AHI going up recently

[st8800]

Been on Dreamstation since my CPAP journey for 4 years. Recently in the past 2 weeks, average AHI has gone from below 2 to more than 4. Raised my min pressure from 11.5 to 12.5 but doesn't seem to have any effect.

What do you guys think could be the reason?

[Ockrocket]

Your situation sounds almost exactly the same as I have recently been going through.

I also use a Dreamstation, and my numbers started rising.

Some of my issue turned out to be that I had started relaxing my jaw when sleeping more than I had been in the past.
Using a nose mask meant that air was escaping through my mouth at times, the solution was switching to a ResMed AirFit F20 full face mask.. it is quieter and seals 100% with ease.

The other thing I found when trying different pressure settings was that the higher pressures actually seemed to make my numbers go up.

I switched from Fixed to Auto (which you are already in).. but found the Max pressure of 20.0 seemed to wake me up when the machine needed to kick the pressure up in response to an event.
With a low of 7.0 in the past I felt starved for air, so had put it up to 8.0 myself.
But on auto I wasn't making headway, so went to 8.5 and then 9.0, and even up to 10.0 at one stage.. each step only making things worse.
Also tried various levels of Flex as well during it all, no luck still.

So I changed tack.. no Flex (have never had a problem breathing out against normal incoming pressure anyway) no ramp, minimum pressure brought back to 8.0, maximum brought down to 15.0, and the new full face mask..

Now I'm consistently below 1.0, normally 0.4 to 0.6 each night, sleeping longer before waking (used to wake in under 4 hours and struggle to get back to sleep) and easily going back to sleep.. now able to sleep 7.5 hours to 9.0 hours each night.

Your changes may take time to refine, just be patient, allow at least four days between each setting change, and only change one thing at a time.. that way you will be able to work out what difference each step makes.

Good luck with it all.. 
The more knowledgeable members here will be able to guide you on specific adjustments from your charts better than I can.

[st8800]

Thanks Ockrocket. Ramp has always been off but I am switching off Flex for now and try. Also lower pressure from 12.5 to 11. I brought it up recently because I found the AHI had been going up. Increasing from 11.5 to 12.5 seems to make the situation worst. 

My go to mask has always been the Amara view FFM because I am a mouth breather. Resmed F10, F20, F30 and Dreamwear all leak too much for me.

Don't ask me to wear a cervical collar though. Been there done that, took it out after half a year and AHI was still averaging less than 1.5 previously. I sleep on my sides most of the time so it can't be sleeping positions. 

Other suggestions would be welcome!

[Dormeo]

The clustering is pretty striking, so I suspect you are chin-tucking despite sleeping on your sides. An example would be curling into a fetal-type position.

If the collar solution isn't going to work for you, you might try a neck-support pillow. That's a pillow with a hump that runs along its bottom length. If you try it, I'll be curious whether it does the trick for you.

[Sleeprider]

Classic chin tucking, positional apnea. http://www.apneaboard.com/wiki/index.php...onal_Apnea

[st8800]

Hi Dormeo
Actually, currently using a Tempur pillow. May have to get another collar again. 

[Sleeprider]

For laying on my side, I actually find a less firm, more flexible pillow works best. I use a good quality down and can pull a corner between my shoulder and jaw which prevents any chin tucking. It's really a personal preference, but memory foam pillows have never been very good for me. Just be aware that the clusters of OA that are increasing your AHI have nothing to do with the CPAP therapy or settings, but arise from your sleeping position. With that awareness you can probably do something about it.

[st8800]

Thanks Sleeprider. Need the foam pillow for my neck issue. Just ordered a cervical collar. Thought I had seen the last of it. Guess not to be....