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[Treatment] AHI/Event counts going up while on CPAP
#1
AHI/Event counts going up while on CPAP
Hey everyone! 

This is my first post here, although I'm not new to CPAP therapy.  It's not exactly been a smooth road for me, hence my username, problemchild.  I apologize for the long post.  Smile

I was originally diagnosed with obstructive apnea in 2011.  They started me out on a Fisher Paykel CPAP machine with humidifier.  I believe my original pressure was 10.  I had trouble with masks.  My mouth seemed to come open, but full face masks never seemed to fit the contours of my face.  I spent several years with nasal pillows, with a mask to cover my mouth.  Even then, I had trouble with leaks or with my nostrils eventually stretching out over time to leak.  Also, the mouth part of the mask mashed into my teeth/gums, which was uncomfortable. 

In 2013, I had a followup sleep study, but the only change was the recommendation of a chin strap to help keep my mouth closed.  Part of the challenge of keeping my mouth closed is that I wear an NTI bite guard over my front teeth to keep me from grinding my teeth at night.  The NTI guard allows me to keep my lips closed, but it's a head start on opening my mouth.

I used a chin strap for about a year, but it really wasn't helping with my mouth, so I quit using it.  Eventually, I switched to the full face mask that I've used ever since.

For six years, I used the Fisher Paykel CPAP machine, but I was still having problems with extreme sleepiness during the day and trouble with feeling rested after sleeping at night.

I had major back surgery in January and during my three-day stay in the hospital, under the effects of anesthesia and pain meds, I was having non-stop problems keeping my O2 levels up.  They even had a nurse watch my O2 levels one night, while on my Fisher Paykel CPAP.  I improved enough to go home, but the doctors and nurses said I probably needed a new sleep study.  They suspected I might be edging toward central apnea, or complex, at least.

I had that sleep study a couple months ago.  The study showed little sign of central/complex apnea, but moderate obstructive.  They titrated me up to a pressure of 14.  As a result, I got a new CPAP machine, the Resmed Airsense 10.

Unlike my old machine the Airsense has mobile access, which means that for the first time in six years, I have a machine that can record what's happening at home while I'm sleeping.  They started me at a static pressure of 14, with humidity.  Once again, I started seeing problems.  Smile

---

From the start, on 5/31, I haven't had an AHI less than 8.6.  Most have been 12 or higher.  When multipled times the number of hours I slept, I've been averaging almost 100 events a night.  OA's and HA's are the bulk, but I've had some nights with significant clear airway (CA) events (where I apparently am not breathing, but not obstructed.  My Airsense was recording a lot of leaks, as well, but I wasn't sure when they were happening.

The resperatory therapist at the supply company was monitoring my progress and was concerned at the AHI levels and number of events I was having.  She talked with my pulmonologist and he agreed to move me to autoset pressure, with a range of 14-20.  The thought was that I might need higher pressure to address the obstructions. 

The past five days of autoset pressure has seen my AHI numbers, and total number of events, spike.  I've been 12-15 AHI, but multiplied out to the number of hours I was sleeping, I've been having 120-140 events per night.

One night, my mouth had come open (but the mask wasn't leaking yet), and it was loud enough to wake my wife up.  She watched me not breathing for a long time before waking me up and telling me to breath.  This, on my CPAP, with the pressure ramped up to almost the max.

I downloaded Sleepyhead and started reviewing my events against the times when I was aware of having issues.  What I saw was pretty scary.

Last night, I had a six minute frame of time of OA's that added up to three minutes of not breathing (spread across four or five events) and bracketed by two 10-second HA's.  One OA was over 90 seconds and two were over 60 seconds.  My flow rate was almost pegged at 20.  And a leak followed that, suggesting (to my uneducated mind) that the apneas are increasing the mask pressure until it blows my mouth open, drops my jaw, deforms my cheeks, or blows out the cushion on my mask to create a leak. 

If you get the impression that I don't think I'm getting the proper CPAP therapy, you're spot on.  Smile

My frustration is that, upon telling my pulmonologist about my concerns, and upon his reviewing all my events, he opted to believe, not the stats returned from my Airsense and my personal experiences, but the sleep study that (apparently) had not observed the same level of events.  He told me to "ignore" the AHI and has set my Airsense to a lower base autoset range.  Tonight, I'm going to have a 12-20 range, but I can't say I'm convinced it's going to be different from what I've seen.

I've read a lot of comment threads out here, but I've not seen any describing the same kinds of issues I'm having. 

