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Looking for threads on "end of sleep REM and AHI increase"
#1
Looking for threads on "end of sleep REM and AHI increase"
I bet there's lots of great info here already on what I'm trying to understand - but I'm not quite using the right search terms yet.
Basically, while I wait to hear back about my sleep studies, I'm curious to know more about this pattern I see most nights (not all) where my AHI will skyrocket in the last hour or two of sleep. So far, I get the vague impression it may be related to REM sleep and cycles - but I also hope to learn more about how important this is to my overall health and daytime quality. After these nights, I want to nap about an hour after waking up and eating. Only my busy work routine prevents it :-(

I've even wondered if the AHI is so high at the end of a long sleep cycle, if it might not be better to wake up before it happens? Not that I even know how this could be done - but I'm assuming these periods will have the lowest O2 levels, and not be healthy.

Anyway, any suggestions on better search terms for this site or others are appreciated.
Thanks!


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#2
RE: Looking for threads on "end of sleep REM and AHI increase"
Your machine is not able to help you when you run into a 'situation'.  It's set to a max of 8 cm, which apparently is not enough at least some of the time, but the most worrying artefact we see is the enormous numbers of centrals.  You have EPR set to 3 cm, and that's probably too much.  You'll end up raising your PAP max a bit and probably reducing your EPR to 1, perhaps even off altogether.  Also, the events tend to cluster, and this is usually indicative of problems with sleep position, or maybe just tucking your chin. A cervical collar might help. The soft foam kind.

BUT...wait for more structured and considered advice.  It's sure to come.
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#3
RE: Looking for threads on "end of sleep REM and AHI increase"
(10-14-2019, 01:34 PM)mesenteria Wrote: Your machine is not able to help you when you run into a 'situation'.  It's set to a max of 8 cm, which apparently is not enough at least some of the time, but the most worrying artefact we see is the enormous numbers of centrals.  You have EPR set to 3 cm, and that's probably too much.  You'll end up raising your PAP max a bit and probably reducing your EPR to 1, perhaps even off altogether.  Also, the events tend to cluster, and this is usually indicative of problems with sleep position, or maybe just tucking your chin.  A cervical collar might help.  The soft foam kind.

BUT...wait for more structured and considered advice.  It's sure to come.

Hi mesenteria,

Thanks for the quick response! I should have added that I'm still in the initial diagnostic phase (only about 6 weeks on CPAP), and have another thread with feedback about what changes I might make when I have my final equipment and control over it. Lower EPR has been suggested, and I will shoot for that. I will also try my collar again, and see if I can make any difference with it. I got it for mouth leaks, but that problem seemed to be short lived, for now.

This question was meant more for me to educate myself about this particular "latent AHI spike" pattern - if it's common, how harmful it might be, etc. For example, if I find indications that it's significant, I might be able to press the issue with my health providers, for example saying "hey, it's not good enough to look at my average 14 AHI alone - you need to acknowledge this consistent spike of 80+, and adapt my treatment". 

I read one research paper on "AHI 2 hour window" - but it was too clinical for me to fully follow. Looking for more grass roots threads in this forum to educate myself with.

Thanks!
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#4
RE: Looking for threads on "end of sleep REM and AHI increase"
Thanks for clearing that up.  Without running afoul of the forum rules prohibiting links to commercial sites, especially (and even) to sites owned by DMEs that might have commercial links on pages to reference material, would it be possible to provide a link to that article?  I will look for your other thread in case you have done that over there, so no need to reply if that's the case...I'll find it.

BTW, you are correct that there are limits to what we can infer from the AHI posted on our reports each morning.  It's merely an average, but if you have no events at all until the last hour of a seven-hour sleep, and then get 20-30 in that final hour, your reported AHI will only be 4-5 and still seem acceptable.
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#5
RE: Looking for threads on "end of sleep REM and AHI increase"
(10-14-2019, 02:04 PM)mesenteria Wrote: Thanks for clearing that up.  Without running afoul of the forum rules prohibiting links to commercial sites, especially (and even) to sites owned by DMEs that might have commercial links on pages to reference material, would it be possible to provide a link to that article?  I will look for your other thread in case you have done that over there, so no need to reply if that's the case...I'll find it.

BTW, you are correct that there are limits to what we can infer from the AHI posted on our reports each morning.  It's merely an average, but if you have no events at all until the last hour of a seven-hour sleep, and then get 20-30 in that final hour, your reported AHI will only be 4-5 and still seem acceptable.

I may not be able to post links yet anyway - but it may be a commercial site. If you search the web for this, I'm sure the article will come up: "Intra-night variation in apnea-hypopnea index affects diagnostics and prognostics of obstructive sleep apnea"

Thanks!
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#6
RE: Looking for threads on "end of sleep REM and AHI increase"
Hi Schlafer,
Your graphs are not too unlike my initial results from a few years ago. Your average respiration rate is quite low and the strong clustering of centrals near the end of your sleep may be simply a result of arousal and subsequent lowering if your respiration rate further which can generate many spurious "centrals".
You should try to find a collar that is comfortable and explore higher pressures - a pressure of 8 with epr set to 3 is certainly too low for most people.
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