AHI spiking - what could be the cause and what to do now

[sheepless]

ideally we'd be looking for a section within the green area containing central apnea.

meanwhile, let's see if the more experienced members agree: my opinion is that what you've shown is not csr.

nor is it clearly plm, but there are hints of it, especially in the non-green area. the sinusoidal waxing & waning might reflect plm as well but that pattern is also common during a series of events & after an event as a form of recovery breathing.

anyway, if you feel less than par once you are satisfied your settings are optimized, I think there's enough 'evidence' to warrant looking into treatment for plm.

[Gideon]

1. This is not CSR and does not contain Central Apnea. The waxing and Waning of your periodic breathing is most likely caused by your CO2 concentration approaching the apenic threshold (CO2 levels dropping and your breathing diminishing) then retreating as your shallow breathing increases your CO2 concentrations. This is the mechanism that produces CSR but the periods are much longer and your lacks the central apnea stoppage of breathing between cycles..

[MCS2014]

1. This is not CSR and does not contain Central Apnea.  The waxing and Waning of your periodic breathing is most likely caused by your CO2 concentration approaching the apenic threshold (CO2 levels dropping and your breathing diminishing) then retreating as your shallow breathing increases your CO2 concentrations.  This is the mechanism that produces CSR but the periods are much longer and your lacks the central apnea stoppage of breathing between cycles..

Thanks for the insightful response. I wonder what's causing the C02 levels to drop in the first place.

Last night's readings much improved for some unknown reason and I can definitely feel it (more refreshed). No changes were made to pressure.


[MCS2014]

Followup titration study.
Compared to last study:
- PLM index and arousals increased
- sleep efficiency improved
- hypopnea and apnea + hypopneas improved

[sheepless]

"majority of plm not associated w arousals" is really dismissive & misleading. idk how they define arousals but ask anyone how they'd feel after a night with 6.4/hr of them from any cause, on top of essentially being shoved another 52 times per hour without arousal. idk what & how other problems affect your sleep but I suspect you would sleep & feel better with treatment to reduce your plm. sleep med folks seem to ignore rls & plm. I had to get help from my primary family doc.

[MCS2014]

"majority of plm not associated w arousals" is really dismissive & misleading. idk how they define arousals but ask anyone how they'd feel after a night with 6.4/hr of them from any cause, on top of essentially being shoved another 52 times per hour without arousal. idk what & how other problems affect your sleep but I suspect you would sleep & feel better with treatment to reduce your plm. sleep med folks seem to ignore rls & plm. I had to get help from my primary family doc.

Is there a reference range for PLM?

It just dawned on me that it may be no coincidence that my long term (5y) tapering off a common drug widely used for RLS/PLMD (Klonopin) could be what's contributing to it and perhaps my PVCs, as these are known withdrawal symptoms and I am almost down to zero. That's not what the drug was prescribed for though and I should've never been put on it but that's another story.

[sheepless]

I'm not sure of the range so I searched for plm index. lot's of hits as usual. first one I looked at (jpgmonline) said this:

The universally accepted criteria for diagnosis of PLMs are as follows:

There should be at least four leg movements in a 90-s period. Contractions should be more than 0.5-s and less than 5-s. [3] When they are recorded from both anterior tibialis muscles, they should be separated by an interval of at least 5-s for them to be counted as two separate movements. They can either be associated with EEG arousals or in severe cases even overt arousals. The PLM Index (PLMI) is calculated by dividing the total number of PLMs by sleep time in hours. Periodic Limb Movements Index of more than 5 and less than 25 is considered mild; PLMI of >25 and <50 is considered moderate and >50 is severe.

yours is 58.4/hr with 6.4 arousals/hr. even if you only count the arousals, you're waking 6.4 times an hour. who thinks that's okay?

while idk anything about Klonopin, I can imagine weaning off it could increase plm and also complicate alternative treatment. idle speculation on my part; best to talk to your doc.