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[Treatment] Large daily AHI variation, please help
#1
Large daily AHI variation, please help
Hi, I'm new to this forum.  Would like to seek help for my desperate BiPAP usage experience.

I have been using CPAP for one year.  My doctor prescribed BiPAP for me in April.   

I like my BiPAP because it offers different pressures for breathing in and out, which makes me much more comfortable than CPAP.  My initial pressure setting is VAUTO, PS=4, Max IPAP=8.4, Min EPAP=4.0.  

For the first week, the AHI were all around 3 to 4.  However after that, without changing the setting, AHI went up to around 7 to 8, and stayed at that level since.  Sometime I even saw AHI went up to beyond 15.  No matter how I changed the setting, the AHI is still high.  I generally do not have central apnea, and no leakage, 

A week ago, I tried to increase my presssure to 14, and it created even more apnea due to the high pressure.  Also with the pressure higher than 9, my cheek will puff up like a balloon, which always wakes me up.

But when I reduced my pressure back to 8, the AHI became 2.5.  However, it only lasted for one day.  The next few days, the AHI are 7, 8, 10.

I don't know what to do now to keep my AHI below 5.  Please help!
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#2
RE: Large daily AHI variation, please help
Hi Dreamtosleep - Welcome
Without data it would nothing more than a wild guess.  I strongly recommend that you download OSCAR and use it to display a daily screenshot.  OSCAR is available for Windows, Mac, and Linux platforms.  

Your CPAP has an SD card slot to capture your sleep data and make it available to download for analysis.  IF you don't have an SD card, you can get one from almost any pharmacy or big box store for a reasonable price.  Any size from 2GB up to 32GB will work.  

Also, please review the links I have below to help in OSCAR's usage and understanding.

Looking forward to seeing some screenshots.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#3
RE: Large daily AHI variation, please help
Just as a SWAG, and based on the information of varying kinds in your post, Dreamtosleep, I would guess that your troubles may not lie in the max, but in the min.  4.0 is too low, judging by a few years worth of posts from people coming here with the same low setting and wondering why they hate PAP therapy, or distrust it, or distrust their machine, are anxious, oxygen-starved as they attempt to fall asleep...……...etc.  We typically urge people who are willing to do it to up their min to at least 5.0, and you may have to end up nearer to 6.0.  

Whatever changes you decide to make, based on great advice here from well-intentioned people, please do not rely on a single night's worth of results.  Let it ride for several nights since nite-to-nite variation is substantial for a great many of us, even when our PAP therapy seems to be going swimmingly.

As Crimson Nape has urged, though, we really need to see some hard facts from your machine.  It will tell us a lot about what is happening...or what ain't. 

Welcome.
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#4
RE: Large daily AHI variation, please help
I will add that with those settings there is no room for your VAuto to react. Please download OSCAR and post daily charts as per the above post.
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#5
RE: Large daily AHI variation, please help
Thanks for all of your reply!

Here I attached 3 screenshots, 1st one started with pressure 7-14, then changed to pressure 4-8 due to waking up too often by cheek puffing up.  2nd one (next day) with AHI=2.5 (pressure 4-8), 3rd one (two days later) with AHI=10.7 (pressure 4-8).

These are some of the examples to show the large variation of the AHI.  

Would you please let me know what you think?

Thank you very much for your help!
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#6
RE: Large daily AHI variation, please help
Events are clusters of apnea typical of positional apnea. Please read the link in my signature on Optimizing Therapy and take a look at the positional apnea section. Your solution will be to increase the IPAP max setting so your Vauto can respond to obstruction with higher EPAP, but mostly, you need to consider the benefits of a soft cervical collar in resolving the positional apnea. Higher pressure is the first step along with shortening or eliminating that 45 minute ramp.

