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AHI increased since starting Auto CPAP
#1
AHI increased since starting Auto CPAP
Hi all - I'm new to this forum and the world of sleep apnea.  I have a Respironics DreamStation with a ResMed AirFit full face mask.  I was diagnosed with sleep apnea a few months ago but, unfortunately, never had an in-lab sleep study and insurance denied my Dr's request.  My home sleep study indicated I had an AHI of 19.1  I've been using my CPAP for a week and have an average AHI of 30 (High 35 and low 27).  Dr has no explanation why this would happen and will request an in-lab study again.  Curious if anyone else experienced this issue.  Getting a little discouraged . . . seems nothing goes smoothly for me!

I've learned so much from this forum in just a week. Thanks for all your input!
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#2
RE: AH I increased since starting Auto CPAP
The home sleep study can be inconclusive on some results that a full polysomnogram will reveal. I believe that the doctor isnt speculating on anything and an in lab study will provide more data (evidence) that will clarify some of the details required to determine the appropriate actions to take as far as prescription and what in fact are all the parameters a lab report can possibly include. I would get the lab study done for sure.
Jesse


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#3
RE: AH I increased since starting Auto CPAP
ccmac, we need to know which model CPAP you have. The model number will be DSX200, 400 or 500. If it is the 400 (fixed) or 500 (auto) you can get full efficacy data using the SleepyHead software.

It would help us to help you if your would let us know what your machine pressure settings are, and what kind of apnea events DreamMapper is identifying. I believe along with AHI, it breaks down the results for central, obstructive and hypopnea events. You can actually take a screenshot of your DreamMapper results and post them as an attachment on the forum. The Organizing your Charts link in my signature shows how. The Pro and Auto CPAPs also provide a report of the apnea type on-screen. CPAP can effectively treat obstructive sleep apnea, but if you are having central events, you have the wrong machine.

If you cannot get good data with the machine you have, then call your doctor and inform him that your events with CPAP have doubled from your diagnostic study. Given this terrible result, my recommendation is that you discontinue use until your doctor and supplier come up with a plan to provide effective therapy by scheduling an appropriate titration sleep study. I think it is pretty obvious that we submit to therapy with the idea of improving our health. In your case, clearly the opposite has occurred, and your doctor needs to reconsider his approach. Where have I heard "First do no harm" (primum non nocere).
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: AH I increased since starting Auto CPAP
I should think it encouraging that your physician seems to be hearing what you say and is open to prescribing a proper diagnostic regimen of some kind.  A proper sleep diagnosis in a controlled setting will provide a lot of information which your insurer insist they need, per their policy, in order to offer you compensation and other support.  I would look at this drawn out experience as a journey toward better health, even if it is substantially different from others' experiences.  With your own determination and firm hand, and their good will, you should come out ahead before long.

Good luck, and hang in there.  Virtually none of us, here or on other sharing fora, have an easy time with the realities of our own customized treatment initially.  Later, it will all be second nature.
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#5
RE: AH I increased since starting Auto CPAP
Hi ccmac,
I had a very similar start to my PAP therapy. Within a very short time it was resolved. It may take some time to get into the in-lab study.
I would encourage you to follow Sleeprider's suggestions. Without the data we can only speculate. With the data from the machine, displayed by Sleepyhead, some members can determine a lot.
There is a very good chance your issue maybe resolved before you get into the sleep study if you follow through with the data.
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#6
RE: AHI increased since starting Auto CPAP
Hi ccmac,
WELCOME! to the forum.!
Hopefully, you get your CPAP therapy on track for better sleep.
Good luck on your sleep apnea journey.
Hang in there for more responses to your post.
trish6hundred
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#7
RE: AHI increased since starting Auto CPAP
I had/have a similar experience with over 2 years of APAP therapy with a Respironics System One and then a DreamStation. 2 sleep/titration studies (and 2 sleep centers) showed untreated AHI of 23 (w/ only rare centrals) and prescribed treatment at 7cm with full face mask due to being a mouth breather. Doctor recommendations over 2 years have had me up to 14cm, but eventually settled to a recommended APAP 7cm-10cm. Reported AHI ranges from 10 to 65, with an average AHI of low 30’s (yes, you read that right). 90% pressure has always hit the APAP Max (currently 10cm). Breakdown of apnea events per night are: clear airway 3-79; obstructive 1-56; hypopnea 58-303.  Average obstructive are in mid 20’s. Doctor has no answers other than “ignore what the machine reports - I don’t trust them.

Desperate, I went to an ear, nose throat specialist who said I had a slightly deviated septum and enlarged turbinates. 1 week after turbinate reduction surgery, AHI dropped to 3.3-11 w/ 90% pressure remaining at 10cm. I am now trying a ResMed AirSense 10 and AHI instanstly dropped to 2.8-4 w/ 90% pressure of 8cm. 

Not sure what to make of all this, but I don’t wake up congested anymore and the ResMed seems to work much better for me. I may be a rare exception, but, I don’t trust sleep centers. If the prescribed treatment doesn’t work for you, they don’t seem to know what to do.
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#8
RE: AHI increased since starting Auto CPAP
(03-12-2018, 04:04 PM)jmortensenjr Wrote: I had/have a similar experience with over 2 years of APAP therapy with a Respironics System One and then a DreamStation. 2 sleep/titration studies (and 2 sleep centers) showed untreated AHI of 23 (w/ only rare centrals) and prescribed treatment at 7cm with full face mask due to being a mouth breather. Doctor recommendations over 2 years have had me up to 14cm, but eventually settled to a recommended APAP 7cm-10cm. Reported AHI ranges from 10 to 65, with an average AHI of low 30’s (yes, you read that right). 90% pressure has always hit the APAP Max (currently 10cm). Breakdown of apnea events per night are: clear airway 3-79; obstructive 1-56; hypopnea 58-303.  Average obstructive are in mid 20’s. Doctor has no answers other than “ignore what the machine reports - I don’t trust them.

Desperate, I went to an ear, nose throat specialist who said I had a slightly deviated septum and enlarged turbinates. 1 week after turbinate reduction surgery, AHI dropped to 3.3-11 w/ 90% pressure remaining at 10cm. I am now trying a ResMed AirSense 10 and AHI instanstly dropped to 2.8-4 w/ 90% pressure of 8cm. 

Not sure what to make of all this, but I don’t wake up congested anymore and the ResMed seems to work much better for me. I may be a rare exception, but, I don’t trust sleep centers. If the prescribed treatment doesn’t work for you, they don’t seem to know what to do.

Post some charts including close-ups of the flow rate chart during events.  Your doctor may not trust them, but research shows they are pretty reliable.  I don't read the AHI and assume it is absolutely correct, and I often see obstructive and central apnea issues confused by the machine, but you still have moderate to severe sleep apnea with your treatment, and your machine thinks you have complex apnea.  I think you may need a new doctor that doesn't reject machine data without good reason or clinical evidence.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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