AHI higher with migraine or when sick? Doc doesn't care

[Daisylouu]

My numbers are never good. My doc doesn't seem to care at all as long as im compliant. I was very sick yesterday with a severe headache and nausea, not sure the cause - although neurologist thinks my sporadic bouts of brief severe vertigo are tia's. Do things like this cause high AHI's like mine was last night? I'm usually around 5 and last night was 15!

[Ghost1958]

Looks positional to me.
Hybrid masks and ffm most times need narrow pressure range and higher pressures .

Your max is borderline high enough but your min should be at least 10 looks like.
If you could get on nasal mask or pillows youd have better numbers at lower pressures.
Not everyone can though.
Ive not noticed being sick really changing much unless ive been given some med that really konks me out.

[Daisylouu]

I have a Liberty mask, it covers my mouth and has 2 nasal pillows in my nose. Is this what you think is best? The reason I have this mask is because I'm a mouth breather, but I also have had a severely broken nose, and can't have anything resting on the bridge of my nose

[PaulaO2]

Yeah, my suggestion is to move that minimum up to about 8 or 10.

With the OA events happening so suddenly like that and in such a short time frame, I agree that it is most likely positional. You rolled onto your back.

As for migraines and AHI, mine tend to be all over the place. Some nights the AHI is very high, some nights it is gloriously low. Sometimes the medication makes no difference, sometimes it does. I can never find any rhythm to it. One migraine specific medication always cause my CA index to rise dramatically (while not really working well on the migraines) so I stopped it.

[Ghost1958]

I have a Liberty mask, it covers my mouth and has 2 nasal pillows in my nose. Is this what you think is best? The reason I have this mask is because I'm a mouth breather, but I also have had a severely broken nose, and can't have anything resting on the bridge of my nose

Daisy, if you truely cant use a chin strap and pillows, there is another mask that works very well that doesnt sit on your nose. The Fitlife.

It was my first mask. Its look puts some folks off from trying it, but its a very comfortable mask. I could and can get decent numbers with one. In the 2 to 3 ahi range, just have to run higher pressures with it. But that goes for any FFM vs pillows or nasal masks.
As Paula and I mentioned you need your min pressure higher, probably 10 min. Probably need to set your PR resistance setting at 0 with the Liberty.
As for the Fitlife they arent expensive and are very durable. Last a year with a min of care. Seal well at hgher pressures also.
And doesnt touch your nose at all. Its a Respironics mask and the PR resistance setting for it is x1.
I use an Eason now with less pressure because I finally learned to keep my mouth shut with no strap lol.

[eseedhouse]

I think we should remember that our body is not a fixed thing. It changes every day in response to the environment, what it is fed, how much stress it undergoes, and so on. We cannot expect it to respond exactly the same way to positive airway pressure under all circumstances. Also, every measurement has a margin of error, so even if our bodies didn't change the reported measurements would.

Astronomers were among the first to understand this when they tried to measure the exact position of a star. From night to night the exact same star would measure a different position relative to background stars. They learned to average the results over a long time to narrow down the spot where it really is, but there are always small errors that can't be averaged out this way. So they will say things like "we are 95% confident that the star is at this co-ordinate to within a radius of x arc seconds".

If our AHI stays below 5 most of the time and we are also feeling better with the PAP working, then it's not reasonable, to my mind at least, to worry about changes of less than 1 in our AHI. Not that reasonableness ever stopped anyone from worrying, least of all me!

[Want2SleepInMT]

I think we should remember that our body is not a fixed thing. It changes every day in response to the environment, what it is fed, how much stress it undergoes, and so on. We cannot expect it to respond exactly the same way to positive airway pressure under all circumstances. Also, every measurement has a margin of error, so even if our bodies didn't change the reported measurements would.

Exactly this. I had a discussion with my DME RT (away from our respective workplaces where we could "unofficially speak off the record") and what he said was that it makes more sense for people to be on auto machines, which can alter its actions based on patients needs. He said my Sleep Clinic Doc is "old school" in that they rely on titration from the sleep study for a set pressure, which is all well and good, in that room, in that bed, with all the probes taped to us. The machines of old that were auto tended to chase leaks more often than they were chasing events. This led the old school guys to shy away from auto on most people. My RT doesn't care what I do other than compliance levels to keep the insurance company happy and paying, and my Sleep clinic doc, and PA-C handling me, doesn't care that I change my own settings, as long as I keep her informed as to what settings I am messing with, and keep within "XYZ guidelines." that way she can update a prescription and her notes as necessary.
I can really tell the difference on pressure needs from one night to the other, and if I have taken imitrex, or had too much caffeine, or am sick etc. Also, I seem to alternate from my higher pressure, to lower pressure, and back again....... I should probably change my info to reflect the current settings!

[Sleeprider]

Daisylouu, that chart reflects a lot of pain. Not only is your AHI very high, but your RERA suggests you don't sleep well. I can't imagine how bad you must feel. Your starting pressure of 5.0 is not preventing the obstructive events when they start, and the pressure never catches up. The events are obstructive and will require higher minimum pressure to stop, so I agree with Paula your minimum pressure is probably around 10.

You can slowly increase your minimum pressure, or use Ramp to give yourself a chance to fall asleep before the higher pressures occur. Many of us use much higher pressures than even your maximum on the chart above. You reached 15.4, which is pretty typical for my IPAP pressure.

With AHI this high, you are failign APAP, which might not be a bad thing. The next step is to get a machine that can provide the pressure you need, while giving you pressure relief for comfort. A bilevel machine will use a lower exhale pressure and higher inhale pressure. EPAP will need to be titrated to minimize OA events, and IPAP will resolve residual hypopnea and RERA.

It's probably time for you to discuss the ineffectiveness of your therapy with your doctor and inquire about changing to a bipap which will be more comfortable and effective at higher pressures. Be sure to emphasize your desire to make this work and get good treatment. Your leak data is not that bad, and it looks likeyou're putting in the hours. Your pressure is too low. If you can't tolerate higher pressures, bilevel is your next stop. Meanwhile give a minimum pressure of 8.0 a try, and I think it needs to go to at least 10.