AHi Changes Starting CPAP and Weight

[Hojo]

Hi all, been reading and trying to understand more and this is a first time post with a couple of questions.

When I had my initial sleep study done I felt it was a 'good' night for me in that I didn't wake up sweating, didn't wake up feeling short of breath like I just got done running a marathon (my cardiopulmonary function is great), and actually, I don't think I woke up at all so I thought the study may not show my usual sleep apnea.  

The results showed an AHI of 6 and my lowest saturation was 83%, it showed I have central apnea.  I was heavy at the time of the study but not obese.

I haven't been able to get the Sleep Software to work on this computer (yet) so I called the DME to find out what they are seeing.  They said they noticed my AHI has gone up but it isn't uncommon when first starting CPAP (I'm 5 days in).  After I hung up the phone I realized that I should have asked what AHI is she comparing to, from the original sleep study which I think showed a fairly good AHI compared to some of my very bad nights, or has my AHI progressively gone up over the last 5 days.  So my question is, do folks really see their AHI initially go up and then settle down within the first two weeks of starting CPAP.  I must say, maybe it's a placebo right now, but I feel like I'm waking up better, my lungs don't feel like I'm! trying to re-expand them, my heart doesn't feel tired when I first get up.

My next question is CPAP pressure vs weight.  I decided to drop some weight, I've lost 12 pounds so far since my sleep study, and I read elsewhere that weight loss may require a higher pressure, which seems odd to me.  Thoughts?

Thanks!

[DavePaulson]

A CPAP is not the right type of machine to treat central apneas.It is not uncommon for people to have some central apneas when first starting CPAP for most people they go away on their own in a short time. I doubt if weight loss will result in much of a change in pressure requirement. Get  [url=https://OSCAR Official Download Page ----> CLICK HERE ./]SleepyHead[/url],  this is the software that people on the forum are used to working with, it provides a wealth of information about your treatment. There is a guide to using it here. Beginner's Guide to SleepyHead. Reports from other software would be ok if that is what you are using already. There are a couple of guides on how to post and organize your charts here. Posting an Image in 5 Easy Steps       Organize your SleepyHead Charts. If you need more help with any aspect of posting data don't hesitate to ask.

Best of luck,

Dave

[Hojo]

This is the error that I get with trying to put in SleepyHead:

“SleepyHead” can’t be opened because it is from an unidentified developer.
Your security preferences allow installation of only apps from the Mac App Store and identified developers.

I'm not sure how to override this.

[Walla Walla]

Google changing mac security preference it's show you how.

[trish6hundred]

Hi Hojo,
WELCOME! to the forum.!
Hang in there for more responses to your post, good luck with CPAP therapy.

[tmoody]

The results showed an AHI of 6 and my lowest saturation was 83%, it showed I have central apnea.  I was heavy at the time of the study but not obese.

I haven't been able to get the Sleep Software to work on this computer (yet) so I called the DME to find out what they are seeing.  They said they noticed my AHI has gone up but it isn't uncommon when first starting CPAP (I'm 5 days in).  After I hung up the phone I realized that I should have asked what AHI is she comparing to, from the original sleep study which I think showed a fairly good AHI compared to some of my very bad nights, or has my AHI progressively gone up over the last 5 days.  So my question is, do folks really see their AHI initially go up and then settle down within the first two weeks of starting CPAP.  I must say, maybe it's a placebo right now, but I feel like I'm waking up better, my lungs don't feel like I'm! trying to re-expand them, my heart doesn't feel tired when I first get up.

My next question is CPAP pressure vs weight.  I decided to drop some weight, I've lost 12 pounds so far since my sleep study, and I read elsewhere that weight loss may require a higher pressure, which seems odd to me.  Thoughts?

Thanks!

I think it's fair to say that AHI can vary all over the place during the first few weeks, or even months, of xPAP therapy. It's a lot to get used to. And for some of us veterans it can still vary quite a bit.

