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10-31-2024, 05:48 PM (This post was last modified: 10-31-2024, 05:52 PM by eddr.
Edit Reason: Add EPR
)
Help Needed Addressing Cause of Sudden Increase In AHI/CSR
My spouse has been using her APAP over the past 15 years with an overall good response. Her equipment is the same as what i currently use. Yesterday, she woke up early in the morning having trouble breathing and couldn't go back to sleep. At that time, she felt she had some nasal swelling/congestion making it difficult to breath. Her stats that night showed AHI 7.49, OA 2.25, and CA 5.24. Her AHI for the past 6 months was 2.11. Her EPR is set full time at 3.
This morning she again woke up early in the morning with trouble breathing using her APAP and couldn't go back to sleep. She didn't report any nasal swelling/congestion this morning. If she opened her mouth, she indicated that helped with being able to breath. Her stats this night showed AHI 10.79, H 0.34, OA 1.69, and CA 8.76 and percent time in Cheyne Stokes Respiration (CSR) 5.9%. She has no signs of congestive heart failure.
Looking for any ideas on what may be going on as well as any settings that may need adjusting.
RE: Help Needed Addressing Cause of Sudden Increase In AHI/CSR
Might I suggest a medical work up including an echocardiogram to rule out any underlying cardiopulmonary medical issues that may exist beyond xPAP therapy.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
RE: Help Needed Addressing Cause of Sudden Increase In AHI/CSR
The flagging of CSR is not diagnostic of that condition, but indicates a periodic breathing pattern that can be attributed to many different root causes. The number of CA events is a concern due to the disruption in sleep, however the events are mainly clustered at times of sleep transition and disruption, rather than through the night. This chart shows some positional obstruction with clusters of OA and flow limitation, with high leaks, interspersed with relatively quiet periods of steady pressure, low leaks and good therapy. Respiration is normal rate, but volume is low indicative of a relatively small person.
Before moving forward with any changes to settings, I think you should try to address the complaint of breathing obstruction directly. Get some Flonase or its generic equal (fluticasone propionate) and realize it takes several days of doses before inflammation will clear up. This is safe to use longer term and can make a big difference when inflammation associated with allergies or other causes interferes with comfort or sleep integrity. Read the positional apnea article and look for opportunities to prevent chin-tucking. If there is any way to correlate sleep position with the events that can often provide a clue. https://www.apneaboard.com/wiki/index.ph...onal_Apnea Other than that, let's monitor the situation before deciding a different direction in therapy or settings.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Help Needed Addressing Cause of Sudden Increase In AHI/CSR
She had a full workup with ECHO, stress treadmill and heart cath earlier this year with a clean bill of health. Last night, I lowered her EPR from 3 to 2. She slept well throughout the night. Her AHI was down to 3.68 and there were no CSR reported (see new screenshot).
RE: Help Needed Addressing Cause of Sudden Increase In AHI/CSR
With her having a good night last night, I suspect her issues may have been related to some transient nasal inflammation as well as positional issues as you indicated. I will review the article on positional apnea, especially the issue with chin tucking. Thank you! May up the EPR back to 3 as well.