Given the fact your events are entirely obstructive, I would encourage higher pressure, and will suggest the following settings unless you have a reason not to use higher pressure in Vauto mode:
EPAP min 6.0
EPAP max 14.0
PS 4.0
Ramp on Auto or Off.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
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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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#7
RE: Large daily AHI variation, please help
Hi, Sleeprider,

Thank you very much for your reply!  I have read your article "Optimizing Therapy", it is very helpful and educational.  I will try your suggestions to see how it works for me.

One question I have is: When I used higher pressure (>9), the air will puff up my cheek and wake me up.  Do most of the people using higher pressure experience this? or just me?  And can you explain why it happen?  This really bothers me and prevents me from using higher pressure setting.

Also recently I have seasonal allergy which sometime I will feel difficult breathing with nose.  Would this contribute to my high AHI?

Please help, thanks!
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#8
RE: Large daily AHI variation, please help
You 'should' get used to the cheek puff. I use a nasal cushion, covering only my nose, but I'm also an open-mouth sleeper.  When my chin sags during sleep, the PAP device blows a gale out of my mouth, and of course I awaken almost immediately.  So, I have to tape my lips closed.  As I fall asleep, sometimes my cheeks begin to puff, but I have gotten used to it.  Those with full face masks should experience some cheek puff as well.

So, it's very common, and it is something you can get used to.  The idea is to keep reminding yourself that this is a natural artefact to your therapy, which is itself essential to your well-being.

Seasonal allergies, rhinitis, and other conditions will indeed alter the efficacy of both your therapy and the way you sleep (with or without the device working properly and in place on your face). It might be worth trying a nasal spray to control 'thickness' when it gets especially bad. Even if you have to do this after awakening partway through the night. Some manage to fall asleep, but awaken at zero dark thirty to have a pee. If you are likely to awaken two or three hours later with a plugged nose, that might be the time to give your tissues a quick spritz before donning the mask again. It could work.
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#9
RE: Large daily AHI variation, please help
(05-21-2019, 10:31 PM)Dreamtosleep Wrote: One question I have is: When I used higher pressure (>9), the air will puff up my cheek and wake me up.  Do most of the people using higher pressure experience this? or just me?

Just another user here: 
This was a big problem for me. Dry mouth and cheek bloating. I thought the machine was just not going to work for me. 
I was feeling terrific during the next days compared to not using the machine, so I stayed with it.
Then before I went to sleep I told my brain to keep my mouth shut and block of the air entering my mouth. When I began to wake up from the bloating I shut my mouth or just shoved out the air and told my brain to keep it shut or not allow the pressure to get into my mouth. 
I used my tongue to shut off air from getting into my mouth and moisten my mouth. 
After persistent attention to the problem it stopped. 
Rarely now my mouth will bloat, but I shove out the air and go back to sleep. That's my 2 cents...LOL


You can stop it from happening if you are determined... Sleep-well
My worst night on CPAP is 10X better than my best night without it  Eat-popcorn 
Good night Chesty, wherever you are..Semper Fi
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#10
RE: Large daily AHI variation, please help
(05-21-2019, 10:31 PM)Dreamtosleep Wrote: One question I have is: When I used higher pressure (>9), the air will puff up my cheek and wake me up.  Do most of the people using higher pressure experience this? or just me?

Just another user here: 
This was a big problem for me. Dry mouth and cheek bloating. I thought the machine was just not going to work for me. 
I was feeling terrific during the next days compared to not using the machine, so I stayed with it.
Then before I went to sleep I told my brain to keep my mouth shut and block of the air entering my mouth. When I began to wake up from the bloating I shut my mouth or just shoved out the air and told my brain to keep it shut or not allow the pressure to get into my mouth. 
I used my tongue to shut off air from getting into my mouth and moisten my mouth. 
After persistent attention to the problem it stopped. 
Rarely now my mouth will bloat, but I shove out the air and go back to sleep. That's my 2 cents...LOL


You can stop it from happening if you are determined... Sleep-well
My worst night on CPAP is 10X better than my best night without it  Eat-popcorn 
Good night Chesty, wherever you are..Semper Fi
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