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mystery continues: initial burst of AHIs first hour of sleep
#1
Burst of AHI at the beginning of sleep
    Hi folks, I remain incredibly grateful this forum exists.

It is becoming the norm to get a lot of AHI at the beginning of the night. If I ever turn off the machine to use the toilet in the first hour or so, it often reports 8 or 9 plus AHI.

I've experimented with incremental pressure adjustments in the range of 8 to 15. I've had EPR of 1, 2, and 3. I don't think anything has worked.

Resp Rate... When I used a nasal cushion (which I had to give up because I am a mouth breather), it seemed like the max would always be 22 or so. Lately, with my F20 memory foam mask, it seems to be much higher.

I still don't have a handle on what flow limit is (in spite of having ready ready the wiki), but that seems to be all over the place.

What is going on with the first burst? Should I just ignore it, or continue tweaking?
Thanks!

ps. I do not take it for granted that I have finally found a mask that I really like.
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#2
RE: Burst of AHI at the beginning of sleep
Welcome to the Apnea Board forums. Your pattern of clustered obstructive apnea and hypopnea with high flow limitations practically defines positional obstructive apnea. This is so common we have several wiki articles that show examples of charts showing the problem before and after using the tool that nearly always works...a soft cervcal collar. The clusters are caused by chin tucking which happens as you fall asleep and relax. You can simulate this by sitting in a comfortable chair and letting your head drop towards your chest. You will likely feel more resistance to your breathing or even a snore or apnea as your chin tucks closer to your chest.

Take a look at the articles in my signature links to Optimizing Therapy and look for the Positional Apnea section, and also the Soft Cervical Collar wiki. Nice job on the chart! Based on what we are looking at you will benefit from an EPR setting of 3 to help with the flow limitations by giving you more pressure support during inspiration. In addition your minimum pressure will likely need to go higher based on a median pressure over 12.0 cm. The additional EPR may help reduce flow limitation which is driving your pressure higher, but between the soft cervical collar and higher minimum pressure, I think you will find a complete solution to your clusters of apnea.
Sleeprider
Apnea Board Moderator
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#3
RE: Burst of AHI at the beginning of sleep
Forgot to mention. I use a soft cervical collar. I really like it. I actually wear it "reversed" which seems to keep my chin higher.

My plan was to get a Dr. Dakota, thinking that might even offer more support. I'll get back on that one.

Thanks
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#4
RE: Burst of AHI at the beginning of sleep
In your next chart, it would help if you would remove the pie chart so we can see the remaining respiratory statistics. You have a high minute vent and high respiration rate over 20 BPM, which suggests to me there are things going on in your therapy that would be improved with a bilevel pressure, meanwhile higher EPR setting of 3 will have to do.

You are a more informed user and already doing a lot to improve your therapy. Hopefully we will still be able to work out some bugs.
Sleeprider
Apnea Board Moderator
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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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#5
RE: Burst of AHI at the beginning of sleep
So far I've used a nasal cushion, a Dreamware FFM (which sits below the nose) and my current F20.

My AHI results and other stats seemed to be far superior with the cushion and dreamware. Also, the pressures were much less. But the dreamware was uncomfortable, and I had to mouthtape with the nasal cushion.

My dream is to get decent enough results with my F20 (which, so far, fingers crossed, has been virtually leak free)

One chart below gets rid of the piechart.
The other is a chart from when I was using the nasal cushion.


Attached Files Thumbnail(s)
       
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#6
RE: Burst of AHI at the beginning of sleep
No doubt, the therapy using pillows looks much more comfortable and effective at lower pressures, and as you say, the main problem is leaks. Do you think the restricted airflow with a FFM is nasal? Everything about the October therapy looks better, including resp rate, I:E times, and more continuous therapy with fewer pressure fluctuations. All of this suggests much lower flow limitation and airway restriction. I'd be very tempted to pursue the nasal therapy and try to deal with the leaks. As far as comfort, it's pretty hard to beat the Airfit P10.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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: Burst of AHI at the beginning of sleep
Do you think the restricted airflow with a FFM is nasal?

Not sure, of course. But I do get extreme dry mouth. I could maybe try the nasal strips.

The nasal cushion I used was very comfortable. I just had to spend time each night overcoming the paranoia of mouth taping. I don't miss that.

The dreamware ffm forces air up the nose... my results for it were pretty good... but I did get leaks, and I had to crank it tight, which was uncomfortable. I did try to keep it loose, too, but the leaks were worse.
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#8
mystery continues: initial burst of AHIs first hour of sleep
The phenomena started about five weeks ago. I get bursts of AHIs during my first hour of sleep. The pressure then maxes out, and I believe it awakens me.
Prior to then, I was averaging 2 AHI per hour, and there were no short periods of high AHI

I've gotten several rounds of feedback here and tried every suggestion, with no luck.

I have adjusted EPR to 1, 2, and 3.

I have raised the minimum and maximums pressure a point or two.

I have a soft cervical collar, but I also tried a Dr. Dakota.

I wear an F20 Airfit mask, which leaks very little.

I tried flonase, breathe strips, saline nasal mist, etc

I try different humidity and temperature settings.

Usually, I will awaken after an hour and turn off the machine. That's when I see the AHI is 30 plus. By the end of the night, the number goes down to 5 - 8 AHI.

I am thinking about changing the mask. I really like it, but I don't know what else I can try.

If any has suggestions, I am quite keen to try just about anything.
Thanks as always!
Renoir


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#9
RE: mystery continues: initial burst of AHIs first hour of sleep
The chart says that you have 2 issues.

1. Flow Limits which is best treated with pressure support or EPR. This EPR=3 to get the most help

2. The clusters of events strongly imply a positional issue. The fact that it remains usually indicates that the collar is not preventing the chin tuck because it is too loose or too short or both.

I will now go spend the next 20 to 30 minutes finding your other posts to review them and see what history they reveal.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#10
RE: mystery continues: initial burst of AHIs first hour of sleep
Please read this: http://www.apneaboard.com/forums/Thread-...f-together
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