On weight: I'm borderline obese. What that means is that my has tended to hover around 30, the boundary of clinical obesity. Recently I've lost weight and it's below that, but over the past few years it's mainly been around 30. When I was diagnosed I asked my doc about the effect of weight loss. He said it might result in a need for lower pressures but he'd never seen a case where a person was able to cease xPAP therapy after losing weight. But he added that he'd also never seen a case where anybody lost that much weight and kept it off. As we all know, the success rate for weight loss is only around 2%.

I've done a little reading on this, and formed a few conclusions. These are just my opinions, so don't take them as anything more than that. First, people wear their fat in different ways. Some of us, like myself, have a lot of fat beneath the abdominal wall, around the viscera. We don't show a lot of "loose" fat externally (although there's certainly some). This is considered the worst kind of fat, medically. Why should that be? Well, for one thing, it puts pressure on the internal organs. It crowds the abdominal cavity and this in itself tends to cause blood pressure to rise. In some cases, it may make it harder to breathe, by creating resistance to the diaphragm. I've noticed a correlation between my weight and my sleeping respiration rate, which is above normal. A person whose fat is mainly stored externally (visible rolls of fat) might not see this correlation.

There is something called Obesity Hypoventilation Syndrome (OHS), which is pretty much what I've just described. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/ and scroll down to "Hypercapnic CSA". From the text:

Another form of hypercapnic CSA is OHS,45 the prevalence of which is likely on the rise.4 This disorder is typically defined as a combination of obesity (body mass index > 30 kg/m2) and arterial hypercapnia (Paco2 >45 mm Hg) during wakefulness not explained by other known causes of hypoventilation.46 Hypoventilation worsens during non-REM sleep and further during REM sleep, resulting in marked hypercapnia with accompanying hypoxemia. Typical symptoms may be similar to patients with OSA, including morning headaches and daytime hypersomnolence.47 Indeed, some patients with OHS also have OSA, suggesting there is mechanistic overlap between these obesity-related forms of SDB. The underlying mechanisms and the reasons why some obese patients have OHS but not others remains a major unresolved issue within the field. [/url]
[url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/]
That's from seven years ago but I think it's relevant to some of our situations, including mine and possibly yours.

[Walla Walla]

tmoody,
             You said  "As we all know, the success rate for weight loss is only around 2%".  Could you tell me where I can get that reference?

[tmoody]

tmoody,
             You said  "As we all know, the success rate for weight loss is only around 2%".  Could you tell me where I can get that reference?

Various failure rates are reported in various studies and reports. Here's one: diets_do_not_work_the_thin_evidence_that_losing_weight_makes_you_healthier.html

It hasn't stopped me from dieting.

[Walla Walla]

tmoody, Thanks. I saw a story saying 5%. Just wondering if there was a real number or just best guesses. Looks like best guesses. Either way it's not a good thing.

[tmoody]

tmoody, Thanks. I saw a story saying 5%. Just wondering if there was a real number or just best guesses. Looks like best guesses. Either way it's not a good thing.

Yeah. It's hard to study diet outcomes, so a lot of guesswork is involved. But I think the general picture is pretty clear: Most diets fail. Some will say it's not the diet that fails but the dieter. Personally I think that's a meaningless distinction. Most obese people are highly motivated to lose weight, to the point of obsession. And yet their experience is analogous to holding a beach ball underwater. You can do it for a while but eventually you lose your grip and it pops back up. Why is this so? I've read more books about diet and weight loss than I care to reveal, because I've struggled with my weight my entire adult life. The one that makes the most sense of it to me is not strictly a diet book at all: The Pleasure Trap, by Doug Lisle, PhD (psychology). A similar, but more updated approach is The Hungry Brain, by Stephen Guyenet, PhD (neuroscience). Both discuss how foods can "light up" our reward centers in a way similar to how certain drugs do it. Putting their ideas into practice has helped me to lose about 20 pounds in the past year. That's not a lot, I know, but it has been steady and relatively painless. There have been slip-ups along the way but the basic approach is working. I won't say it's easy, because it's not.

I do believe that obesity is an exacerbating factor in sleep apnea, although I don't think it's the whole story by any means. As I described above, my personal suspicion is that it may play a role in idiopathic central apnea. In any case, even though I'm still significantly overweight, I believe losing some weight has improved my apnea situation. Anecdotes are not science but this is an area in which the science is still pretty thin.