[Diagnosis] Why is my AHI so high?

[Lagotto]

This is my first post. I was diagnosed with mild obstructive sleep apnea a year or two ago.  The only thing I did at that point was to start sleeping on my side which seemed to improve things for a while.  Then things became worse - sleeping 10-11 hours at night.  So on October 25 2019 I started CPAP use with DreamStnAutoCPAPHumCell DSX500H11C.  Settings "AFlex3", "Ramp 30", pressure 7-20, mask "0", "Humidity 5" and "Hose 2". I started to use the Dreamstation every day on Nov 10, 2019. I don't use the ramp to get started.

Mask usage:
Oct 25 2019 to Feb 5 2020 used Resmed P10 nasal pillow mask
Feb 5, 2020 to Feb 13 used Resmed P10 and Resmed F10
Feb 13, 2020 to Feb 24, 2020 started using Dreamwear Full Face under nose cushion.
Feb 24, 2020 got provider guide and set mask type from "0" to "X1"
March 4, 2020 started using Resmed F30i.  This mask is less prone to leakage for me than the F10

I am mostly a nose breather however once or twice a night my nose gets a bit stuffy and I need to breath through my mouth for a bit - hence the mask change.

One other consideration - I have had very dry eyes for about 40 years.  I use drops during the day and ointment during the night.  At night I wake up after 2-4 hours and need to put drops in my eyes to open them and then more ointment.  I always felt that this was interfering with REM sleep since if my eyes blink they irritate the cornea and wake me up. Usually there is a second wakeup due to eyes and I have to put in more drops.

Can anyone tell from these 3 charts why my AHI is so high?  What more more information would be helpful?

Thank you
Lagotto

[DeepBreathing]

G'day Lagotto. Welcome to Apnea Board.

There are a number of things which show up in the charts, one easy and the others no so much.

First there is a lot of "periodic breathing" (the green areas). This may just be repetitive apneas or near-apneas or it could be something more significant called Cheyne Stokes Respiration. Do you have a heart condition? Could you get us a screen shot zoomed in cluse on one of those green areas so we can see exactly what's going on? My guess is that it's related to the next item...

...which is positional apnea. When we see tight clusters of apneas it's a pretty good sign that your airway is being compressed by your chin dropping down to your chest. A simple soft collar is the magic solution. See here: http://www.apneaboard.com/wiki/index.php...onal_Apnea and here: http://www.apneaboard.com/wiki/index.php...cal_Collar

Last thing is the number of central apneas. It's important to know if these were there before you started cpap therapy or if they are "treatment emergent" central apnea. It would be great if you could post a copy of your sleep study report (the full report including charts and tables). Make sure you erase any personal identification before posting.

[Lagotto]

Here is a zoomed in green area.

Thanks so very much
Lagotto

[SarcasticDave94]

DeepBreathing has all the bases covered. I'll revisit an aspect; any sleep study info you can post? The full detailed and redacted report is best. You should attempt to obtain a copy even if it might not be needed here. I have my copy in a personal medical history file in case it's needed and the docs office cannot supply it in a future need.

At a minimum, if you have the event stats, that is some of the most important info found. The doc write-up is less helpful.

[Sleeprider]

Lagotto, a lot of people have a problem with respiration sync when using Flex at a setting of 3. Try turning it down to 1 or 2.

Higher pressure seems to be a trigger for CA events, so let's reduce your maximum pressure setting to 12.0

[Lagotto]

I occasionally have tachycardia but that has stopped once I stopped coffee/chocolate overload.  I can still get it when I wake up at night - possibly from an apnea?  I am taking a very small dose of a betablocker which has stopped this.  I have order a cervical collar.  I sleep on my side and try to stay there with various buckwheat pillows.

[Lagotto]

I have set Flex=1 and am using an under chin pillow.   I tried to attach my sleep study but I got an error that I had reached my attachment quota.  How do I post this study?

[Damiansd]

Hello Lagotto,

Each post can only have three attachments. So post up your sleep report, three pages at a time.

Regards,
Damian.

[Sleeprider]

Also, you just transitioned to the Member group and as a result you have more attachment space.