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Weight Loss and AHI change
#11
Ugly, you have it a little wrong - it is not a question of excess weight around the throat - instead, it is a perceived correlation between necks sizes of 40 cm or above and the presence of Apnoea. Why it is so is still not understood - throat laxity can occur at any weight, although it is more likely the heavier one is. But a one to one relationship with the fat excess is not established. Age correlation is well established - the older one is the more likely one is to have apnoea of some level and form.

As to the importance of losing weight, well, there are so many factors the are eased by dropping a few and so much data to back it up that there is no controversy there. And although we do notice that some apnoeas go away with weight loss, it is far from always the case. In fact, the chances are that it will not go away although the level of it may be decreased. It depends on why you have apnoea in the first place.

One area being explored right now is the relationship between CA and the risk of developing Alzheimers, and if it may be a very early warning, since Alzheimers effects the breathing reflexes of the brain - indeed more mortalities from Alzheimers occur because of breathing problems caused by deterioration in the breathing centres of the brain than any other reason. Don't get all worried just yet, the research is in the early phases.
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#12
I also lean toward the increase in central events.

You could try an experiment but it will take time.

Decrease your pressure by half a point, maybe a whole one. Wait a week or more and see if the events decrease and/or you feel better. If slightly better or no difference, decrease pressure again, waiting yet another week or more.

If the weight loss was not on purpose, it is time to see your GP.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#13
(02-21-2013, 09:35 PM)Ugly Wrote: Well you just learned a dirty little secret.
Yes it's true. Despite the hoopla that they sometimes make about the "importance" of losing weight, sometimes it just doesn't matter.

Indeed - I have two friends with OSA. one is bigger than me with a BMI of over 40... The other is a string bean with a BMI of 20...

I don't say thae conection of BMI and OSA is spurious - I just think its over rated.
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#14
(02-21-2013, 08:17 PM)zonk Wrote: whats the leak? acceptable leak 0.4 L/s (24 L/m)

Whats AI and HI
AHI (Apnea Hypopnea Index) made up of AI (Apnea Index) plus HI (Hypopnea Index)

to see any detailed data you,ll need Resscan software (available from here)
first you,ll need the S8 special card reader which is not available at many places as the S8 is been discontinued
you might have luck obtaining the card reader on ebay from Israel

maybe its co-incidental, weight loss and not feeling well
maybe not getting enough nutrition/sleep or something else, checked out with your doctor

My leak for yesterday was 0.02L/s, which is actually lower than the weekly average that is recorded in the device.
My AI yesterday was 1.9 (weekly average is 0.3) and my HI was 13.1 (weekly average is 5.8 ).

My numbers jumped (other than the leak) but I'm not sure what any of it means.

And yeah, unfortunately I don't have the card reader.

(02-21-2013, 09:25 PM)wilorg Wrote: In Canada you can just send the query to your specialist or via your GP (or both), who is the gateway for your specialist, in the form of an e-mail or letter.
Thanks for the advice. I'm actually outside of Toronto, and my sleep doctor works at a Toronto hospital, but it's not that convenient to get there. I always assumed that they don't take email inquiries (since they can't properly bill for those, I guess?) so I never thought to try that.

If it keeps up, I'll probably have to give them a call either way though.

(02-21-2013, 09:35 PM)Ugly Wrote: Well you just learned a dirty little secret.
Yes it's true. Despite the hoopla that they sometimes make about the "importance" of losing weight, sometimes it just doesn't matter. Nowadays we don't have a scale in the house. But at times when I did monitor my weight, it didn't seem to make any difference.
The theory as explained to me was excess "weight" around your neck and throat supposedly contribute to or are the cause of sleep apnea. That's not necessarily so, of course. If you're going to lose weight, do it for your own well being or self esteem or whatever, but don't expect an apnea cure. I guess it could happen. But don't count on it.
Unsure

Heh, that's actually what I was told - that losing weight would ease apnea in the long term. Oh well. lol

(02-21-2013, 09:28 PM)Sleepster Wrote: I was thinking the same thing. Follow zonk's directions and see if your CA index is the dominant part of your AHI. AHI equals sum of CA index, OA index, and hypopnea index. If the CA index is by far the biggest of the three that could indicate that your pressure is too high.

