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[Pressure] High AHI in the last month?
#1
High AHI in the last month?
This forum is amazing! You were able to help tremendously when I first got a CPAP about 3.5 years ago.

I had my AHI consistently down to .2 - .8 every night. Recently I am now at 16 -25 every night..... clearly I went awry somewhere. I am hoping that someone can offer some suggestions after looking at the graphs? I did used to use a full-face mask, though I have been on nasal pillows for almost 9 months without any issues. Also, I did make a small pressure change and got the AHI down to 10, wondering if I just need to continue making the same increases to pressure?

Any and all thoughts are appreciated. Thank you!

Equipment Info:
Resmed AirSense 10 Autoset
Resmed AirFit N30i Nasal Pillow Mask
Regular Hose

Machine Settings:
Min Pressure: 8 (previously 7)
Max Pressure: 17 (previously 15)
EPR: 3
Humidity: 4
Ramp Pressure: 6
Ramp Time: 20 min


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#2
RE: High AHI in the last month?
Hello, SleepySleep! First a couple of questions. Has your weight changed more than, say, 5 pounds in the runup to this surge in AHI? And have you added or subtracted any medications (OTC or prescription) from your usual line-up?

You are showing quite a lot of leaking on the chart you've posted. Is that usual? You are up in large leak territory fairly frequently, which is probably why so many of your events are labelled as unidentified. The machine basically can't tell what kind of event your having given all the leaking, and it can't compensate adequately for the leaking.

So one thing that's important is to figure out how to control the leaks, unless this was a very atypical chart. It's hard to tell, but they look like a combination of mouth leaks and leaks at the pillow/nose interface. Could you check your mask fit while lying down using the mask-fit function on the machine? Also, just to be sure, could you check whether you changed your settings to pillow from full-face? And do you think there is any kind of tug on your mask being produced during the night?

Do you think your mouth opens while you sleep? Dry mouth, perhaps? If yes, there are various ideas you could try out.

Finally, could you tweak your charts so you can post just one with all the key information on it? From top to bottom, stack your graphs like this:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

No need to show any other graphs for now. To squeeze everything in, just grab the horizontal gray bars between the graphs and move them up.
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#3
RE: High AHI in the last month?
The clustering of events indicates a positional problem such as tucking your chin to your chest. Have you changed pillows or your sleeping position? I suggest you read the positional apnea section of this article http://www.apneaboard.com/wiki/index.php...onal_Apnea

Often the best solution is a soft cervical collar. See the link below for more information.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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#4
RE: High AHI in the last month?
Hi Dormeo,

My weight has decreased about 90 lbs since when I started CPAP. Maybe 10 lbs drop when I know that all of my numbers were good. Per my biological dentist, I do have a small airway and I will likely need CPAP support until I get that surgically altered.

As to medications or supplements, I have changed some around, I didn't consider that it would affect my AHI, though in retrospect that makes sense; I track my Deep / Light / REM sleep meticulously every night.

I do tend to toss and turn a bit at night and that could be leading to the hose being pulled; I do have a hose elevation holder (forgot the name the forum uses) to help with this.

I already tape my mouth shut, though I am certainly a recovering mouth breather. I will consider if I need to go to a chinstrap; hoping that the cervical collar that Melman mentioned will help hold my chin up.

Thank you both for the ideas and suggestions!
SleepySleeps
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#5
RE: High AHI in the last month?
If your tape is in place at the end of the night, then the leaks must be mask leaks (or conceivably leaks at the junction of the short hose and the long hose??). Once you get them under control, we can see what kind of events all those UAs actually are, and that will help inform the advice you need.

Try providing a little more slack between the hose hanger/lift/stand and the mask and see whether that reduces the leaks. And see whether there are any online videos about mask fit for your mask that might suggest any adjustments. Oh, and did you try using the mask-fit function on the machine while lying down in different positions?

If you had gained weight, that might help to explain your AHI increase, but you've lost weight, and I'm not sure what the connection to that could be. As for meds, you might ask your doctor whether any of the changes might affect AHI.
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#6
RE: High AHI in the last month?
Thank you! Last night was under 4, so obviously a significantly lower AHI; I made a conscious effort to keep my chin up, and subsequently airway open. Smile
I went ahead and ordered a soft cervical collar.

Though I would love any other insights that can be gleaned from the graphs if you have the time to take a look. Hopefully the order and sizing of graphs is correct this time.

Thanks for the help.
SleepySleeps


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#7
RE: High AHI in the last month?
The chart is in perfect shape. It's good to see your AHI coming down. Something I should have asked about when I saw your earlier chart: what are all the apparent breaks about? There are easily a dozen in this recent chart. Are you turning the machine off that often?
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#8
RE: High AHI in the last month?
I got up twice I think to use the restroom, though that certainly doesn’t explain that many interruptions. I also was in bed for about 2 hours longer than the machine recorded, so maybe I just forgot to hook my mask back up when going back to sleep.
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#9
RE: High AHI in the last month?
I bet you’re right about the missing time at the end, but I’m baffled by all those other stops and starts. I hope an expert will be able to swing by and take a look.
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