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Help with increasing AHI
#1
Hello

I am 44 and was diagnosed with OSA 1.5 yrs back . My first sleep study revealed my AHI was 40. I was tested with CPAP on and the AHI came down to 2.9 . Since on CPAP then, My AHI is pretty much below 2 . From last 2 weeks , I see my AHI is between 3 to 5.5 . Wondering what caused all of a sudden. for last 2 weeks , I am waking up with a feeling that the pressure is high and feeling of suffocation. When i check in the morning , the Max pressure is between 13 to 14 range.
I use Resmed s9 autoset and the machine is set to auto

I did an echo yesterday and the PAP was 45mmHg. I have been doing PAP for last 4 yrs . 4 yrs back was 35, then 30 , then 35 and this time 45 . Last yr PFT showed my
lung capacity as 72%. 4 yrs back it was 62%. I quit smoking and that improved my Lung capacity . Also PFT revealed mild restriction and did a CT of lungs 4 yrs back and everything came out normal . Restriction is there every time I do PFT .

Family history, My Mom had ILD and passed away and My Dad has COPD and he is so far doing ok .

I will be meeting my Pulmo soon, But want to hear if anyone in the same boat or any expert comments as I am little concerned .

Thanks in advance
Raz
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#2
Hello, Raz. I am not sure I understand from your post - do get 90% or 95% pressure values from your machine or in ReScan? If you do, posting those values here would be helpful. (Typical value when your AHI was below 2 and a recent value.)

If you want to download the SleepyHead software (link at the top of this page), you will be able to see detailed daily graphs of your apnea events and your machine's pressure response, plus lots of other data.

I don't have the knowledge to respond to the rest of your post, so I will leave that for someone else.

(06-11-2016, 01:09 AM)razheev Wrote: Since on CPAP then, My AHI is pretty much below 2 . From last 2 weeks , I see my AHI is between 3 to 5.5 . Wondering what caused all of a sudden. for last 2 weeks , I am waking up with a feeling that the pressure is high and feeling of suffocation. When i check in the morning , the Max pressure is between 13 to 14 range.
I use Resmed s9 autoset and the machine is set to auto

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#3
Razheev, it might be possible to improve results and reduce AHI back to your normal baseline, it could even happen without intervention. It would help to know what kind of events is contributing to your AHI and if that is distributed through the night or if it is clustered at certain times. It makes no sense recommending setting adjustments without knowing what is going on. Also, are you using your exhale pressure relief feature (EPR)?

Free Sleepyhead software mentioned above will give you that information.
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#4
Thanks sleeprider .

My EPR is set to fulltime , 3 . I am using both Sleepyhead and Rescan .

If I look yesterday, which was probably the highest since 1 year with AHI of 5.98

Date Sleep Wake Hours
10-06-2016 22:54:25 05:26:03 06:31:07
Clear Airway 1.38
Unclassified Apnea 0.00
Obstructive 4.14
Hypopnea 0.46

Clear Airway 9 events
Hypopnea 3 events - 20,12,24
Obstructive 27 events

I dont know how to upload the report to this post.

Thanks
Raz

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#5
That helps quite a bit. With the predominately obstructive events, an increase in minimum pressure is indicated. I would suggest that your Autoset is being run wide open, and this is rarely the most effective mode. Your minimum pressure is currently 4.0. It will work much better if you adjust it up to your average or median pressure as indicated by the data. Your therapy pressure is probably close to your 90-95% pressure, so the median is a conservative move. Increasing the minimum pressure will put the machine closer to the pressure you need to avoid obstructive events, and will probably bring you right back to less than 2 events per hour, and may actually improve on that.
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#6
Hi razheev,
WELCOME! to the forum.!
Much success to you as you continue your CPAP therapy.
trish6hundred
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#7
Thank you much All.

I will bring it up When I meet my Pulmo next week and try to adjust my starting pressure to the Mean as you suggested .

I have read that OSA causes increase in Pulmonary artery pressure and our OSA need to be controlled
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#8
Has anything changed in your life in the last two weeks? Drinking alcohol, medications, allergies, local air pollution, stress -- there are many things that might affect AHI. With the settings you are using, increases in events will prompt the machine to continue increasing the pressure and that is likely what wakes you. I know it wakes me up! Using SleepyHead to get some idea of what is going on is a very good idea.
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