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AHI is erratic...can't figure out why
#1
AHI is erratic...can't figure out why
My problem is that I can't determine what to tweak to start moving in the right direction.  The last two nights are extreme examples of what i have been dealing with this past month.  

Last night (terrible) and the night before (by the numbers one of the best nights ever for me).  SleepyHead

Does anything jump out at anyone?  outlined below, I am trying to ratchet my pressure up to 12, but am not sure if i should get things to stabilize first.

Backstory:

I have had an up and down three weeks since i last posted.  before three weeks ago I had about 3-4 weeks of very reasonable improvement.   I have an AUTO CPAP that starts at 10.5 and can go up to 18.  per conversations with my sleep tech from my last sleep study (3 months ago now), I am trying to ratchet my min pressure up to 12 because that is where my 95% number is.

I have been slowly turning the pressure up each week or two and was seeing very good results for a while.  Initially AHI was around 8 and was able to ratchet that down to consistently in the 4-5 range.  Starting about 4 weeks ago I saw my AHI jump back up into the 8-10 range consistently.  I haven't ever been able to put my  finger on what variable it was that changed.  I travel often and take my CPAP, so the 3-4 weeks of good data included times in at least 4 different locations.  At the time, it seemed that my pressure was having a direct impact (positive) on my AHI. 

And then something happened around july 1st.  I have a previous post about thinking it was the house I am in, but I have since been in 4 other locations (hotels and friends houses) with similar results.

I am sorry this is so disjointed.  I weeks of SH data that shows a roller coaster of AHI.  I appreciate any thoughts or suggestions.
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#2
RE: AHI is erratic...can't figure out why
Your events are predominately obstructive, even on the good nights. The clustering of events looks like positional issues like chin tucking that might be improved with an ergonomic pillow or cervical collar. My impression is that you need a minimum pressure of 11.0, and should consider trying a cervical collar or changing your pillow to resolve the closing of your airway.

Just as an exercise, consider what happens if you tuck your chin towards your chest. Does it obstruct your airway? The problem tends to be worse at night when sleeping, and you may not even be aware of it happening. If you go with a cervical collar, get it a bit oversized so you have about 2-inches of extra space, and it does not need to be overly tall as long as it creates resistance when your head and neck get out of alignment. I think positional therapy may be 75% of the issue here.

An increase of pressure to 11.0 is not much different than your pressure all night on the better results night and I don't think you will notice much difference, however it will prevent the machine from trying to drop below your effective therapy pressure. Your leak rates look great and really the most likely cause of obstruction appears positional. Especially the clustering of events followed by breaks in therapy on 8/5.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: AHI is erratic...can't figure out why
Last night, for me, was a good example of what a cervical collar can do for you. I forgot to put mine on last night and my AHI was 1.5. I know that sounds good but with the cervical collar I have been between 0 and 0.5 consistently. My events were obstructive and clustered and all occurred in the first 4hrs. At 4 hours I woke up and put on the collar. After that I had one hypopnea for the remainder of the night. So my actual AHI  for the period without the collar was close to 3. A good choice is the OTC soft cervical collar from amazon. it costs about $10 and comes in 3 heights and a good selection of neck sizes.

I also recommend trying a buckwheat chaff pillow which can be configured to stabilize your neck position. I use the CPAPfit pillow ($49 at amazon) which is very comfortable. Before I began using it my AHIs were all over the place, frequently in the teens.

I find I get the best results using both the pillow and the collar.
Download OSCAR

Organize Charts
Attaching Charts

Mask Primer
Soft Cervical Collar

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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#4
RE: AHI is erratic...can't figure out why
Thanks for the thoughtful responses.  I have a cervical collar from a while back.  I tried it several months ago, but at that time I was still sleeping on my back and struggling w/ pressure issues, so hopefully the second go round w/ a better understanding of what is going on will do the trick.

Again, thanks for the quick response.  I'll likely be back with results.
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