AHI - Mid 20's to High 30's (I'm tired!)

[DarDirk]

Hi all, 

I am on a Bi-Pap DreamStation. Since December last year, I've noticed that I have been low on energy, lethargic, and struggle to get through a day. I associated it with seasonal depression at the time, being in the NorthEast. 

Fast forward to late March, after looking at options to ease the chronic fatigue, I happenstance download the DreamWeaver mobile app for my machine as I got a new phone and thought it cool that I could see data from the device to my phone. Doing so sent me down a path to where I am talking to you all. I've even brought the data into OSCAR, which has given more perspective.

My AHI numbers are high in looking at the historical data, which I am homing in on the root of my issues. I have several central apnea events on any given night. 

Last week AHI's:

Sunday, March 13 --> 15.99
Monday, 14th --> 26.37
Tuesday, 15th --> 17.87
Wednesday 16th --> 35.81
Thursday 17th --> 38.14
Friday 18th --> 24.31
Saturday 19th --> 22.82

The numbers are similar for the week before. I added screenshots for Wed, Thur, and Friday.

Any thoughts on what should be adjusted, if anything? My Bi-Pap pressure settings are 7 and 15 from a sleep study done ~6 years ago. Also, not sure if relevant, but it sometimes feels like the airflow isn't enough when going to sleep. I sometimes have to take a deep breath through my mouth before drifting off to sleep. I use a nose-style mask today.

I appreciate any help or guidance in advance. Thank you all! ??

~Bob

[SarcasticDave94]

Problem number 1: you have a big Central Apnea trainwreck of events. If this CA pattern has been there any length of time, you will need ASV to treat this. This BPAP you have now can't handle these CA. What did your diagnosic sleep study report on events type and count? Post the redacted report if you have it. Even so, I think you'll find you now need a ResMed ASV. CA will always be consistently inconsistent.

Problem 2: you have sometimes a mid level Positional Apnea clusters. Look for the Obstructive events flags that appear one after another or a tight group every few seconds. Correction is to review your pillow first. Do you sleep on a stack of pillows? Cut it to one if you do. Next try this, sit in a chair, relax, slow steady breaths, now slowly drop your chin. Did breathing get harder? Yes then welcome to Positional Apnea. Again a single thin pillow may correct this or tougher methods like a soft cervical collar to keep your neck straight, preventing the airway from kinking like a garden hose.

[DarDirk]

Thanks much for the reply, Dave.

I tweaked some settings before bed last night. 

• Changed the mode from Bi-Pap to A-Pap
  
• Set Epap pressure at 7.0
  
• Set Ipap at 14 with a max of 18
  
• I turned off Flex entirely
  

Attached are the results. I achieved an AHI score of 3.75, which is the first I have seen below 5 in quite some time. I woke up briefly at 5am to hit the restroom. I turned off the machine and turned it back on when I returned to bed. Make mention of it as there was a pocket of CA's that may be coincidental to that event?

I'm thinking of making the following tweaks tonight based on last night's data (looking at the Statistics and the Med numbers). 

• Epap 9
  
• Ipap 15
  

I was also wondering if I went back to Bi-Pap mode where the pressures are constant if you would recommend these settings?

Thanks again for the assistance (and others). Placebo or not, I felt rested today.

~Bob

[SarcasticDave94]

Two things I'd change

1. Just to clean up OSCAR, turn off the VS2 flag. It's referring to vibratory snore 2, but this can actually even be due to hose vibrations, etc. The data this hides is far more valuable.

2. PS/pressure support starts at min 6, I'd try dropping it to 4 or 3. At 6 you're setting yourself up to get high CA.

[DarDirk]

Thanks much, Dave. 
I'll adjust only the PS setting tonight and see what happens.

I turned off Vs2 data in Oscar and attached a new screenshot, if helpful.

I will follow up tomorrow! Thank you again.

~Bob

[DarDirk]

Check these results out from the last three days! 
I'm inclined not to change anything further, but curious if there is any obvious tweaking you would recommend?

Is it safe to conclude that the pressure may have been too high for me originally? The C-Apneas are significantly lower now.

Thanks again. I can feel a difference in my energy level in the last couple of days. I can't express enough how helpful you have been.

Bob