Over time, AHI increase has progressed (2-3 avg for the last couple years). I was good up until May, 2020, and then AHI started a faster ascent to an avg of 6.9 in the last 2 weeks. Why the very recent increase remains a mystery. That's what I'm here for, as hopefully someone experienced in reading my data can make some substantive inferences.
I was @ minimum pressure of 5 for last couple years (APAP 5.0-20.0), then went to 6 on APAP for this last year and just increased it to 6.5 4 days ago to see if it would improve when it actually worsened. Such a small adjustment, it's hard for me to believe this much difference.
Another observance which I know can be related but not certain is that around same time the jump in AHI, my PVCs started increasing. I am fully aware that ectopic beats and OSA can go hand-in-hand.
I had a septoplasty/turbinate reduction to correct a deviated septum 12/16. While my nasal airflow and breathing improved, it was limited to mostly the right nostril and many times, I wake with zero airflow in the left nostril. This, I believe, also contributes to sleep-disordered breathing.
Mask fit has been consistently 99-100%. I do not drink alcohol, don't smoke, and have not changed any meds (blood pressure, thyroid), supplements or diet. My weight is pretty much the same as it was last year, maybe a couple lbs heavier.
Following my last titration, after about 11 days @ 8.0 pressure with AHIs averaging in the mid 3's, but with stable heart sinus rhythm and minor PB/CA levels, I decided to titrate up a notch to 8.50. My AHI dropped dramatically (see below) which inspired me move forward at this pressure. I held steady and moderately felt a better sense of well-being.
After only 3 days @ 8.50, my AHI started creeping up incrementally again. At the same time, I started noticing a slight rise in ectopic beats (PVCs) again, followed by a noticeable sudden spike in PB as detailed in the snapshots below.
Though I've had a history of benign ectopic beats (premature ventricular contractions or PVCs) over the last couple years, there has been no evidence of heart failure (recently had a normal echocardiogram).
During the time noticed an onset of ectopic beats, I also noticed an increase in blood pressure and fasting blood glucose - all can be dead ringers for nocturnal hypoxia.
I typically do not feel as well when my AHI is >2.0 + I start to feel more irritable and tired.
If the slight increase in pressure from 8.0 to 8.50 didn't produce an increase CAs, then it can't be triggering CSA, correct?
So as my pulmonologist goes by symptoms and not readings which, based on my latest readings/symptoms, he felt I was not optimally treated via CPAP 8.0 or higher and advised to do yet another titration study to trial BIPAP and failing that, ASV. He emphasized that readings are mostly for insurance cos. Only thing I can say is although I hate overnight studies as I never can sleep well, I pay zero, as insurance covers it all. I cannot pinpoint what has changed recently to cause such disruption in my AHI and accompanying heart rhythm. Only thing I can think of is a slight increase in weight over the last few months.
My cardiologist is out of her league when it comes to other than the basics of OSA. For heart issues - in the absence of any CHF, she feels strongly that it's all about hypoxia during sleep, especially during REM. For CPAP pressure/settings and changes in AHI, PB, CA, etc. is where she will defer everything to the pulmonologist and he, as already stated, which will default everything to a titration study.
Do I really need yet another in-lab titration? I realize that hacking my own pressure settings and observing over a few days sounds way better than an in-lab titration where they set a pressure and observe for minutes (in a foreign bed and environment where I can barely sleep), but it can be potentially harmful.
Initially, yes, my AHI dropped dramatically, but the honeymoon was over in a matter of days, and the AHI starting shooting up again, along with the PVCs.
As long as the CA readings don't increase by much, then should I still be concerned? Is it possible the added pressure eventually causes the lung to over-inflate and somehow irritate my heart's sinus rhythm?
Thoughts?
Most recent titration - no incidence of CSA:
Dropped pressure to 8.0 for fear the added pressure was causing all this: