AIH increasing trend

[Pierrec83]

Hello to all
So I started CPAP in Dec 2020, got advises of SCC + set-up of my machine by this forum, which got me from an average (before SCC and settings optimization) of AHI at 4.0 to an average at 2 along Feb. Then it slowly decreased, without settings changes, to an average of 1 in March

Now in April, I changed of life location (different country). And since I am there, the AHI is now averaging at 3.5, while I did not change anything
If I look at Oscar, I see the pressure going up to 15 (the max) at least half a dozen times during the nights, which was not the case before. And I feel less energized than in March.

Any advises on changes which could get me back to the Feb-March? Should I post some views?

Thank you

[SarcasticDave94]

You could post some standard OSCAR shots, but the thing that comes to my mind immediately is this, is the altitude a lot higher than the past? I'm wondering if you're seeing more Central Apnea?

[Pierrec83]

Thanks for the quick answer
I will post charts later today

So the change is from Switzerland (Altitude 400 m) to Bahrein (Alt 0), but key difference may be on the air humidity I guess

I extracted this view from Oscar summary
Details avril/ mars/ février/ janvier/ décembre
AHI 2.34 /1.22/ 1.31/ 2.02 /2.66
Obstructive Index 1.22/ 0.52/ 0.49 /1.06 /1.86
Hypopnea Index 0.65 /0.37/ 0.35/ 0.52/ 0.42
Clear Airway Index 0.46 /0.32 /0.46 /0.44 /0.38
Average Pressure 12.07 /10.71/ 9.76 /9.62/ 9.16/ 8.12

and the increasing trend on OA and H and Av pressure is really since I am in Bahrain (April 6)

Thank you

[trenton78]

Could the air quality be the culprit? Bahrain has relatively high pollution (https://www.iqair.com/de/bahrain). A hypoallergenic air filter for your Resmed or an air purifier for your bedroom might be worth trying out.

Greetings from Switzerland, where the air smells of roses (and cow dung).

[Gideon]

The differences you show, though small enough to be normal variation, could be simply seasonal, possibly alergies as winter changes to spring. Yes, your sensitivity to air quality could also be a cause.

If you dig a little deeper I suspect you will find your flow limits have increased as well.

When you post your charts we can see if anything stands out.

[Pierrec83]

Hello

Here are my charts of a night at 4.63 AHI, full night and focused

Thank you
   
   

[mesenteria]

Something has changed, but we don't really know what it is.  

Temperatures at night in Switzerland vs. Bahrain.  

Is air conditioning involved?  

Are the filters in the unit clean?

Is pollen involved, or molds?  Possibly?

How about humidity?

Even a different mattress can be a problem.  Or, did you bring your favourite pillow?  Is the pillow new or used?

Different laundry?  Different soaps, softeners, used appliances that could stand some cleaning?

----------------------------

You show a lot of clusters of 'obstructive' events.  We don't know if you historically sleep in such a way that it causes clustering of events, but you're definitely doing so at present in Bahrain.  The clustering suggests you slouch, or slump, while you sleep, probably on your back, and that your pillow forces your chin toward your sternum.  This has the effect of closing off your airway.  If this goes on, your sleep will be interfered with, you'll dream less, and you'll feel like crap.  Also, your machine WILL raise pressure to compensate, and that's what it says it's doing.

Many resort to the use of a soft foam cervical collar.  They're warm, and they're intrusive in their own way, but you'll eventually accept them as necessary to keep from tucking your chin.

[Gideon]

As you can see your pressure increases are mostly driven by flow limits.

Increase EPR to 3 to decrease these.

[Pierrec83]

Thank you all for the feedbacks

First to answer : I am in a hotel room, 
-with air-con, most of the day
-in a bed which is not mine
-with nice new pillows
-some new soap, softeners, pollen... all is possible
This will be my life for some time anyway (Air con is a must have around here, I will spend quite some time in hotel before I get set-up in my own place, ...), so I need to optimize my therapy to this

I use an SCC since Jan. That was this forum advise and has improved my sleep big time. I believe that the clusters we see may be that I should get it tighter around my neck to ensure the best effect, which I started last night.

What I actually did is to increase the max pressure from 15 to 16, which has improved for 2 nights (allowing the machine to go into the 15 to 16 pressure range), but last night, it actually maxed at 13, and the AHI was 1.04.

I will monitor for some days now (I am changing hotel and country in 4 days). I tend to believe that there is a time to adapt to the conditions, and condition changes triggers bumps. I mean  :
-when in Switzerland, and after applying the advises from this forum, it took one month to gradually go to a stable AHI around 1, all this under stable conditions (my bed, my house, my country, my soap, my laundry, my food)
-I drastically changed conditions, and I see a what I hope is a bump before stabilizing down

Thanks again for you guys spending time in looking at this, especially as I know that AIH at 3-4 is not that bad compared to a number of people under same therapy. Though I personally clearly perceive  a big difference between a 4 and a 1 in term of energy