Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

AHI spiking - what could be the cause and what to do now
#1
AHI spiking - what could be the cause and what to do now
3 year anniversary of using the Philips Respironics DreamStation.
 
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:
 
[Image: Gfha43E.jpg]
[Image: zGJ6Ahx.jpg]
[Image: 2NKhXWQ.jpg]
[Image: QCMQWyw.png]
[Image: 4EpvPW6.png]
[Image: aFo93C1.png]
[Image: znUJeTm.png]
[Image: ILuLDdy.png]
[Image: YTxR6NC.png]
[Image: 3Gvy1ik.png]
[Image: PiYMpzC.png]
 
Dropped pressure to 8.0 for fear the added pressure was causing all this:
[Image: unxct9l.png]
[Image: pfPoPGB.png]
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: AHI spiking - what could be the cause and what to do now
Okay, so my AHI #'s have been remaining fairly steady the last few days in the mid 3's. PB is still higher than normal. CA is <1.00. But I initially got better AHI @ 8.00. 

Should I re-try @ 8.50 or stay the course @ 8.00?
Post Reply Post Reply
#3
RE: AHI spiking - what could be the cause and what to do now
You are on cpap mode, have you tried auto instead?
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
Cervical Collar  
Mask Primer 
Dealing w DME
Post Reply Post Reply
#4
RE: AHI spiking - what could be the cause and what to do now
with 42 plm/hr & 3 plm arousals/hr noted in your sleep study, I'd consider plm as a potential source of your pb, some events & any residual tiredness you feel.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: AHI spiking - what could be the cause and what to do now
As indicated in my original post, I was on APAP for the last couple years and recently switched to CPAP.

PB seems to increase with increased pressure. I tried 8.50 last night, while my AHI was @ 2.91, my PB shot up to 13.56. Have no idea what is going on.
Post Reply Post Reply
#6
RE: AHI spiking - what could be the cause and what to do now
Spikes in PB are still a problem. Here, we see it increase with testing out increased pressure last night. 
[Image: DBZhDvq.png]
 
I did not show CSR or CSA on my titration from last month. I assume that CSR is the same as PB on the titration study?
 
I don't what to make of these findings.
 
I go in for another titration tomorrow to determine whether BIPAP or ASV will better serve me than what I've already tried and now seem to not be stabilizing (APAP, CPAP). 
 
 
Post Reply Post Reply
#7
RE: AHI spiking - what could be the cause and what to do now
pressure can induce ca. pb is not csr, more often than not. post a 10 minute view in a pb area inluding some ca for a closer look. note that plm is periodic, repetitious. took me a couple years to figure out much of my pb is my response to plm. if not plm, you may well do better w asv but bilevel won't treat ca and pb.
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: AHI spiking - what could be the cause and what to do now
(Yesterday, 03:26 PM)sheepless Wrote: pressure can induce ca. pb is not csr, more often than not.  post a 10 minute view in a pb area inluding some ca for a closer look. note that plm is periodic, repetitious. took me a couple years to figure out much of my pb is my response to plm. if not plm, you may well do better w asv but bilevel won't treat ca and pb.
Don't know if this is any better:


[Image: WpApDnF.png]
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  [Treatment] Snore/Spiking graph data/Sleepyhead johnprz 4 1,769 09-04-2014, 11:13 AM
Last Post: NickDanger


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.