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What It Really Means to Be in a Coma


Coma: Types, Causes, Treatments, Prognosis

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The word coma has terrifying connotations to most people. Many people have learned almost all they know about coma by watching television, where coma is a condition from which recoveries are both predictable to viewers and miraculous to the characters. In reality, depending on the cause and severity of the coma, a recovery can be almost guaranteed or extremely unlikely.The definition of coma is any condition where the patient is unconscious with their eyes closed and unable to be aroused by even vigorous or painful stimulation. This is not the same thing as sleeping since the brain does not go through the normal activity associated with sleep during a coma. Whereas someone who is sleeping may move if they are uncomfortable, a comatose person will not, except for spinal reflexes.Note that by this definition, doctors frequently put people into coma intentionally every time they use general anesthesia for a surgical procedure. Similarly, many people in hospitals take a long time to rid their body of foreign substances, whether those substances are medications or infections. In these cases, we would expect the person to wake up when the body finally rids itself of the infection, medication, or toxin.On the other hand, there are forms of coma from which it may be impossible to wake. Contrary to what we used to think, nerve cells can regenerate, but they do so only in specific parts of the brain, and even then, very slowly. If enough nerve cells die in a region that is essential for maintaining wakefulness, such as the thalamus, brainstem, or large areas of the cerebral cortex, then the person will probably never regain normal consciousness.

The Other States of Unconsciousness

While everyone seems to focus on coma, there are even more severe states of unconsciousness. For example, some types of coma are eventually replaced by what is called a vegetative state. Whereas comatose patients appear to be sleeping, people in a vegetative state regain some degree of crude arousal, resulting in the eyes open. The eyes may even reflexively move, appearing to gaze at things in the room. However, people in a vegetative state do not show any true awareness of themselves or their environment. If the brainstem remains intact, the heart, lungs, and gastrointestinal tracts continue to function. If this condition lasts for months, the patient is considered to be in a persistent vegetative state.Brain death is an even more severe situation in which the functions of the brainstem are compromised in a comatose patient, and someone can no longer even breathe on their own. The unconscious patient’s ability to increase or decrease their heart rate appropriately may also be affected. There have been no well-documented cases of people accurately diagnosed with brain death who have had any kind of meaningful recovery. While a qualified physician can make a diagnosis of brain death based on the physical exam alone, given the seriousness of the diagnosis, some families prefer to have additional tests done as well. However, if the bedside exam can be done completely and accurately, additional tests are unlikely to show any new or more hopeful information. If an autopsy is done on a brain-dead patient, many cells of the brain will have wasted away.

The Minimally Conscious States

Because of the severe prognosis of these conditions, neurologists hope to find a sign that their patient may actually not be in a true coma or vegetative state, but rather in a minimally conscious state. Minimally conscious states still signify a severe deficit in awareness, but there is at least some glimmer of preserved awareness of the self or the surrounding environment. This may be a clearly reproducible ability to follow simple commands, appropriately give yes/no responses, demonstrate purposeful behavior such as appropriate smiling or crying, or adjusting their hands to the size and shape of held objects. In general, people in minimally conscious states have much better outcomes than patients in sustained comas.Determining whether a person is in a minimally conscious state or a coma is more difficult than one would initially think. A comatose person may move in ways that seem like they are awake, misleading friends and family. For example, comatose patients may grimace if a painful stimulus is applied to a finger or toe. They may even appear to pull the limb back away from such pain. In what is called Lazarus syndrome, an especially strong reflex can lead a comatose patient to sit upright. However, these responses are just reflexes, similar to what happens to your leg when a neurologist taps your knee with a hammer. Such movements do not necessarily mean that someone is awake.


When most people ask if their loved one is in a coma, what they really want to know is how soon the patient will wake up, if ever. As you’ve seen, this can vary depending on the cause and severity of the unconscious state. For example, coma due to traumatic brain injury tends to have a better prognosis than coma due to cardiac arrest. Younger patients tend to do better than older ones. Someone in a drug-induced coma may wake naturally as the drug is cleared from their system, whereas someone with a permanent brain lesion may progress to a persistent vegetative state or even brain death. In general, the longer someone remains unconscious, the less likely they are to recover their alertness.However, even the guidelines above can be something of an oversimplification. Neurologists can make predictions about the future, but this is not the same as a metaphorical crystal ball. Unfortunately, the only way of knowing for sure whether someone will recover from a coma is to wait for a reasonable amount of time and see. How much time to wait can be a hard decision, depends on the unique circumstances of the patient and their family, and should be discussed carefully with the entire medical team.

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How Sinus Infection Is Treated


Sinus Infection | Causes, Symptoms & Treatment | 

The treatment for a sinus infection depends on the type of sinusitis and the source of the inflammation or infection at its root. Acute viral sinusitis can resolve on its own and treatment is only for symptom relief, while acute bacterial sinusitis can usually be cured with a round of antibiotics. Treating allergies that might be contributing to an acute or chronic sinus infection can also help.

Chronic sinusitis may be a bit more complicated, as diseased or abnormal tissue may be blocking the sinus cavities and require surgery.

If a fungus, rather than a bacterium, has grown inside of the sinuses, anti-fungal medications and endoscopic surgery may be needed to clear it out.

Home Remedies and Lifestyle

There are quite a few at-home remedies that can greatly reduce sinus infection symptoms. Saltwater nasal irrigation is one of the treatments of choice for the symptoms of chronic sinusitis in adults, though studiesshow no benefit for children. Nasal irrigation is easy to do at home using a neti pot or other sinus rinse methods.Using a steam vaporizer or a warm or cool mist humidifier may help keep your mucus thin. Inhalation of steam mixed with eucalyptus, chamomile, or peppermint may also help. While there’s no scientific research that these additives improve symptoms, you may find them soothing. (Note: Hot vaporizers are a burn hazard and should not be used around children.)

Other helpful tips:

  • A hot shower will relieve pain, promote drainage, and open up the sinus cavities.
  • Reduce facial pain and swelling by applying a warm compress to your face.
  • Drink lots of fluids and get plenty of rest.

Over-the-Counter Therapies

With the exception of antibiotics and anti-fungal medications, which are prescriptions, any medications recommended for sinusitis are for symptom management and not to cure the infection. The main symptoms most seek to treat are related to sinus pain, congestion, and allergy relief. Even though many of the medications listed below are available over-the-counter, you should always check with your doctor or pharmacist before taking a new medication or combining medications.

Sinus Pain Relief

Sinusitis can cause headaches, toothache, and pain and pressure in the face. Over-the-counter pain relievers can be helpful in managing the discomfort and include:

  • Tylenol (acetaminophen)
  • Advil, Motrin (ibuprofen)
  • Aleve (naproxen)
  • Aspirin

Some of these medications can be combined; for example, most healthy adults can take both acetaminophen and ibuprofen simultaneously, as long as they follow the dosing instructions included in the package. It’s typically recommended that ibuprofen and naproxen not be combined, as the action of these two drugs is very similar. Aspirin is a potent blood thinner and should not be taken by anyone who is already taking blood thinners, or by people with certain high-risk conditions. Aspirin should not be given to children due to the risk of Reye’s syndrome.If your symptoms become worse after taking aspirin, you may be one of the unlucky few that have aspirin intolerance that actually aggravates the symptoms of sinusitis. Indications include feelings of tightness in the chest, wheezing, cough, and sudden nasal congestion within a few hours of taking aspirin, ibuprofen, or naproxen. If you suspect you might have this condition, avoid taking these medications and use acetaminophen instead.If over-the-counter pain relievers are not effective in controlling pain, consult your doctor.

Nasal Congestion Relief

Nasal congestion, runny nose, and postnasal drip can all be symptoms of sinusitis. Saline nasal spray and Mucinex (guaifenesin) work to thin your mucus and help it drain easier, which may help to relieve congestion. Like other methods of nasal irrigation, a saline nasal spray is recommended for adults with acute bacterial sinusitis and chronic sinusitis.There are a variety of over-the-counter decongestant medications available to control symptoms in those with chronic sinusitis.

Use should be limited to three to five days to avoid rebound congestion, which happens when the body reacts to the decongestant wearing off by producing increased swelling.

