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[Pressure] Sudden elevated AHI. HELP!!!!
#1
I have severe OSA. In Oct 2016, sleep study gave AHI of 38. Don't have that report so cant say what the breakup of the AHI was. However, i immediately started using dreamstation auto cpap from october 2016. Did not buy humidifier at that time.

Now initially all was well. I never miss a single day of therapy.

But then somethings started happening. I became so dependent on the machine that even taking a nap of 10 minutes without the machine became impossible for me. This was after 2-3 months of usage. I felt shortness of breath, elevated hear beat and sweating and instantly woke up. Simultaneously as sonn as i lay down, my nose started choking. if i sleep on my sides, one of the nostrils chokes. This never happened before. I had sleep apnea symptoms since quite a while before therapy but these things i.e. nasal blockage on lying down and getting extremely restless without machine in 10-15 minutes nap never happened.

So i got another sleep study done. Due to the above issues, I used Otrivin nasal drops while going in the sleep study. (maybe it was a mistake). The Ahi was then 32. Mostly hypopneas, some obstructive apneas and a central apnea reading of 1. then went to doctor with that report and told him about problems i mentioned above. He suggested fluticasone nasal spray, humidifier and yoga.

I did not use fluticasone or yoga but did buy the humidifer 1 month back.I thought that humidify will relieve all my nasal symptoms. And if it clears my persistent nasal blockage on lying down, i can atleast take naps.

However, the nasal blockage is the same even after using the humidifier since 1 month. I have tried different settings on the humidifer. Havent tested setting of 4 and 5. its hot summer right now in India. Now I am not sure what is causing my nasal blockage. I feel better sleeping in supine position(Which is the worst position for a sleep apnea patient). i know optimal position is sleeping on sides, but one nostril chokes instantly and the other one chokes partially so i revert to supine again.

Now the second issue. Since about a week or so, I am having elevated AHi. Readings like 8,9,10,12,13 have been generated within a week. I stated playing with the pressure range then. The device is Dreamstation Auto Cpap. it was by default set at 4-16 with A-flex setting at 3. So I tried setting the range of 4-20. The machine did went upto the max pressure of 20. My average pressure of overall use is around 9-10. So i tried setting it at +-2 of the average setting of 10.8. Still elevated AHi. The mask fir has always been around 100%. Very minimal leakage and also periodic breathing is nil always. i dont breathe through the mouth.

I am not sure why the elevated AHI suddenly. generally it hovers around 4-7. Now since 1 week, its almost crossing 10 everytime. Also, i have seen the Clear airway apneas have increased significantly. I have always had events of clear airway apnea. But since the sleep study in August 2017 had a central apnea of 1 only, the doctor ignored it. I tried reducing the pressure range to 8-13 to eliminate the pressure induced sleep apnea, but still getting all the events.

I am also worried if I seriously need to relook at the Clear Airway events. Although, i feel fine overall upon getting up, but can't deny the fact that my memory has degraded quite a bit and 1.5 years of usage has not improved it much.

If i confused you somewhere, please feel free to ask. From extensive reading about sleep apnea on the net and this forum, i have acquired quite vast knowledge about various aspects of it but this increase in AHI stumps me.


So overall my basic concerns are:
1. Nasal Blockage on lying down
2. Sudden Increased AHi

My BMI is around 28-29.


Do you guys have any input on this. From what i have seen on the forum, you guys are quite knowledgeable about all these. I can share the Sleepyhead data if required..

Help me brothers.
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#2
Posting some Sleepyhead screenshots.


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#3
monthly data screenshot and an elevated ahi screenshot.


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#4
I think a Sleepyhead chart or two might help. You have experimented with some alternate pressures and found that during certain clusters of events. This sounds a LOT like positional apnea to me, but seeing the chart and pattern of events will help. For the nasal congestion, I suggest you try a nasal pillows mask like the Resmed Airfit P10. They are inexpensive and inject the air pressure directly into the nares. A nasal mask can pressure the sinus along the side of the nose and actually contribute to congestion, while nasal pillow have no contact along the sinus. The Airfit comes with all 3-sizes of nasal pillow, remember larger is better for most of us.

Good luck, welcome, post a chart!
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#5
Thanks for replying. I have posted some screenshots. Kindly check if they help or if you need something else.
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#6
Ah, you posted while I was writing. You need to change your pressure range to 9-16. Your events are primarily obstructive, and you definitely need to give the Philips Dreamstation a head start on pressure. I think we can take a look at your results at 9-16 before passing judgement on positional apnea or soft cervical collars. Also cut your flex to 1 or 2. I have generally found higher flex can result in more CA and H events. You do have some leaks going on with your current mask and that may be improved with nasal pillows, or not if the leaks are coming from an open mouth. What are your thought? Is the mask slipping, or is air coming from your mouth?
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#7
In fact I have turned off the Flex completely since yesterday. I don't feel the need for any pressure relief at 8.5 even. I will set the range you mentioned today.

I was going through the data and i also noticed that leakage has increased recently. Generally leakage is extremely low. Mask fit is normally around 97-98%. Periodic breathing is always nil. I never breathe through mouth. Uploading 3 more screenshots for you to consider.

Are the marginal Clear Airway events a cause for concern?


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#8
I would not worry about the CA for now. The may be an artifact of sleep disturbance or transition from the excess obstructive events.  I think the range I suggested is confirmed by your 90% pressure being 10 cm.  At least this puts you into the therapeutic range.  On your chart, you can see that obstructive events tend to cluster and don't respond to relatively high pressure. That clustering is often a sign that the apnea is positional, and that is the kind of thing the soft cervical collar eliminates, keeping pressure lower. That in turn can help with the few CA events.  You might want to start getting your mind around the idea of using a soft collar to keep your airway aligned and that can also help with leaks in addition to the obstruction.

[Image: attachment.php?aid=6245]
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#9
From your post i gather that there maybe less reason to worry than I am currently worrying. I will research about cervical collar. Meanwhile I will post the results after setting the pressure range as you said.

About positioning, nasal blockage is least in supine. That's why I sleep in supine. Don't know what position i keep during the night though. I sleep alone. Also do you think my sleeping so late can have a effect on all this?? I mean i sleep at unnatural times for sure.

Will post the results tomorrow.

Also, I would like to tell you that doctors have told me that i have a short neck. Although I am a bit overweight, not obese, 2 different doctors have told me that weight is not the issue here. My brother and mother also have sleep apnea. Mine is the most severe though. does genetics have an effect on sleep apnea? I mean can my sleep apnea be genetic?


See the attached screenshot. its from the sleep study done in august 2017. Maybe you can draw something from the positions.


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#10
Very good discussion of collars here.

http://www.apneaboard.com/forums/Thread-...oft-collar

The Dr. Dakota looks like an excellent bet for a short neck, but if you want a quick trial, $15 at the corner drugstore at least gets you started. I was quite surprised at how well it keeps my mouth shut (and my wife likely wishes I would wear it all day...)
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