[Treatment] Why is my AHI going up all the sudden? OSCAR data attached

[SpaceSpud]

I have been at an autocpap pressure of 7-9 for the past few weeks, but all of the sudden my AHI is going up despite me also increasing my pressures. Can someone figure out whats going on? My leak rate rarely goes above 10L/min.

OSCAR screenshots attached

           

[Gideon]

Welcome to the forum.

Why no PS?
PS is used to treat Flow Limits, RERAs, hypopneas, and UARS (which you have no sign of).

I would try Min PS = Max PS = 3
Min EPAP = 5 (Starting EPAP will be 8, 5 + 3)
Max IPAP = 10, just to provide some room to work.

[staceyburke]

You are running as basically a Cpap instea of an autoset. Your low is 7 (exhale)  and max is 8 (inhale) and no pressure support. 

I would set min of 8 the max at 15 ( it will not go that high unless it needs to) ps a
T 3 for both. 

That will take care of most of the events you are having (H).  Give it a try tonight and post to. You should feel little to no difference with these settings.

[SpaceSpud]

Why no PS?
PS is used to treat Flow Limits, RERAs, hypopneas, and UARS (which you have no sign of).

I would try Min PS = Max PS = 3
Min EPAP = 5 (Starting EPAP will be 8, 5 + 3)
Max IPAP = 10, just to provide some room to work.

You are running as basically a Cpap instea of an autoset. Your low is 7 (exhale)  and max is 8 (inhale) and no pressure support. 

I had previously had settings of EPAP min 9, IPAP max 14, PS min 1, PS max 3. Unfortunately I started experiencing tear duct air regurgitation, leading to severe dry eye which would actually wake me up in the middle of the night and had to reduce my pressure to a maximum of 9.

My lacrimal duct must have been permanently enlarged, because now even at a max pressure of 9, I still experience moderate dry eye while swearing swimming goggles.

I should also add that I am using a MAD in conjunction with PAP therapy, and the screenshot provided is with the MAD in use.

I guess I am moreso wondering if there is a fix that doesn't involve increasing pressure, because that causes me to have tear duct air regurgitation.

[mesenteria]

Well, ummm...is it really necessary to swear or to wear swimming goggles?  Or do you do both concurrently? 

Just kidding.

It seems you must keep a lid on your high pressure then.  But it sounds as if the others have a good idea that you need more pressure relief. I wonder if you're not also doing some chin-tucking now and then, just enough to close down on your airway and to cause flow restrictions. Is it possible?

[staceyburke]

I’m sorry but adding pressure is about all a pap machine can do. The min pressure needs to be raised to combat all the different apnea you have and you were maxed out several times with your graph Plateaued which means you need a higher max pressure.

[Sleeprider]

For the problem you describe, I like this solution best. I will result in lower pressure, and address the hypopnea and flow limitation. Since there is no OA events, you can give up some EPAP pressure, but PS will treat what ails you. Keep BiFlex at 1 or 2. Try it.

Welcome to the forum.

Why no PS?
PS is used to treat Flow Limits, RERAs, hypopneas, and UARS (which you have no sign of).

I would try Min PS = Max PS = 3
Min EPAP = 5 (Starting EPAP will be 8, 5 + 3)
Max IPAP = 10, just to provide some room to work.

[SpaceSpud]

It seems you must keep a lid on your high pressure then.  But it sounds as if the others have a good idea that you need more pressure relief. I wonder if you're not also doing some chin-tucking now and then, just enough to close down on your airway and to cause flow restrictions. Is it possible?

What are the other signs of chin tucking? Im not overweight, but I always do have red lines on my neck in the morning when I wake up, like I was looking down all night.

Also, what are the fixes to chin tucking? Will a chinstrap do? I currently use a knightsbridge dual band chin strap.

For the problem you describe, I like this solution best. I will result in lower pressure, and address the hypopnea and flow limitation. Since there is no OA events, you can give up some EPAP pressure, but PS will treat what ails you. Keep BiFlex at 1 or 2. Try it.

Welcome to the forum.

Why no PS?
PS is used to treat Flow Limits, RERAs, hypopneas, and UARS (which you have no sign of).

I would try Min PS = Max PS = 3
Min EPAP = 5 (Starting EPAP will be 8, 5 + 3)
Max IPAP = 10, just to provide some room to work.

I'll try this tonight!

[Gideon]

Chin tucking, the main sign is that your obstructive events are clustered close together. Your are not close enough to make a definite conclusion. I don't feel you are at the point need a Soft Cervical Collar at this time, but it will not hurt you, at least not more than a few bucks. See the Soft Cervical collar link in my signature. The main other sign is an elevated AHI, double digits is not uncommon. Your warrants watching, not worrying.