[Treatment] AHI going up - Should I change anything?

[doubledrive]

ResMed Airsense 10 APAP
Min Pressure - 5cm
Max Pressure - 15cm
EPR - 1cm
Ramp - Off
Diagnosed AHI - 19
Phillips Dreamwear Gel Pillows Mask


Hi everyone!

I started CPAP therapy 4 months ago.  I have definitely felt the difference since starting, going from needing a nap at about 3pm everyday and taking about 2 hours+ just to wake up in the mornings, to now being wide awake and staying clear headed all day long.  I'll admit, there were a few days where I took a nap anyway for one reason or another though. 

According to the data, my AHI and overall sleep health improved immediately after starting therapy.  Being a born tinkerer, I did change my minimum pressures a few times, just so see if I could improve them, based on my very unprofessional diagnosis of the data in Sleepyhead, but I've pretty much found that my best AHI came when I stuck to my Dr's recommended settings.  Not that I didn't believe him, he's been one of the best docs I've ever had (he's also my PCP as I live in a fairly a small town). 

Anyway, I have a follow up scheduled for next month, but I've been noticing that my AHI has been creeping upward pretty dramatically since the holidays, and thought I'd ask you fine people for an opinion.  

As far as changes?  I did start a new diet program (Nutrisystem) last week.  I'm also a stomach sleeper (yes, I know... bad, bad, bad...), but haven't been able to sleep on my stomach lately because it has been making my back hurt in the morning (more than usual).  I've experimented in the past with new sleeping positions and adjustable bed settings, and still got a good AHI number.  I am on a cocktail of different meds for various reasons, but they haven't changed what so ever in the last year.  

Here's the overall view from the last 4 months. Sorry about the data gap from 12/21 to Jan 7.  I left the SD card in the computer and forgot it wasn't in the machine until then.

[doubledrive]

Well, crap, I'm an idiot. Sorry...

[DeepBreathing]

G'day doubledrive. I took the liberty of tidying up your post for you.

You might want to look at the guidelines for posting an image here: http://www.apneaboard.com/forums/Thread-...ttachments

[Gideon]

Welcome to the forum.  

Here is what I see.
You have predominantly Central/Complex/Mixed Apnea.
Your Central (Clear Airway) Apnea is not treatment emergent apnea as evidenced by the fact that it has persisted for 4 months.
A CPAP or Auto-CPAP (AutoSet) is designed to treat Obstructive Apnea, not Central/Mixed Apnea.
Your current numbers should qualify you for an advanced bilevel w backup (ASV) machine which is intended to treat Central Apnea.
Your Symptoms as you describe them say that you are doing fine which will make your Medical team want to stick with the AutoSet.

You have 2 paths that you can follow, at the least these are conversations for you to have with your doctor.

Path 1: The path that you were thrown into whether you realize it or not. That is to treat your apnea, whatever types of apnea that you have, with the machine they gave you, a CPAP, preferable an auto-CPAP either the ResMed or the Philips Respironics machines. New members of the forum come here looking for help with intractable apnea and discomfort from these problems. The forum members and "gurus" are very good at optimizing therapy to reduce these problems, and increase comfort with the therapy.

Path 2: Take the often difficult and lengthy journey to procure an advanced PAP machine. The new member that has been advised they have central or complex apnea needs to be aware that optimizing may provide significant immediate relief from symptoms and improve AHI, but improved therapy results can disqualify them from higher levels of therapy (ASV), that might be possible without this self-optimization. Sometimes individuals resolve central and complex apnea with CPAP and find long-term comfort, however, if results are inconsistent, or produce good AHI but not comfort or relief from other symptoms, The forum optimization should be discontinued as soon as possible to avoid disqualification from higher levels of therapy. This path frequently requires failing at CPAP, then failing at BiLevel E0470, before succeeding at ASV E0471

Justifying_Advanced_PAP_Machines WIKI article

As you have stated you have improved with CPAP, not uncommon.  The question, the all important question is how do you feel?  Use the following Symptom guide to see if you need improvement with ant of these.


Symptoms
Note that these are not all specific to Central/Mixed/Complex apnea. They are symptoms that impact our sleeping, arousals, and yes apnea too. Think of these, but do not limit yourself to these when you are asked "How do you feel?"

• Daytime hypersomnolence;
  
  
• Excessive fatigue;
  
  
• Morning headache;
  
  
• Cognitive dysfunction;
  
  
• Dyspnea, etc.;
  
  
• Fatigue;
  
  
• Insomnia;
  
  
• Difficulty going to sleep;
  
  
• Difficulty falling asleep;
  
  
• Wakening during the night;
  
  
• Daytime Sleepiness;
  
  
• Excessive Daytime Sleepiness (EDS);
  
  
• Poor concentration;
  
  
• Difficulty with balance;
  
  
• Shortness of breath;
  
  
• Dry mouth;
  
  
• Restless Sleep;
  
  
• Non-Restorative Sleep;
  
  
• Snoring;
  
  
• Obstructive Sleep Apnea;
  
  
• Restless Leg Syndrome;
  
  
• Nocturnal Leg Cramps;
  

For Path 1 I will suggest starting by setting your Max Pressure to 12.  This is because many of your Central events occur above this pressure and we know that in general higher pressures typically cause increased Central events.

The decision here is which path do you want to proceed down?  From my point of view either path is acceptable.  With the ASV machine many users here get an AHI approaching zero.  Those users will confirm that it was a long and winding road to get the ASV machine.

The choice is yours.

Fred