Decongestants are not recommended for adults or children with acute sinusitis, as studies have shown no benefit. Examples of decongestants include:

  • Afrin (oxymetazoline) nasal spray
  • Sudafed (pseudoephedrine)
  • Sudafed PE (phenylephrine)

There are also over-the-counter steroid nasal sprays that can help treat congestion, especially with chronic sinusitis. These need to be taken over a longer period in order to get the full benefit. They are safe to use daily for an extended time. They include:

  • Flonase (fluticasone)
  • Nasacort (triamcinolone acetonide)


Antihistamine medications may work to “dry up” mucus, but they’re most effective in people who develop sinusitis as a result of allergies. As with decongestants, they are not recommended for adults or children with acute bacterial sinusitis. Some antihistamines cause drowsiness, which may also be beneficial if you’re unable to sleep at night because of bothersome symptoms. If you are looking for an antihistamine that can also help you rest, the following are known for causing drowsiness:

  • Benadryl (diphenhydramine)
  • Unisom (doxylamine)

The following antihistamines are considered non-drowsy:

  • Allegra (fexofenadine hydrochloride)
  • Claritin (loratadine)
  • Zyrtec (cetirizine hydrochloride)

Antihistamine nasal spray is also available. These drugs do not pose a risk of rebound congestion.While medications can be helpful in treating sinusitis, you may also need to try other suggestions, like nasal irrigation or lifestyle changes, to decrease symptoms of sinusitis.


Your doctor may prescribe medications that can help relieve symptoms as well as treat the underlying cause of the sinusitis.

Prescription Steroid Medications

If the over-the-counter steroid nasal sprays do not work for you, you may respond better to prescription steroid medications, including:

  • Nasonex (mometasone)
  • Rhinocort (budesonide)

These are steroid nasal sprays that work to open up the nasal passageways by relieving inflammation. They are superior to steroid medications taken in pill form because they don’t have as many side effects throughout the body. That said, if nasal sprays are not effective in treating your congestion, your physician may prescribe an oral steroid (prednisone). Oral steroids are preferred for allergic fungal sinusitis.Steroid nasal sprays, drops, or oral corticosteroids may also be used if you have nasal polyps that are contributing to the sinusitis. There is no risk of rebound congestion with their use.

Leukotriene Modifiers

Another group of oral medications called leukotriene modifiers may be beneficial for some people with chronic sinusitis and those who have sinusitis associated with an aspirin allergy. These prescription medications include:

  • Singulair (montelukast)
  • Accolate (zafirlukast)


Antibiotics are not given until there is an indication that the infection is bacterial rather than viral. Bacterial acute sinusitis is presumed in children and adults when the symptoms are not improving after 10 days, they are severe for more than three days, or there is a double-sickening seen after three to four days (the symptoms got better, then got worse again). A doctor may use a three-day period of observation before prescribing antibiotics to see if there is an improvement without them to avoid prescribing the drugs unnecessarily.Children and adults who are not at risk of having an infection caused by a resistant bacteria may be treated with a regular dose of amoxicillin. Antibiotic treatment in adults should be continued for five to seven days. In children, it should be given for 10 to 14 days.Those risk factors for antibiotic resistance include being under the age of 2 or over age 65; having taken antibiotics in the past month; having been hospitalized in the past five days; being immunocompromised; or having other associated health conditions. Those at increased risk of resistant bacterial infection and those who do not improve on amoxicillin after three to five days may be given high-dose amoxicillin or high-dose Augmentin ES (amoxicillin-clavulanate).Alternatives can include Omnicef (cefdinir), Ceftin (cefuroxime), Vantin (cefpodoxime), or, if someone is experiencing vomiting, a shot of Rocephin (ceftriaxone). For children and adults with a serious allergy to penicillin, Biaxin (clarithromycin), Zithromax (azithromycin), or Cleocin (clindamycin) may be used. Because many bacteria are resistant to older antibiotics, Bactrim (trimethoprim-sulfamethoxazole) and Pediazole (erythromycin-sulfisoxazole) are less likely to be used.People who fail to respond to two antibiotics may be treated with intravenous cefotaxime or ceftriaxone, or referred to an ENT specialist to take sinus cultures or perform imaging studies to look for noninfectious causes.In the case of chronic sinusitis, antibiotics may be used if you have a bacterial infection or if the doctor can’t rule out an infection. The course of the antibiotics might be extended to four to six weeks.

Antifungal Agents

Antifungal medications are usually not given for allergic fungal sinusitis or non-invasive fungal sinusitis (fungus ball or mycetoma). Antifungal medications may be prescribed for invasive fungal sinusitis, along with surgical procedures.

Immunotherapy for Allergies

If your sinusitis is caused or worsened by allergies (including fungal allergy), an allergist can give you allergy shots or oral medications to desensitize you to those triggers. These are customized for each person and steadily increase the amount of allergen to reduce your sensitivity. Desensitization treatment can also be done for those whose aspirin allergy is the cause of their sinusitis.

