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New user - AHI jumped to 3.72 from 0.37
#1
New user - AHI jumped to 3.72 from 0.37
   
       
I am a new APAP machine user in mid 60s and was surprised to see AHI jumped to 3.72 yesterday.  Previous numbers were 1.14, 1.27.
I tried nose pillow and nasal masks before but full face (F20) seems to be the best for me so far.
I've been using it almost a week but yesterday was rough with more events than before.  I am concerned that full face mask might not help either.

Three files are attached, today's and previous 2 days'.  Appreciate your review and opinion.
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#2
RE: New user - AHI jumped to 3.72 from 0.37
The Obstructives that are clumped together suggest a positional sleep issue. You may have rolled over onto your back which causes your chin to fall into your chest, which then cuts off your air supply. This is called chin tucking and can also happen if using a too tall pillow.

One thing that has helped many here is by using a soft cervical collar.

http://www.apneaboard.com/wiki/index.php...cal_Collar
OpalRose
Apnea Board Administrator
www.ApneaBoard.com
Dreaming


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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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#3
RE: New user - AHI jumped to 3.72 from 0.37
Thank you so much for your comments.
Yes, it makes sense. Will try the soft cervical collar.
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#4
RE: New user - AHI jumped to 3.72 from 0.37
As Opal said, that 'bad' night is likely chin tucking. While her advice is sound I suggest waiting to see if it is a 1-off night. 2 of the 3 nights did not demonstrate the positional element. Any kind of 'frequent' recurrence and I would follow her advice.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#5
RE: New user - AHI jumped to 3.72 from 0.37
My AHI's can vary quite a bit. My lowest so far, has been 0.01, and that was just a day or so ago.  

About two weeks or so prior to that, it was over 5. I have a feeling that was stress induced............. Oh-jeez
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#6
RE: New user - AHI jumped to 3.72 from 0.37
Thank you all for your comments and insights!
I feel much relieved now.

Following Opal's suggestion, I already placed an order the Eliminator series washable travel sleep pillow from Amazon.
Hope it was just an anomaly.
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#7
RE: New user - AHI jumped to 3.72 from 0.37
I have another results that I would like to ask for your insights.
Air pressure started to increase around 03:46, from 6 to 11 and then to 16-18.
The high air pressure woke me and I slept with my mask off.  I didn't have a good sleep with mask off.

Any idea what caused air pressure to increase and go higher?
And what is the best way to return CPAP to normal pressure?
       
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#8
RE: New user - AHI jumped to 3.72 from 0.37
It's obvious, Flow Limits, though you cut off the bottom of the flow limit chart.

Set your Mask Pressure to 12. This is for comfort. The pressure is not rising due to OA or H, they are not there.

I would like to see a couple of 2-3 minute sections where the flow limits are and where they are not. Reset the verticle to +/+70 so the flow rate shows.
I do not see a reason, besides the obvious for the flow limits.

You can try a soft cervical collar to see if that lessens the flow limitations.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#9
RE: New user - AHI jumped to 3.72 from 0.37
The pressure is increasing because of high amounts of flow limitation. Can you post a couple 2 minute windows (duration length is specified on flow rate chart) showing the flow rate chart. I'd like to see one from this last day(where flow limitations were quite bad) and one from another days where it was saying that flow limitation wasn't bad.

Also can you post your sleep study report or at least some of the important details (AHI etc) (remove any personal information you don't want shared)? I am curious how bad your untreated apnea was?

Your minute ventilations are on the low side and you have high flow limitation, RERAs and obstructive apneas which may indicate you need a machine with more capability. It is definitely worse at some times which could be because of a positional nature, seeing if the eliminator pillow helps will be interesting.

Your data looks similar to my grandfathers and one thing we found with him is that a full face mask makes his apnea worse. My theory is that his mouth stays open or he is breathing through his mouth and the pressure doesn't help hold tongue etc forward as well resulting in the apneas. We had to give up on the full face mask and he has gone back to nasal pillows which doesn't cause the same issue although he leaks like a sieve out his mouth...

It might be worth setting a max pressure of 15, I don't think the pressures over that are actually helping you.
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#10
RE: New user - AHI jumped to 3.72 from 0.37
Many thanks to both Geer1 and bonjour.
Yeah, I see the link between air pressure and flow limitation now.

First, below shows the previous test results done several years ago.
Kaiser Permanente Anaheim Ambulatory Sleep Study Report
Date of Study:  8/27/2013
Neck Circumference: 13.5 inch.   Epworth Score: 12
Referring Physician: Nguyen, Boichuyen Thi (M.D.)
Reason:   Loud  Snoring at night ,  Fatigue,  HA  In Am  ,  R/o
Sleep apnea
Recording channels: Airflow, heart rate and oximetry,
thoracic/abdominal respiratory effort, body position.  
Total Recording Time: 452.0 min.
Respiratory Events Criteria
Obstructive Apnea : 10 or more seconds cessation of airflow with
active respiratory effort
Central Apnea: 10 or more seconds in cessation of airflow without
respiratory effort
Hypopnea: 30% reduction in air flow with 3 % oxygen desaturation
Oximetry Data:
SaO2 < 90%: 10.4 min.    2.30 Percentage of Study Time
Average SaO2 %: 95%.  
Lowest SpO2 (more than 2 sec) (%):77 %
Desaturation Index: 18.6 per hr.
Heart Rate Data:
Average Heart Rate: 67.4 bpm.  
Maximum Heart Rate:  100 bpm.  
# of high heart rate episodes:  23
Respiratory Event Data:
Obstructive Apnea Index: 8.9 per hr.  
Mixed Apnea Index: 0.3 per hr.  
Central Apnea Index: 0.0 per hr.          
Hypopnea Index: 11.5 per hr.
Respiratory Event Data and Body Position Summary:
     Supine:   Index (#/h): 23.7  
Time: 391.7 min.   O2 desaturations (#): 138 CA (#): 0  OA(#): 67
  MA(#): 2   HYP(#): 86
     Right:   Index (#/h): 0.0  
Time: 8.6 min.   O2 desaturations (#): 0  CA (#):0  OA(#): 0  
MA(#): 0   HYP(#): 0
     Left:      Index (#/h): 1.4  
Time: 43.8 min.   O2 desaturations (#): 2  CA (#):0  OA(#): 0  
MA(#): 0   HYP(#): 1
     Prone:   Index (#/h): 0.0  
Time: 0.4 min.   O2 desaturations (#): 0  CA (#):0    OA(#): 0  
MA(#): 0   HYP(#): 0

Total AHI:  20.7 per hour

3 captures are attached as follows:
Feb 5th: results from yesterday.
Feb 6th - 03_20: 3 minutes of high flow limitation
Feb 6th 04_09-worse: worst section

Bonjour - regarding your mask pressure of 12, is it max pressure too?
Is it something that I can adjust from the machine setup?

           
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