CA = clear-airway or central apnea
OA = obstructed-airway apnea
hypopnea = partially obstructed airway

The sum of these three indices equals the AHI (apnea-hypopnea index).
I posted my AI and HI numbers above... how do I interpret them?

Thanks everyone for your responses. Smile

(02-21-2013, 09:52 PM)PaulaO2 Wrote: I also lean toward the increase in central events.

You could try an experiment but it will take time.

Decrease your pressure by half a point, maybe a whole one. Wait a week or more and see if the events decrease and/or you feel better. If slightly better or no difference, decrease pressure again, waiting yet another week or more.

If the weight loss was not on purpose, it is time to see your GP.

On another board, someone recommended lowering the EPR number - would that help as well?
And yeah, the weight loss was planned so no real problem there (I hope!).
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#15
(02-21-2013, 10:22 PM)firehawk12 Wrote: I posted my AI and HI numbers above... how do I interpret them?

Well, they show that your AHI is dominated by hypopneas. That means that CPAP-induced central apnea is not the issue.

But that data shows you had a average AHI of about 6 for the last week and 15 for just the last day. I'm trying to reconcile this with what you said in your original post:

Quote:I've been losing some weight and at first I noticed that I was sleeping well and my average AHI was hovering at around the 6 range. I've continued to lose weight, but I have noticed I haven't been sleeping as well and sure enough my AHI is now at around 15.

I wouldn't worry about this unless it persists for a longer time. At any rate, we know your AHI is not dominated by CA's, it's dominated by hypopneas, which is an indication that your pressure might be too low.

You may want to discuss this with your doctor. You may be able to get a new S9 Autoset out of the deal, justifying it on the basis that your AHI is fluctuating due to your weight loss and you need a newer machine that can adjust itself to your changing pressure needs. Who knows, it might just work!
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#16
(02-21-2013, 11:42 PM)Sleepster Wrote: Well, they show that your AHI is dominated by hypopneas. That means that CPAP-induced central apnea is not the issue.

But that data shows you had a average AHI of about 6 for the last week and 15 for just the last day. I'm trying to reconcile this with what you said in your original post:

Hrm, that's good to know. Hypopnea events are the ones where you are waking because you aren't getting enough oxygen and not too much, right?

Quote:I wouldn't worry about this unless it persists for a longer time. At any rate, we know your AHI is not dominated by CA's, it's dominated by hypopneas, which is an indication that your pressure might be too low.

You may want to discuss this with your doctor. You may be able to get a new S9 Autoset out of the deal, justifying it on the basis that your AHI is fluctuating due to your weight loss and you need a newer machine that can adjust itself to your changing pressure needs. Who knows, it might just work!

I was just concerned because I was sleeping decently for the last few weeks as I was losing weight until the last couple of days. But I'm probably due for a consultation at least.

Unfortunately, Ontario only subsidizes new CPAP machines every 5 years and it's only been a couple since I bought the S8.
(Although, maybe because of various taxes and fees, the subsidized Canadian price typically ends up being higher than the price on a site like Supplier #1).

Thanks again for the information! Smile
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#17
(02-22-2013, 12:28 AM)firehawk12 Wrote: Hrm, that's good to know. Hypopnea events are the ones where you are waking because you aren't getting enough oxygen and not too much, right?

A hypopnea is when your breathing becomes shallow. I'm not sure of the quantitative details but your breathing would have to fall below a specified percentage of normal for a specified amount of time, probably 10 seconds.

As to whether or not this causes an arousal from sleep, well, that's the million dollar question. In a sleep study they'd know because they are monitoring your brain activity, but at home with a CPAP machine there's no way to tell if an apnea or a hypopnea caused an arousal.

So that's an important difference between what a sleep study can tell you and what a good CPAP machine can tell you. Important because it's a factor that can interfere with the quality of your sleep and therefore affect how you feel and function during the day.