Specialist-Driven Procedures

Enlarged tissues, abnormal growths, scar tissue, and structural abnormalities can block the sinuses and contribute to recurrent and chronic sinus infections. These often require surgery to treat and may be done by an ENT specialist.Sinus surgery can often be done with an endoscope and is minimally invasive. A tiny fiber-optic tube is passed through the nostrils into the sinus cavities and no incision is needed. It is usually performed on an outpatient basis, but you may receive general anesthesia. While you are usually able to go home the same day, you need to be in the care of another adult for 24 hours and you should not drive.Enlarged adenoids in the back of the throat can be removed by an adenoidectomy, which is often done as a day surgery and is performed through the mouth.Turbinates are structures in the nasal passages that warm and humidify the air you breathe. They can become enlarged and may develop an air pocket in the middle turbinate called a concha bullosa. These problems can be corrected with endoscopic surgery.

You may have a deviated septum, the piece of cartilage that divides your nostrils, due to a birth defect or an injury. A septoplasty surgery repairs this problem. Other facial birth defects (such as cleft palate) or injuries can require surgical correction if they are contributing to sinusitis.
Nasal polyps are benign masses of tissue that can develop due to inflammation and then further contribute to blocking the sinuses and sinusitis. They can be removed with endoscopic surgery. Malignant or benign tumors are less common causes of sinus blockage that can be removed by surgery.
Fungal sinus infections may require sinus surgery to resolve as a fungal ball or invasive fungal infection may not be cleared by antifungal medications alone. Endoscopic surgery can clean out the infectious material as well as any damaged tissues.

Complementary Medicine (CAM)

Nasal irrigation is one CAM treatment that has become mainstream and recommended by conventional medical practitioners for adults with sinusitis. Other CAM therapies/approaches may also be suggested, but there’s simply not enough supporting research to recommend them at this point. Many alternative medicine practitioners believe that food sensitivities can cause sinus congestion and sinusitis, although this is not generally supported by conventional medicine. Sensitivities to dairy, wheat, oranges, or sugar are purported to promote the formation of mucus, and some may consider removing these foods from their diet to see if it helps.As with any alternative therapy, it’s important to discuss the use of these or other such options with your primary care provider first.

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Types of Bunions


Common Types of Bunions

Bunions are bony bumps on the feet that can be very painful and make it difficult to wear shoes without discomfort. Bunions are often caused by ill-fitting shoes and are found in about 30 percent of the population. They’re more common in women and become more likely with age. In serious cases, large bunions may require surgery to remove them. Preventing bunion pain and further inflammation requires selecting the right shoes and socks. Look for shoes with a wide toe box, wide instep, and soft soles that have a smooth surface in the bunion area.You don’t want your foot moving too much within the shoe and rubbing the bunion, but it has to be wide enough to fit. Shoes that have stretchy material in the uppers will often be more comfortable. High-heeled or pointed shoes are not ideal if you have bunions. Here’s how to recognize the different kinds of bunions.

Bunion with Skin Irritation

A bunion with skin irritation.
zlisjak/Getty Images

Some bunions are more severe and cause more symptoms than others. The bump on the side of the big toe joint may be red and painful from rubbing against the shoe. Inflammation of the big toe joint and surrounding area may also contribute to the pain. Sometimes bursitis, an inflamed pocket of fluid, can occur over the bump.Notice the redness of the bump and shifting of the toes outward, all common signs of a significant bunion.

When you have a large, irritated bunion you need to find shoes that have a wide enough toe box. Once a bunion is very large, it’s hard to find shoes that fit and don’t cause further inflammation.

Large Bunion

A large bunion.
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This foot has a large bunion at the big toe joint, as well as a tailor’s bunion at the pinkie toe. A bunion like this is likely to be easily viewed on an X-ray and may make it challenging to find comfortable shoes.

Bunion with Hallux Limitus

A bunion seen with hallux limitus.
Peter Dazeley/Getty Images

This smaller type of bunion is often seen with a condition called hallux limitus, which is characterized by a limited range of motion at the big toe joint. The limited range of motion leads to jamming of the big toe joint, which over time can cause a bunion to develop on the top of the big toe joint.

Another term for hallux limitus is hallux rigidus.

Stiff-soled shoes or styles with rocker soles are often recommended for hallux limitus. Custom orthotics may also help.

