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[Treatment] Just started CPAP, and my AHI has skyrocketed, advice?
#1
Just started CPAP, and my AHI has skyrocketed, advice?
Greetings all! Thank you to anyone taking the time to read this.

I recently was diagnosed with mild sleep apnea via an at-home WatchPat test with an AHI of 7.4 and an o2 low of 92. I've been very symptomatic (extreme daily fatigue, exercise intolerance, emergent anxiety disorder after sleep ceased to be restful) but I understand these numbers to be quite mild compared to moderate or severe apnea sufferers.

My doctor ordered a further in-lab sleep study, but its a month or more away, and I was impatient for some kind of relief. So he gave me the OK to rent a machine from a third party (the CPAP box) while I wait for the study to see if insurance will cover a machine for me. Its a ResMed 10 AutoSet with Humidifier. I'm using a DreamWisp nasal mask and standard tubing (a heated tube just arrived today) 

The first night was rough, but I was still adjusting to the mask and I woke up feeling OK but not great, with an AHI of 6.7. The second night was wonderful, I had the most detailed dream in recent memory and felt better rested, but my AHI crept up to an 8.28. Hmm strange but I felt alright so I just shrugged it off as getting used to the machine. Fast forward to last night, and It was the worst sleep I can remember having in weeks, I really felt like I was fighting the machine to breathe and when I woke up and got the data surely enough it was reflected in an AHI more than double my original diagnosis at 17.78.

I noticed that the vast majority of my events were labeled in OSCAR as Clear Airway, so I did a bit of research, and to my horror found out that it stands for central apnea events. It was at this point that I almost wished I had waited for the in lab study as I'm fairly certain the Watch PAT was unable to distinguish between central and obstructive and therefore it could be hard to know if the central apneas where there before or not. Being 26 and in generally good health without a history of neurological issues, however, I figured that central apnea was unlikely to have existed before the machine. 

After some further research on sleep apnea on Reddit and elsewhere, it seems to me what makes the most sense is treatment-emergent central sleep apnea. My machine's pressure is rather low, but it still seems it is tricking my brain into sending too few signals to breathe at night. I've read that these can go away on their own, but a high AHI like 17.78 scares me. What should I do? Do I counterintuitively need more pressure? I titrated max pressure down to 4-7 as the first night did not go above 7 hardly at all. Perhaps I should discontinue use and wait for the sleep doc? Or should I just stick it out and hope they resolve themselves? 

I had an Imgur link, but could not post, instead I've attached the three nights oscar data below. 

Thanks again! This forum is a lifesaver. 
   

   
   
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#2
RE: Just started CPAP, and my AHI has skyrocketed, advice?
Without the detailed diagnostic data, as you haven't have the lab test taken yet, so that isn't available. However, you did take a Watchpat test. Request that detailed data. Post that report redacted of your personal info.

You may want to run CPAP 7 cmH20 pressure. This is to avoid some CA. You can't treat these with the AutoSet.

CA/Clear Airway/Central Apnea all are a breath pause of 10 plus seconds. Calm thyself a bit, it's Apnea. Smile

You can pause the CPAP therapy if you do choose. No harm, no foul. Tell the doctor your concern over CA. However you'll need to know whether or not CA shows in the diagnostic. If yes in quantity, you'll possibly need to treat those CA. If they're lower, then it's probably treatment emergent Central Apnea due to CPAP use, flushing a bit extra CO2.

Also there's a possibility of Positional Apnea patterns, clustered events. This is applicable is a chin tuck issue.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Just started CPAP, and my AHI has skyrocketed, advice?
Thanks for the reply SarcasticDave! Good idea on the raw WatchPat data, I'll go ahead and post that now             

So you think I should try cpap mode at 7 pressure for a night to see if it helps the central apneas? Is the idea that the APAP mode is making them worse?

Thanks again! 
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#4
RE: Just started CPAP, and my AHI has skyrocketed, advice?
Yes the APAP pressure might be making this worse. Try it and see what happens.

I saw 3 CA under pAHIc 3%, so these aren't predominant Central Apnea in this test.

You don't happen to live at high elevation do you? That's about possible source of CA.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Just started CPAP, and my AHI has skyrocketed, advice?
No, unfortunately, I live rather close to sea level on the west coast US, so no dice on altitude being the cause
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