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Lost Weight, AHI went sky high
#1
Lost Weight, AHI went sky high
Hey all! I just recently lost a bunch of weight (~40 lbs) and now my AHIs are way way higher than they used to be (went from .5-3 to 6-18).

Is it fairly safe to switch to VAUTO mode from S mode?

My S-Mode numbers were:

IPAP: 11
EPAP: 8
Ti Max: 2.0s
Ti Min: 0.3s

Would it be suitable to swap to VAUTO and do Min EPAP of 4 and Max IPAP of 11? Or is it magical and I can leave Max IPAP @ 25?

I've attached a chart showing last night.

Thanks!

   
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#2
RE: Lost Weight, AHI went sky high
Also, forgot to mention, almost *all* of the AHI events are Clear Airway or Unclassified events (but mostly clear airway). Attached is a photo of one of my worst nights AHI events.


Attached Files Thumbnail(s)
   
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#3
RE: Lost Weight, AHI went sky high
Just my opinion, but with a large leak rate at about 46%, I'm not sure if your therapy is doing so well. I'd suggest a focus on controlling the leaks first, either by adjusting the current mask, maybe replacing a worn mask cushion or strap if applicable. It could also be that it's not the right mask for you, maybe it's a reflection of a leaner face after weight loss.

Again this is what I'd do first, others may have different advice. Best wishes towards your success and congrats on that weight loss.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: Lost Weight, AHI went sky high
(01-19-2020, 09:22 PM)SarcasticDave94 Wrote: Just my opinion, but with a large leak rate at about 46%, I'm not sure if your therapy is doing so well. I'd suggest a focus on controlling the leaks first, either by adjusting the current mask, maybe replacing a worn mask cushion or strap if applicable. It could also be that it's not the right mask for you, maybe it's a reflection of a leaner face after weight loss.

Again this is what I'd do first, others may have different advice. Best wishes towards your success and congrats on that weight loss.

I'll shave tonight and tighten up the mask a bit. I looked at multiple days and there seemed to be no correlation between leakage and CAs, for instance I was freshly shaved on this day and had little leakage:

   
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#5
RE: Lost Weight, AHI went sky high
You know, with a full face mask and a 40 pound weight loss, you might need to get a different size cushion. Lots of leaks make the AHI unreliable, but of equal interest is that the apnea is more central or unidentified than obstructive. Maybe it's time to take the hood off the Vauto and see if you might do better with a different pressure. In Vauto mode, let's try this:
EPAP min 6.0
Max pressure 11.0
PS 2.0
Trigger sensitivity HIGH
Cycle sensitivity Medium
Ti Min 0.5
ti Max 2.0

Expiratory time is a little long in your current results, and I suspect you just don't need as much pressure support. How are you feeling during the day and during exercise?
Sleeprider
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#6
RE: Lost Weight, AHI went sky high
(01-19-2020, 10:51 PM)Sleeprider Wrote: You know, with a full face mask and a 40 pound weight loss, you might need to get a different size cushion.  Lots of leaks make the AHI unreliable, but of equal interest is that the apnea is more central or unidentified than obstructive.  Maybe it's time to take the hood off the Vauto and see if you might do better with a different pressure.  In Vauto mode, let's try this:
EPAP min 6.0
Max pressure 11.0
PS 2.0
Trigger sensitivity HIGH
Cycle sensitivity Medium
Ti Min 0.5
ti Max 2.0

Expiratory time is a little long in your current results, and I suspect you just don't need as much pressure support.  How are you feeling during the day and during exercise?


During exercise I get fatigued a little easier than usual (but that is semi expected with the diet I’m on according to the dietician). Otherwise I feel a little lacking in energy (also expected).  

I’ll give those settings a go. 

Thanks,

Nate
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#7
RE: Lost Weight, AHI went sky high
The higher sensitivity on cycle and lower pressure support and pressure should help reduce CA events. Excessive exhale time may be over-ventilation or COPD, so I'm guessing the former is more likely. You might want to look back at some old results before the weight loss and see what respiratory stats have changed.
Sleeprider
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____________________________________________
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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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#8
RE: Lost Weight, AHI went sky high
VAUTO seems to have helped a bit. I shaved as well, but I had also shaved on days when I got 8+ events, so I think that is a moot point.

Here are the charts:




   


Thanks so much for the help! Let me know if you think I should tweak anything else.
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#9
RE: Lost Weight, AHI went sky high
The purpose of using a fairly wide range of pressure was to see where you might settle. With pressure 6-11 PS 2, your median pressure was 9.8/7.8, and the 11.0 pressure still seems like a good maximum. Lower PS raised flow limitation and hypopnea as expected, but in this chart the CAI is reduced from 7.2 to 1.8, and overall AHI improved compared to fixed pressure at 11/8.0 PS 3. You are sensitive to pressure support, and the move from 3 to 2 resulted in a drop in CA events. The use of the higher trigger sensitivity probably helped as well.

I think the minimum EPAP pressure needs to move to 8.0 and maximum pressure increased to 12.0 with PS 2.0. We are not going to act on this next concept for now, but I want you to be aware that you can reduce central apnea events, while maintaining the pressure support that prevents flow limitation and and hypopnea, by using EERS (Enhanced Expiratory Recovery Space), where a short section of tubing is used to reserve some exhaled air and CO2. This approach is somewhat experimental and is being used mainly by a doctor out of Beth Israel Hospital in Boston. We have a Wiki that briefly explains the therapy and there are a couple threads where members are working to verify and refine the use of EERS. http://www.apneaboard.com/wiki/index.php...ace_(EERS)
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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#10
RE: Lost Weight, AHI went sky high
Here is last night. AHI is still < 5, so that is good.


   
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