Tailor’s Bunion

A tailor's bunion.
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A tailor’s bunion, also known as a bunionette, is a bump that forms on the pinkie toe side of the foot. Like a bunion at the big toe, it is caused by abnormal foot structure or function. The pinkie toe has drifted toward the fourth toe due to the bunion.Tailor’s bunions are most prominent at the head of the fifth metatarsal (the long bones of the foot). Unlike most bunions, tailor’s bunions occur on the outside of the foot rather than the inside. The legend has it that this type of bunion became known as a tailor’s bunion because tailors would sit cross-legged while working, with the edges of their feet rubbing on the ground. It was this rubbing that produced the painful bump on the little toe. But backstory aside, tailor’s bunions are often hereditary.

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What Is the Goal AHI for CPAP Treatment of Sleep Apnea?


Understanding the Results | Sleep Apnea

Continuous positive airway pressure (CPAP) is commonly prescribed to treat sleep apnea, a condition diagnosed via a sleep study. The goal is to improve breathing at night, but how do you know if a treatment such as the CPAP is working well enough? The apnea-hypopnea index (AHI) can be a helpful measure to diagnose the severity of the condition at baseline and track the effectiveness of your treatment.What does the AHI reading mean on a sleep study or CPAP machine? What is considered an event? If the AHI number is elevated, you may ask, “How do I adjust my CPAP machine?”Learn what your goal AHI should be to maximize the benefits of using CPAP for optimal therapy and how the pressures are determined and should be adjusted.

What Is AHI?

First, it is important to understand what the apnea-hypopnea index (AHI) reading means, both with sleep studies and on a CPAP machine.This measurement is often presented within the context of a sleep study report. It is the number of times per hour of sleep that your upper airway (tongue or soft palate at the throat) partially or completely collapses, leading to a brief arousal or awakening from sleep or a drop in blood oxygen levels.The partial collapse of the airway is called a hypopnea.The complete absence of airflow through the nose and mouth, despite an effort to breathe as measured at the chest and abdomen, is called an apnea event.The AHI is used to classify the severity of sleep apnea. This same classification is used to assess how well treatment, such as the CPAP machine, is working.

Children’s sleep is analyzed with stricter criteria and more than one event per hour of sleep is considered to be abnormal.

AHI Measurement in a Sleep Study

A sleep study (polysomnogram) is performed in a sleep disorder center and is typically used to diagnose sleep apnea. It is also possible for the condition to be diagnosed based on home sleep apnea testing.A lot of information is collected, and part of the purpose of these studies consists of tracking your breathing patterns through the night. This is accomplished with several sensors:

  • Nasal oxygen cannula (or thermistor) with plastic prongs that sit in the nostrils
  • Respiratory effort belts that stretch across the chest and/or stomach

An oximeter clip that measures continuous oxygen and pulse rate by shining a laser light through a fingertipAll of this information is analyzed to determine how many times you breathe shallowly or stop breathing altogether during the night. Any partial obstruction of the airway is called a hypopnea. Hypopnea refers to a transient reduction of airflow (often while asleep) that lasts for at least 10 seconds. Shallow breathing or an abnormally low respiratory rate may be called hypoventilation.

A complete cessation in breathing is called apnea (from the Greek meaning “no breath”). Hypopnea is less severe than apnea (which is a more complete loss of airflow). It may likewise result in a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. Sleep apnea is more commonly due to partial obstruction of the upper airway.
In order to count in the AHI, these pauses in breathing must last for 10 seconds and be associated with a decrease in the oxygen levels of the blood or cause an awakening called an arousal. These awakenings may fragment sleep, make it unrefreshing, and lead to daytime sleepiness.
There are some sleep facilities that use other measures to assess this degree of severity. The respiratory-disturbance index (RDI) may be used if a measurement of airway resistance with a pressure esophageal manometer is also included in the study. The oxygen-desaturation index (ODI) attempts to calculate the number of apnea or hypopnea events per hour that lead to an oxygen drop of at least 3 percent. This is thought to be important in assessing the risk of long-term cardiovascular (high blood pressure, heart attack, and heart failure) or neurocognitive (stroke and dementia) consequences.
If your sleep study does not contain these more specific measures, this is nothing to worry about.

