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Two plus months in and AHI varying widely
#1
I've been on APAP for a bit over two months now, and while my AHI is vastly better than the 91 in my initial sleep study it is still not great many days and varies widely.

I've had a few single digit AHI days like 4.3, but most are in the 10-15 range and some a lot worse like 21 last night. When the AHI is bad, it's mostly CAs that are contributing to it. I'm running 9-16 with EPR 2, with average 11.8, 90% 13.5.

After those nights with AHI in low single digits I feel noticably better, though of course the AHI 20 nights I still feel better than the untreated 91 AHI.

Thoughts?
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#2
Might help if you'd complete a profile with your machine, mask and pressure information. Also, your profile indicates "not using software", and if that is the case then I recommend you download sleepyhead. Without the data, we are all running just a bit blind, but based on your pressure 9-16, I would move the minimum pressure up to 12.0 which is about your average now. This will put you much closer to your 90% pressure and I think you will get better results.

The type of events that make up your AHI matter, and software should help you break down if this is central, obstructive or hypopnea. If the events are mainly CA, then the suggestion above may not be valid as we don't increase pressure for CA events.
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#3
Most of the "bad" nights are predominantly CAs. I haven't been able to correlate the "good" nights with anything so far, I guess I need to start keeeping a diary of sorts to try to isolate what may be different in the days that result in a "good" night.
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#4
IIRC a S9 Autoset won't help much with CAs. Talk to your sleep doctor, as if you're seeing over 5 you need to figure out what's going on. You may need a more advanced machine to help with your CAs.
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#5
(06-15-2015, 09:46 AM)wp6529 Wrote: Most of the "bad" nights are predominantly CAs. I haven't been able to correlate the "good" nights with anything so far, I guess I need to start keeeping a diary of sorts to try to isolate what may be different in the days that result in a "good" night.

Did you have a titration study, or were you given an auto CPAP and instructed to self-titrate? If you had a sleep study, did centrals appear during the study, or with CPAP pressure during titration?
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#6
WP6529,
Are the CA's scattered or do they occur at or above a certain pressure? Are they occurring at the beginning and/or the end of your sleep cycle?
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#7
There doesn't seem to be much correlation with pressure. Here are Slepyead shots of bad and good days:

[Image: Bad_night.jpg]

[Image: Good_night.jpg]
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#8
One experiment that you may try is reduce your EPR to 1 for a week and then 0 for 1 week. The EPR can contribute to CAs since it is a type of pressure support on a bi level. If after reducing APR to zero, your average CA index for 7 days still doesn't drop below 5, then you need to be reevaluated via a sleep study for a different machine that can take care of CAs for you (probably an ASV machine). FWIW, Medicare does have a criteria for this.

My 2 cents. YMMV.
Started APAP 4-20, Closed range to 7.5-14, then straight 8.0 w/ Aflex 3
RDI always below 1. But sleep much much better at straight pressure.
Started on F10, Tried Quattro Air successfully. Finally settled on P10.
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#9
You may have complex apnea, and regardless of the cause, you need to consult with your doctor to discuss the options. Somehow I doubt changes in EPR alone will change the results. On a "good night" you marginally meet the criteria for being treated. On the bad night, you have moderate to severe apnea with CPAP.

You didn't answer my previous question if you had a titration study. Did you?
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#10
I did the titration study (not split), and it recommended CPAP at 13. I specified the APAP since I figure one night of titration is not a real world simulation, not the variable position and adaptation once you've used a PAP for a week or two so I wanted the auto to be able to adapt and settle in at the most appropriate point. I started at 6-16 and tightened to 9-16 after I had some data showing the average and 90% pressures. This big question is what factors are affecting the good vs. bad nights, which hopefully I might get a handle on if I start a diary.
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