I understand that you're not (necessarily) medical professionals, but I'd like to get some other perspectives on what's happening and, perhaps, some suggestions of things I can try.  Thanks, everyone, for whatever help you can provide!
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#2
RE: AHI/Event counts going up while on CPAP
Hi problemchild - Welcome

We need to see a Daily screenshot.  We have a 4 post minimum before you are allowed to post links.    To speedup your request, add spaces  to the link address to your screenshot.  Please follow the the 5 step posting guide I have in my signature so we can have the required information. Also, to maintain continuity, please add the screenshots to this thread.

Looking forward to seeing it.
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#3
RE: AHI/Event counts going up while on CPAP
I can't see changing minimum 14 to 12 making any difference and I'd probably peg the max down a bit till I'm use to it. Post some charts, it may be positional, where you are on your back or tucking your chin to your chest. some find a cheap, foam cervical collar a god send.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min at 'med' median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#4
RE: AHI/Event counts going up while on CPAP
Here on the forum we use the data you collect to help you tweak your therapy. We recognise the importance of your sleep study data so please post a copy of it. But we also realize that a s llamo rep study occurs in a 'll an with wires attached everywhere and that is considerably different than your own bed.  So as said above please post your dailies.

Read the links in my Sig. You know s lot of the info already but I'm sure you will learn more.

Do you know to change your pressure settings?
Fred Bonjour - 0 - LAUNCH Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Download OSCAR
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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#5
RE: AHI/Event counts going up while on CPAP
Hi problemchild,
WELCOME! to the forum.!
You have come to the right place for guidance.
Good luck to you as you continue CPAP therapy and finally getting it adjusted to meet your needs.
Hang in there for more responses to your post.
.
trish6hundred
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#6
RE: AHI/Event counts going up while on CPAP
I'm at work for awhile longer, so I won't be able to post more info (like my data) until later, after I get home. 

I *will* say that my flag chart is lit up like a rainbow.  Smile

Thanks for the comments so far.
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#7
RE: AHI/Event counts going up while on CPAP
A couple more replies and you won't need to add a space in your Imgur posting. See my signature line on how to best arrange your data and how to post with Imgur.

Welcome to the board! Don't worry, you'll definitely get some help here once you start posting your data.
Download [url=https://OSCAR Page ----> CLICK HERE ./]Sleepyhead[/url] 
Organizing SleepyHead Charts:
Attaching Images and Files on Apnea Board:
Robysue's Beginner's Guide to Sleepyhead
Bonjour's Mask Primer

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#8
RE: AHI/Event counts going up while on CPAP
Couple more replies, hmm?  Smile

I only peeked at last night's data before I left for work.  I had a 7 minute segment with 5-6 OA's and a couple HA's.  The HA's were 10 seconds, but the OA's ranged from 15-34 seconds.  In a 7 minute period. 

Last night was the first night on the "new" settings, where the bottom end of my autoset range was lower.  It didn't seem to change anything because the upper end was still at 20.  My pressure rose to 17 during that 7 minute span.  And following that span, I had a leak episode where, not surprisingly, there weren't any other recorded events because my Airsense can't record during leaks.
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#9
RE: AHI/Event counts going up while on CPAP
And there's this:  my armchair observation is that:

1.  Apnea events (be it OA, HA, or CA) result in higher pressure (and blowback) on autoset, or a build-up of blowback on static pressure.
2.  Blowback leads to mouth breathing (knocks my tongue out of the way, inflates my cheeks, and/or drops my jaw).
3.  Mouth breathing leads to leaks. 

My flag graph seems to show cycles of apnea event clusters, followed by leaks.  I'm guessing they're sequentially-related, although it can be quite awhile before I wake up with the leak.

Also...I'm intrigued by the cervical collar.  Chin straps didn't work for me.  I'll have to check out more when I get home.  Smile
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#10
RE: AHI/Event counts going up while on CPAP
You only need one more reply now... Smile

Another thing you could try if you have an issue with your mouth dropping open is a soft cervical collar. The kind that you can buy for around $5 at Walmart in the US. It has helped many with positional apneas (when your chin drops down and increased airway apneas occur as a result.) Of course once you post your data we will be able to see if there are indeed clusters of events which would be helped with the soft cervical collar and it would also have the side benefit of preventing your mouth from dropping down creating the leaks. Might be worth a shot. Though I am jumping the gun a bit here without actually seeing your data. The collar would definitely help with your mouth opening up at the least.

Not sure what kind of pillow you are using, but if it is big and fluffy...you might want to transition to a firm memory foam pillow or a buckwheat hull pillow which is best purchased on Amazon.
Download [url=https://OSCAR Page ----> CLICK HERE ./]Sleepyhead[/url] 
Organizing SleepyHead Charts:
Attaching Images and Files on Apnea Board:
Robysue's Beginner's Guide to Sleepyhead
Bonjour's Mask Primer

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