[CPAP] AHI Creeping Up

[Sleeprider]

If you regularly experience an AHI this high, you may have complex apnea.  Did you have a titration study?

Also, please do not start new threads or we lose continuity with previous issues and comments.  I am going to report this thread and ask that it be merged with your previous one. http://www.apneaboard.com/forums/Thread-...reeping-Up


<Moderator Note: Threads have been merged. --Sleepster>

[Sleeprider]

The moderators have helped us out by keeping this in one thread.  Let's take look at what's happening.  In your first post you had very high AHI over 20, with mostly OA and H events based on CPAP pressure at 7 and EPR of 1.  Your treatment history showed that you had tried other CPAP pressures, with generally better results at lower pressure.  Now at a fixed pressure of 8, you are having abundant CA and H (chart 3). 

You initially reported some positive results from some pressure changes and positional therapy.  That has apparently not continued, and your apnea appears to be increasing again.  I don't think there is a magic solution to be achieved from changing pressures on your machine.  This looks a lot like complex apnea, and you should consult with your doctor.  Your best results in the historic results were at low pressure with no EPR.  I think you should consider going back to lower pressure CPAP and no EPR and see if this brings AHI back down, and if it does, it pretty much confirms complex apnea.  Long-term that is going to require an ASV machine to resolve.

[cadogan]

Thanks Sleeprider.  You are very insightful, and I appreciate it, along with everyone else on this Board.

Tonight's results are no better, arguably worse, with abundant CAs.  The mask was hurting the bridge of my nose, so I loosened it up bit, which may account for the leakages.  I also wasn't so mindful about sleeping on my side.

I intend to watch it for a few days, then perhaps adjust the pressure down by one, and see if that gets the CAs down.  I am also thinking that I should return to the nose pillow, which I used in the fall.  I have a deviated septum, and felt a face mask would be better, but the results show otherwise.

The big puzzle is why such a dramatic difference following my trip to Aspen skiing in January, and why it hasn't returned to prior levels. Frustrating.....

Here is last night'c chart:

http://imgur.com/a/33aiI

Here are the statistics:

http://imgur.com/a/RSeaf

And here is a daily overview which shows trends:

http://imgur.com/a/Q98jq

[Sleeprider]

Cadogan, it sure is a mystery to me, which is why I think you need to involve the doctors.  A sudden change for no apparent reason should be investigated, and that is probably beyond the scope of a forum unless you can think of health, medication or lifestyle changes that may be cited.  Your current trend is back in the right direction, and the problem may self-resolve, however at this point you have enough untreated sleep apnea that a new titration evaluation including ASV might be warranted.

Wish I could do more.  

[cadogan]

Hi Sleeprider, and thanks again.

I emailed my sleep physician in NYC at Cornell, and am going to arrange another titration study.  I mentioned complex apnea as a possibility, and the thought that an ASV device might be appropriate, and they will consider that after the titration study results are known.

Thanks again.

[Sleeprider]

Good for you, and good luck. Part of the problem we have is that the data from the machines are pretty good at detecting flow cessations that indicate apnea and hypopnea, but the reliability of determining CA vs OA and getting to root cause is not as clear. The doctors have much better means of determining what is actually going on. It will likely take some time to sort this out, but I hope you will stay involved and keep us posted of your progress.

[cadogan]

Thanks!  For what it is worth, here are last night's results...abit better.

http://imgur.com/a/iNePS

[cadogan]

We live in interesting times.  Two nights ago I put my face mask on, and woke up with a sore/slightly bloody crown of my nose.  The face mask has always irritated me there, but never to this degree.  The AHI was no prize either, coming in at around 8 (see prior posting).

So last night I went back to my nasal pillows - which I had been using prior to December.  I stopped using the nasal pillows due to compliance issues.  My nose would get stuffed up, and I would be unable to breath, so I would take it off after several hours.

Anyway, same thing happened last night.  One side of my nose got stuffed up, and after several hours took it off.

But the interesting - good news- is that when I uploaded the data, the AHI for that period of time came in at .88.

Not certain why there is a marked difference between the pillows and the mask, but there is.  And so the challenge will be figuring out how to be able to use the pillows for a longer duration of time without my nose getting stuffed up. 

Last night:

http://imgur.com/a/qw8TO

[Marillion]

Please keep us posted further Cadogan. Particularly what your sleep physician comes back with once you have a new study done. I wish you all the best!

[Sleeprider]

Little white dogs are always weird, and you're no exception

I have no idea why nasal pillows would improve your results, or why you alternately stuff up your nose on one side or the other. The good news is, I'm allowed to be bewildered since I don't get paid for this. The bad news is, I'm still bewildered.