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  • Target AHI?

    I picked up a pulse oximiter last week and was surprised to find my AI was 10 while on CPAP. So I'm hacking the clinician settings... Power to the people!

    From reading around I suspect that I'm looking to achieve a figure below 5. Has anyone else titrated themselves and, if so, how successful was it?

    It certainly looks like it's no bad thing Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?

    Stewart

  • #2
    Join the club! Lots od us do - with much better results than an over-stretched (by their standards) NHS clinic ever could.

    I regard 5 as a very poor maximum AHI.

    TF
    Respironics REMstar 'M' Series APAP.
    Resmed Mirage 'Quattro FX' Full Face Mask with a 'Quattro' headgear.

    Comment


    • #3
      Thanks Tiger. I noticed from your footer that your pressure is 17. Mine's currently at 11.8 so I suspect I could raise it considerably higher.

      I believe the pressure is dependent upon one's build rather than on one's AHI, does that chime with you? (My BMI is 30.) My untreated AHI is 90 so a simplistic view is that I need much higher pressure.

      I'm planning on notching the pressure up by about 0.8 cm every second night until I either get the AHI right down as far as I can or it becomes too uncomfortable.

      Comment


      • #4
        I'm not a medic. My understanding is that one's optimum pressure is entirely and uniquely dependent on the patient, with no apparent rhyme or reason. High untreated AHI can be fixed with a low pressure and vice versa; ditto large builds, fat necks, etc.

        So we need to talk about you and you alone! The fact that I'm on 17 bears no relation to you at all, at all.

        Pressure and AHI go hand in hand in that - for each individual - there is an optimum pressure that will give the lowest AHI. I suggest that you need to creep up on it rather than rush becuae your body will react, be intolerant of rapidly increasing pressures. My golden rule is 0.5 cm every fourth day oncxe you are anywhere close - more rapidly if you are way off with a high AHI. Don't forget, you may already be too high and thus getting high AHIs as well as too low.

        Let us know how you go.

        TF
        Respironics REMstar 'M' Series APAP.
        Resmed Mirage 'Quattro FX' Full Face Mask with a 'Quattro' headgear.

        Comment


        • #5
          As TF says, tweak gently. I have my AHI under 1 on most nights however you get the occasional bad night, don't let that worry you, if most nights your getting under 3 and you have one or two nights at 6 or more I'd not be worrying about the odd night.

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          • #6
            Speaking to a few other hoseheads in my early days I found three of us newly diagnosed, two males one female, varying shapes & sizes, had all been set up with 11 by the clinic. This is anecdotal stuff though, without the mass information the NHS has one would never be able to work out any pattern. I have no idea what criteria they use but it made me suspect at the time that I needed to ask about it.

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            • #7
              Southampton seems to set up everyone with a CPAP on 10, having asked if you snore.

              Other clinics use neck size, BMI - I've even heard of waist measurement being used to 'calibrate' a machine.

              Do ANY of them use AHI, adjusting pressure over a period of a few weeks?

              TF
              Respironics REMstar 'M' Series APAP.
              Resmed Mirage 'Quattro FX' Full Face Mask with a 'Quattro' headgear.

              Comment


              • #8
                After my home sleep study I had 5 or 6 nights (trial of cpap) with a reactive cpap driver and the Tech used the information from that machine to individually program me a machine at 10.6 and then reviewed me in clinic 3 months later.

                I'm shocked to learn that other units use a less scientfic approach, guess I'm really lucky to have such a great unit.

                Ashington General Hospital, Northumberland

                Comment


                • #9
                  I have to say that I was surprised at how little intervention there was in setting up my pressure. They used a spreadsheet to determine the initial setting (unfortunately I couldn't see it!) and two months later they used a pulse oximeter for one night's follow up; and told me I was fine.

                  I don't regard an AHI of 10 as fine!

                  Anyway, I'm moving in the right direction. From a "diagnosed" pressure of 11.2 and AHI of 10 I'm now at a pressure of 12.8 and AHI of 3.5. I'll leave it at that for a few days and see how it goes.

                  From browsing through the scientific literature I think that APAP really should be the norm. The pressure one requires seems to vary depending upon all sorts of factors: your sleeping position, what you ate, what you drank, the temperature, and the list goes on.

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                  • #10
                    That needs the manufacturers to bring the price of APAP machines down, the main difference between them and the newest CPAP machines that have flex is going to be software, all the flow and pressure metering is in there already in a CPAP, snore can be detected from the pressure sensor or from adding a microphone, the extra electronics do not justify the cost difference but the extra software and development has to be paid for.

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                    • #11
                      Time for me to chime in!

                      At my clinic they used a home sleep study to determine if I had sleep apnoea, including an oximeter to determine how many apnoeas were occurring. Once sleep apnoea has been confirmed I was sent home with an APAP to determine the pressure needed to keep my airway open. This was then replaced by a CPAP set at the required pressure.

                      In my opinion the above sounds like a much more logical approach to determining how much pressure is needed to keep a patient's airway open rather than taking neck & waist measurements and checking these against a spreadsheet. On the one hand these measurements may enable a doctor/consultant/sleep technician/whoever to make an educated guess about the pressure required, but surely it makes better sense to know the required pressure for certain?

                      With regards to the APAP vs CPAP debate, I have mixed feelings about this. On the one hand I have to admit that I find an APAP to be much more comfortable to use, especially as it doesn't tend to be blowing at full pressure as I'm waking up. From an aesthetic point of view the S9 looks much nicer than the S8, and as a techy geek I also like all the bells, whistles and information logged by an S9. On the other hand, I vaguely recall being told by the clinic or another forum member that because an APAP has to wait for an apnoea to occur before it increases the pressure to compensate, it is not as effective as a CPAP in preventing apnoeas from occurring in the first place. I suppose an APAP could be configured with the minimum pressure set to that needed to keep the airway open, but if you're going to do that wouldn't you be better off with a cheaper CPAP set to the correct pressure anyway?


                      Cheers

                      shuckie x

                      Comment


                      • #12
                        manuals

                        If anyone would like manuals or info on setting their machine they will get it @ http://s7.zetaboards.com/Apnea_Board/forum/16411/:)

                        Comment


                        • #13
                          You can't read data based on averages and apply it to your very individual self.

                          Some hospitals don't consider an AHI of 10 to be a problem. Others target sub 5.

                          But you have to remember, some people have an AHI/ODI of 15 and have absolutely no daytime symptoms. Some of those don't get any problems with their health from it either.

                          Others can have an AHI/ODI of 5 and feel terrible.

                          So it's not a case of "everybody should aim for sub 5". It's more a case of "Get used to CPAP, get a stable AHI/ODI, take stock of how you feel, make tweaks elsewhere in your lifestyle, now figure out whether it's realistic to aim higher, can you still feel better at all?"

                          Then you may decide whether say AHI/ODI of 5-7 is good, or bad for YOU.

                          It'll get progressivley harder to reduce the AHI/ODI. Pre CPAP, you could have an AHI of 120 and reduce it to 20 just by turning on the blower. But to get from 20 to 4, you need to open your box of tricks and knuckle down, milking every last bit of advice out of this forum. There's a tipping point somewhere, varying per person, of where the extra efforts and investments yield benefits.

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