Sudden AHI spikes on Airsense 11 apap

[Snoozer65]

Greetings all,
Ive been on therapy for many years (20 +) . About a year ago, i switched from airsense 10 to 11. Have always used swift FX nasal pillow and everything was fine .. AHI has been <5
Lately in the last month or two  , myair apps is reporting AHIs in 20s and 30s some even more 2, 3x a week ? i downloaded the latest OSCAR although to be honest im not sure how to interpret the data. Nothing has changed in health or meds during this time . My APAP is set to 5-9cm.. Sleep has always been troubled but i feel mostly  refreshed even though the high AHI are reported . Seems mostly clear airway events and clustered at certain times ? Ive got a call in to doc, but could benefit from advanced users insights , as these sudden spikes are extremely alarming  .. below is a read of last nights data, others nights  where this occur have similar architecture. 

Your kind consideration and comments would be greatly appreciated !


           

[staceyburke]

You have 2 main problems. The first are mask leaks. If you look at the Event Flags chart you have Large Leaks all most all night. When you have a large leak the cpap can NOT supply the correct pressure or therapy. It can not tell what events you have during a large leak. So most of this chart is not readable. You need a new mask or work on getting the old one to seal.

The other is there is some (we can't tell how much) positional apnea. PA is when you sleep in a position where you cut off your own airway. We also call it chin tucking - your chin drops to your sterumn cutting off your airway. Because you have not been havings these I would check on if you have been using a new pillow that is fuller or been sleeping on your back - both of which can cause you to tuck your chin. If not you may need a collar to stabalize your neck. I have a link to collars in my signature at the bottom of this post. Collars are inexpensive, usually less than 25$ at a drug store or amazon.

[Snoozer65]

Thanks@staceyburke for your kind reply,

indeed , the graphs show large leaks , but when i expressed my concern to my doctor last visit, she wasnt concerned .. Of course at the time my overall AHI was very low . 
But i understand your point that data can be obfuscated without addressing this ... So last night i really tightened up the mask and had 18/20 on my air or about 20L / min .  still got an AHI of near 20, mostly CA.. Unfortunately, I was not able to capture any OSCAR graphs (there is no data to graph) .. possibly because i did not have the SD card inserted during sleep and reinstalled it the next morning to update it ? Ill try again tonight, maybe try some other masks .
Still , i appreciate your insights as it is clear that i should prioritize  chasing  the leakage issue.
Kind regards

oh BTW, I already have a soft cervical collar from an auto mishap a while back, will experiment with that also.

[Narcil]

yes the sd card needs to be in the machine and unlocked during the night.

[staceyburke]

Most of the time tightening the mask makes leaks worse. It should not be loose but not tight.

[Snoozer65]

Thank you both for kindl replies.. tighten was perhaps a bad choice of words, “ readjusted my mask for better fit ..and last nite i tried the cervical collar..  AHI was .2.. ill need to keep using it to see if this really helps.
Leakage was under 15l/min..which myair considers good ?

Anyways , ill report back in a week or so with results 
Many thanks again

[Narcil]

the machine can handle up to 24 l/min (the red bar in oscar). but you should be able to adjust it a bit better, it's still a bit high.

[Snoozer65]

… apologies in delayed follow up.. life happens ..
I tried the cervical collar and indeed saw marked improvements , albeit at the initial expense of literal pain in the neck.. i think i may have had it too tight initially and finally figured it out… Now it doesn't bother me at all . Still getting some nightly Ahi of 10 here and there, but i have not solved the leakage problem yet… its strange because i never had issues with my swift fx and now i do ? So i went to see Doc, and she appeared horrified when i told her about the cervical collar.    Again she confirmed my leakage was ok mostly with only a few nights above 24l . That seems to be the magic number according to resmed and doc, but i average about 18l..she also told me my overall ahi was fine , dismissing the crazy ahi spikes that prompted  me to start this thread ? my next step is to try an N20 mask .. i got to see it at the docs office and liked it so she wrote me a scrip..

As i read thru the forums and your replies, it seems cpap / apap cant really address positional apnea? This is a revelation to me , because in 25 yrs none of my sleep doctors ever brought this up.  It begs the question.. could someone with positional apnea just get by with the cervical collar ?
Thank you all for your comments and this website, its a wonderful resource.. 

[SarcasticDave94]

Take note, when your doctor hears positional they're thinking back, side, supine, and we can as well. However in this discussion is Positional Apnea, found probably exclusively here. This isn't a full body positional thing. It's focusing on a chin tuck sleeping position that will choke your airway closed, externally, otherwise similar to common Sleep Apnea.

Doctor thinks you'll hurt yourself with a soft cervical collar. And she's not concerned about the leaks, because it's not her therapy. This is the key thing, doctor can only guide via textbook objective info, typically. Subjective stuff may fall on deaf ears, unless the doctor is really good and does in fact want the whole story.

[staceyburke]

I don’t think that the collar will solve everything, the only way to know is with a sleep study. They can hook you up to their monitors. If you have 0 AhI while using a Cpap you would still be on therapeutic pressure.