Another example of a factor like this is blood oxygen level. During an apnea or a hypopnea your blood oxygen level can drop, but just how far? This is important because these drops do damage to your cardiovascular system and elevate the risk of heart disease. Of course they also interfere with the quality of your sleep and therefore affect how you feel and function during the day. Again, a sleep study can measure your blood oxygen level wheras a CPAP machine can't. But you can get an oximeter to measure it yourself at home. Another thing you can do is look at the duration of your hypopneas and apneas. They have to last for at least 10 seconds to count in the AHI, but it's good to look at them and see if they last significantly longer. The longer they last the lower your blood oxygen level tends to drop during the event.


Quote:I was just concerned because I was sleeping decently for the last few weeks as I was losing weight until the last couple of days. But I'm probably due for a consultation at least.

You can talk to a doctor, and certainly I'm not one, but in my opinion a couple of days of lousy sleep is just a normal part of life. Anything could be happening in your life that's causing it to happen. It could be stress-related or it could be a change in drug intake. In addition to prescription drugs that we take, we also take drugs like caffeine, nicotine, and alcohol. And those are just the ones that are legal. Coffee

And it's easy to do it by accident. For example I thought Coke Zero was caffeine free and had been drinking it from soda dispensers at restaurants until one day I went to buy one at a convenience store and had a chance to read the list of ingredients.

It's always a good idea to see a doctor if you're due for a check up or are concerned about an issue. I'd be surprised if a doctor would tell you anything other than to be careful of your caffeine intake and don't worry about it. If it persists for a few weeks then that might be a reason for concern, but the worse thing you can do is freak out about it. That'll just increase your stress level and may make the problem worse.

Another thing the doctor will likely ask about is your exercise routine and tell you to increase it. Oh-jeez
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#18
(02-21-2013, 10:22 PM)firehawk12 Wrote: On another board, someone recommended lowering the EPR number - would that help as well?
it might help but EPR is suspended if apnea is detected. some folk find breathing out at lower pressure more comfortable so really its a compromise

EPR 3 - inhale pressure 14, exhale pressure 11
EPR 2 - inhale pressure 14, exhale pressure 12
EPR 1 - exhale pressure 13
EPR off- inhale and exhale pressure 14

this might help, http://www.apneaboard.com/adjust-cpap-pr...re-on-cpap

normally increase pressure would deal with hypopnea but if the pressure increase induced central sleep apnea than pressure is backed off
unlike the S9, the S8 do not detect central sleep apnea
the S9 Autoset do not increase pressure if central sleep apnea detected
http://www.s9morecomfort.com/s9morecomfo...toset.html








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#19
Thanks for the further information guys; it's very helpful!

I do have that guide to adjusting the numbers open. Is the exhale number responsible for the AI/apnea number, while the inhale pressure is related to the HI/hypopnea number?

And I didn't know that external factors such as stress or diet could affect AHI numbers. Because I'm overweight, I've always just assumed that it's completely weight related.
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#20
No, not at all.

Let me back up to make sure you are understanding all of this.

EPR is a comfort feature although some people have made assumptions based on their experience that the exhale relief (by whatever name, EPR is Resmed's name for it) causes events. What it does is make the exhale easier.

The inhale pressure is your prescribed pressure. Some machines can detect when you inhale so it raises the pressure then drops it when it detects the inhale has stopped. Some machines do the opposite, they detect when you exhale and lower it then increase it when the exhale stops. Same thing, different rhythm.

If you have an autoPAP, then it maintains a pressure it determines is best to keep your throat open. If it detects an event, it will increase the pressure to either stop the event or to prevent the next one. If you have a "straight" PAP, then it maintains the same pressure no matter what is going on.

In the case of a ResMed APAP, if your pressure starts at 8 and you have the EPR at 2, then the inhale is 8 and the exhale is 6. When the APAP increases the pressure, say to 12, the inhale is 12 and the exhale is 10. Whatever the top number is, the EPR will be 2 lower. EPR of 1 is 1 lower and EPR of 3 is 3 lower.

In the case of a ResMed CPAP, such as the Elite, if your pressure is set to 12 and the EPR is 2, then the inhale is 12 and the exhale is 10 all night long.

Neither of the numbers are responsible for anything other than what the machine is doing (or not doing) as you sleep.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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