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High AHI with CPAP
#1
Question 
High AHI with CPAP
Hello all.
 
This is my first post since joining in early July, I was hoping to dip my toe in here or there in other threads, but I need some help as I am at my wits end... I'll apologise now as this may be a long read.

I have been using my Resmed Airsense 10 Autoset CPAP since 24th June 2021 after having a sleep study where I was told I have both Obstructive and Central Apnoea along with some other Sleep Disorders and that my AHI was 84.2, the breakdown between them, I do not know as I requested a copy of the results but haven’t been given them yet.

Although my AHI has decreased slightly, I am still having far too many, and I am finding it very hard to find a mask that doesn’t cause more sleep disturbances.

I was given a Resmed Airfit P10 Nasal Pillows mask first but as I was also diagnosed with Catathrenia/Sleep Groaning I kept opening my mouth causing air leaks spikes and the noise would wake me. After some research and asked for an Airfit F30i which I hoped would be perfect, but  it would wake me repeatedly over the course of the night with the dreaded “Mask Farts” and  no matter how much I adjusted it, looser, tighter, each strap in tiny increments, it made no difference. I tried a cloth liner and that just made the leaks a little quieter, but still they kept waking me.

At this point I was desperate for sleep as, although I had Severe Sleep Apnoea, before getting the diagnosis I had grown accustomed to the lack of sleep as one does over time. So I reverted to the P10 and taped my mouth, so it couldn’t open and cause air leaks.

A little under a week later I had a monthly follow-up call with my Sleep Clinic and my Sleep Tech recommend changing my pressures from what I was initially prescribed 4cmH20-15.0cmH20 to 7cmH20-12cmH20 and was not happy that I had been mouth taping. She asked me to come to the clinic to pick up an Airfit F20 and assured me that this mask would not have the issues the F30i had.

The first night with the F20 was the worst I had faced since starting treatment, it was even more noisy with the “Mask Farts” than the F30i, but this time it added pain to the bridge of my nose. My partner even tried to get the straps to stop the air leaks but nothing we tried worked and by the end of the nights I used it, the straps were so tight they left marks and I had the outline of the cushion on my face and a sore on the bridge of my nose.

I emailed my Sleep Clinic and got the cold shoulder, just told to keep trying as it takes time. I tried for a week, and I was so tired I was hallucinating, having panic attacks and genuinely feeling like everything was too much to continue. In desperation, my partner convinced me to continue with the CPAP but to go back to the P10 and use the mouth tape to try to get at least some sleep.

I am lost, to be honest with you all, I don’t know where to turn or what to do. I will be contacting my Sleep Clinic again, but I do not think it will achieve much, I am hoping I can get a little clarity and help here if possible but as this is my first post I cannot post screenshots of my OSCAR reports, but I will when I can. Some stats I can share is that I have a 6-month average AHI of 51.61 but some nights I have hit 72.27 AHI, and my lowest night was 31.22 AHI.

I don’t know which visual reports of what days would be useful, so open to advice on that too.

Sorry again for the essay!
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#2
RE: High AHI with CPAP
If you need more posts to be able to insert Oscar charts, do a couple more on this thread. Just bump it up a couple times. When you can post Oscar with the charts I have in my signature. Pick a couple nights that are typical for you.

If you are not sure of Oscar there is a guide at the top of the site. Wiki and search OSCAR.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: High AHI with CPAP
Thanks for the reply, Good idea. Smile I will collate some days and post them tomorrow once I get my post count up.
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#4
RE: High AHI with CPAP
Sorry for the shameless bump.
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#5
RE: High AHI with CPAP
Last one, hopefully...
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#6
RE: High AHI with CPAP
Rage,
Welcome to Apnea Board!
Hopefully you'll be able to post a chart soon. Sometimes, it takes the forum software to "catch-up."

Please follow the links below in my signature line to guide you.  Organization of the chart is important.

After you've organized your chart according to the directions, take a screenshot and use the attachment feature to post here.

Umm... those bumps won't add to your post count. Go out in the main forum and participate. Smile
OpalRose
Apnea Board Administrator
http://www.ApneaBoard.com


OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy





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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#7
RE: High AHI with CPAP
I have read through the instructions and hope I have done it correctly, if any other charts are needed, or I need to alter something, please let me know. To start, I thought I would post three screenshots.

This one is from when I was on the lower pressures.

   


This one is a little concerning as I have only had two other days when I had Cheyne Stokes Respiration and the highest of the prior two was 5.3%, but this was quite an increase. This is with my current pressures as is below.

   

This one was last night, now I know I fell asleep after 12am and there are a lot of times on the chart showing I had an Apnoea before that time, it's making me wonder if what is reported is real...

   
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#8
RE: High AHI with CPAP
Can you give us some general health history.
Medications
Age
Weight

The first thing I see is you are up against your max.

It is so clustered I am wondering if this is positional apnea. Which would send the machine to the max because you are cutting off your own airway.

We need others to confirm.
Thank you,
Brent aka Factor

Just a Regular guy.
My untreated AHI was 87.  You can do it hang in there.
"You can if you will"   Jerry Kramer

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#9
RE: High AHI with CPAP
I see two things 
  1. Positional Apnea as indicated by clustered obstructive events. You are tucking your chin toward your chest and severely restricting your airway.
  2. Central Apnea, likely Treatment-Emergent Central Apnea
Immediately modify your pillow arrangement, think thinner and flatter, less firm, one pillow instead of two, you got the idea.
Tonight, if possible, go down to your nearby pharmacy and get a soft cervical collar.  This is often an overnight fix.  Read the Collar link in y signature.  

Central Apnea, set your EPR=1 This should help with slowing down your flushing CO2 out of your system,  Your CO2 is likely dropping below your apneic threshold resulting in a central apnea. with your not breathing CO2 is building and you gradually start breathing eventually too strongly and the cycle repeats.
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#10
RE: High AHI with CPAP
Hi factor, thank you for your assistance.

I use one medication that I know may cause Central Apnoea, Fentanyl Patches for Chronic Pain. Which is a catch 22 as lack of sleep makes my pain worse, so I am hoping the better sleep I can get, the quicker I can get off the patches.
But I was told that as I have Catathrenia, it could be that I do have Central Apnoeas that are not caused by the patches... Only time will tell with that, I think. I also have high blood pressure with Amlodipine 10 mg, and Venlafaxine for Depression.

I am 37, and in the last 8 months I have lost 44KG (6.9 st), and still actively losing, but currently I am 62KG (9.7 st).
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