longer. Based on your success with EPR I decided to try it again along with my fixed pressure. After trying a few different combinations I am now using the same fixed pressure of 11 cm but now with a full time EPR of 2 cm. It is working very well to reduce my reported AHI. I had gone over 600 days with the same setting of 11 cm with no EPR and averaged over that time an AHI of 2.1. With the new settings and an EPR of 2 I have averaged an AHI of 0.74 after 19 days. The hypopnea has been reduced to close to zero. While it is nice to see the lower numbers I really do not notice anything different about my sleep. No AhHa moment from the lower numbers.

My thoughts are with the OSCAR reports that you have posted that there is no further opportunity for improvement with more pressure on your CPAP. You could have the maximum pressure increased to 20 and see what the machine does. However, what I would be worried about is that the higher pressure would cause more discomfort and than it would provide benefit. My overall strategy is to keep the pressure as low as possible while still giving good AHI results. Higher pressure can also cause CA events to increase.

Some people use an oximeter to monitor their oxygen levels during the night. If it is a compatible machine the results can be imported into the OSCAR program like you can import your CPAP data. I still use SleepyHead but I assume OSCAR is similar. Here is a screenshot of what the Oximeter introduction screen looks like. You should look at the similar screen in OSCAR if you are going to buy an Oximeter to ensure it is going to be compatible with OSCAR. I have no experience with them, but it might give you some idea as to whether or not your oxygen levels are going low at night despite having good AHI results. On the advice of a doctor there are fittings you can buy for you CPAP tubing that allow you to use supplemental oxygen with your CPAP. You would need their advice as to whether or not you would benefit, and how much oxygen should be used.

Thank you all for your comments.I might consider to buy an Oximeter, but I don't know whether all the brands are compatible with Oscar or not . THanks

Ittiandro

Hi Sierra, Started cpap therapy three months ago with a mixed bag of results, using Resmed AirSense 10 autoset and nasal mask.

AHI numbers are typically under 10, with umbers ranging from 15 to 24 15% of the time. Minimum start pressure is 6.8, max is 8.2 with no ramp time. At times, I blow raspberries, which my pulmonologist suggested might be due to max pressure being too high.

With covid and in lieu of an overnight sleep study, my pulmonologist recommended I turn on the EPR function, as well as experiment a bit with max pressure settings. I’ve read some of your posts and must admit, have difficulty understanding hoe EPR works, but hoping you could provide a bit more insight as to how I might use EPR.

Thanks a lot for the information you provide - it’s very helpful.

I believe you use the OSCAR app with the resmed sd card, right? I apologize, just new to all this.

Thanks a lot for all your help. Hoping to have sd card reader by tomorrow - should have a report in a few days, if you wouldn’t mind taking a look.

Think I’ll try to up my pressure a bit to see how I respond.

And yes, the raspberries I was talking about was just a blowing out of my mouth. Happens some nights, not others.

Thanks again for all your help! Really appreciate you taking the time to help!

Hoping this helps and thank you for your continued replies

Hope this helps and thanks for your replies.

Trying to attach a screenshot twice, but post didn't seem to go through. I've got the text of my daily data - hope this helps and sorry not able to post screenshot. Had a total of 66 clear airway events, which seems pretty high.

AHI 10.74

ResMed AirSense 10 AutoSet PAP Mode: APAP Min 6.4 Max 9.0 (cmH2O)

Date Start End Hours 5/10/2021 21:51:02 05:29:12 07:38:10

Cheyne Stokes Respiration 14.41%

Large Leak 0.02%

Clear Airway 8.64

Obstructive 0.92

Unclassified Apnea 0.00

Hypopnea 1.18

RERA 0.00

Channel Min Med 95% Max

Pressure 6.40 7.96 8.90 9.00

EPAP 4.40 5.96 6.90 7.00

Minute Vent. 0.00 6.25 10.75 14.75

Resp. Rate 0.00 13.80 17.20 24.40

Flow Limit. 0.00 0.00 0.03 0.22

Leak Rate 0.00 0.00 9.60 18.00

Snore 0.00 0.00 0.00 0.00

Insp. Time 0.48 2.16 3.40 5.22

Exp. Time 0.06 1.98 2.72 5.04

Tidal Volume 0.00 440.00 780.00 1160.00

Total time in apnea 00:23:19

Time over leak redline 0.022%

Machine Settings

Mode APAP

Pressure Min 6.40 cmH2O

Pressure Max 9.00 cmH2O

Antibacterial Filter No

Climate Control Auto

EPR Full Time

EPR Level 2 cmH2O

Essentials On

Humidifier Status On

Humidity Level 4

Mask Nasal

Ramp On

Ramp Pressure 6.40 cmH2O

Ramp Time 10.00 Minutes

Smart Start Off

Temperature 27 ºC

Temperature Enable 1

Something seems to be wrong with the layout of your daily report. It should look like this:

In any case can I ask how you ended up on a CPAP machine? Did you have a sleep study done, and what was the result of the study? AHI at diagnosis?

Yes, had at home sleep study, while sleeping on a wedge pillow which pulmonologist said skewed actual AHI. AHI was 17 at study.

Couldn't figure out how to take a screenshot of entire screen - had to take multiple pics.

You appear to be getting central apnea due to the increased pressure. This may be a more serious condition than can be treated with a APAP machine. If you want to try a simple change, and are comfortable with adjusting your machine, I would make the following changes:

• Reduce Maximum Pressure to 7 cm
• Turn the EPR OFF

This would be a test to see if it can reduce your CA events. If it helps there may some other improvements that can be made.

You should be able to capture a screenshot by just pressing the F12 key. The file should be saved in a directory location like this:

C:/Users/(Your Name)/Documents/OSCARData/Screenshots

The key information is the events bar and the Pressure graph

Trying this tonight. Thank you so much!

Apologize for multiple screenshots - can't minimize the data readout to fit on one screen.

AHI went down, which is great. Let me know your thoughts.

Here is a better look at this CSR graph.