Goal AHI to Optimize CPAP Therapy

The AHI will be used to help select the most appropriate treatment. The use of continuous positive airway pressure (CPAP) is appropriate for mild, moderate, or severe sleep apnea. In contrast, the use of an oral appliance may be limited to mild or moderate sleep apnea. Surgery may be selected based on risk factors related to your anatomy. Positional therapy may be suggested if your sleep apnea is worsened by sleeping on your back. Other treatments may be recommended, depending on the level of AHI that is observed with your sleep study.What should your goal AHI be with sleep apnea treatment like CPAP therapy? First, understand that there can be night-to-night variability in this measure. Sleep apnea may be worsened by:

  • Sleeping more on your back
  • Having more REM sleep
  • Using muscle relaxants
  • Drinking more alcohol near bedtime
  • Having nasal congestion due to a cold or allergies
Therefore, it is not useful to chase a daily number. Rather, these variations should be averaged out over 30 to 90 days.
In general, the AHI should be kept at fewer than five events per hour, which is within the normal range. Some sleep specialists will target an AHI of one or two with the thinking that fewer events will be less disruptive to sleep. If the baseline AHI on the sleep study is quite high, such as 100 events per hour, even 10 events per hour may represent a significant improvement.

The types of events registered by a CPAP device may be of three types:

  • Obstructive (airway collapse)
  • Central (representing breath-holding episodes)
  • Unknown (related to leak)

These types have unique resolutions. For example, the CPAP pressure may need to be turned up—or down—or the mask may need fitting or replacement.The optimal goal for you may depend on the severity and nature of your initial condition. It may be tempered by your compliance with treatment, with lower pressures allowed to improve comfort. The best pressure setting for you is best determined by your board-certified sleep specialist with the average AHI used in the context of your experience with the treatment.

How CPAP Machines Treat Sleep Apnea

Modern CPAP and bilevel machines are able to track the residual number of breathing events occurring at your current pressure setting. Each of these events could correlate with a brief awakening or a transient drop in the blood oxygen level.You may believe that using your CPAP will prevent the condition entirely, but this is not necessarily the case. It depends, in part, on the pressure set by your sleep specialist.Imagine trying to inflate a long floppy tube by blowing air into it. With too little air, the tube will not open and it will remain collapsed. Similarly, if the pressure is set too low on your CPAP machine, your upper airway can still collapse. This may result in either persistent hypopnea or apnea events. Moreover, your symptoms may persist because of inadequate treatment.It is also possible that other variables will affect the amount of pressure that is needed to keep your airway open, as noted above.

Tracking Residual Sleep Apnea Events

Newer machines can track your residual abnormal breathing events and generate an AHI. This may be accessible on the device or via associated tracking websites or apps. How is this accomplished?Well, the short answer is that these methods are proprietary, confidential, and are not disclosed by the companies who make the devices. In simple terms, however, consider that the machine generates a constant pressure. It can also generate intermittent bursts of additional pressure. It then measures the resistance within the airway to this additional pressure.If there is no clear difference in resistance between the lower and higher pressures, it is understood that the airway is open. However, if the airway is still partially (or even completely) collapsing, the additional pressure may encounter resistance. In “auto” machines, this will prompt the machine to turn up the pressure within the prescribed range to better support your airway.Remember that this measurement is not as accurate as that which occurs in a formal sleep study. The measurement may be compromised by a high mask leak. If it remains elevated without a good explanation, it may require a repeat sleep study to assess your condition.

The AHI that the machine calculates is then recorded on the compliance data card. Your equipment provider or physician can then download this and generate a report to direct your treatment. It also may be displayed in the morning on the device’s screen or user interface. This information can also be shared to the cloud and provide you with information about the effectiveness of your therapy with related programs.

Pressure Needs and Adjusting a CPAP

As previously mentioned, there are a number of variables to consider when interpreting the AHI reading. It may not be resolved by simply turning the device’s pressure up or down.The needed amount of change may also be complicated. For example, someone with a high AHI on a sleep study may not necessarily require a high CPAP pressure to resolve the condition. Anatomy and other factors may have a role. If the device is turned up too high, it may cause central sleep apnea to occur. If the settings are too low, it may not work well enough to resolve the condition.

If the AHI remains elevated, it is time to return to your board-certified sleep specialist for an assessment.

Your provider can interpret the AHI in the context of your baseline sleep study, anatomy, medications, change in health status, and other factors. This person should be the one to adjust your CPAP machine’s settings. Though the settings can be changed by anyone, only your provider can make an informed decision.If surgery is performed or an oral appliance is fabricated to treat sleep apnea, a test may be repeated to ensure the treatment has been effective in resolving the AHI.

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