Unable settle ongoing AHI Variation low - high

[ICEMAN]

Hi, I am frustrated trying to getting on top AHI the variation range between 2-10 AHI. Noting back in 2016 home sleep study Identified  Mild OSA with AHI 5.6  "see attached"
Sleep study, Daily Statistics & AHI Charts [attachment=6616],[attachment=6620][attachment=6619][attachment=6622][attachment=6621]


2016 Trial on APAP machine & mask set at 5-15, 4 weeks to me little interaction at end of trial pushed to buy overpriced Machine from them, I hadn't been impressed of the trial and on inquiring of the over all end average treated AHI,  which given as being was 4. something and replied couldn't justify to buy APAP with only a AHI 1 of improvement on the untreated  Home Sleep study.

Some later purchased APAP machine online and have since  trying to improve my Numbers noting previously worked close to 4O years around clock shift work, broken sleeping hours patterns but now has been over year ago since stopped shift work and now every night in bed and fatigue and sleeping pattern improving . 

Time has taken while for my body to adjust to normal sleeping hrs, also adjusting to the APAP the dry mouth, leaks, turning tossing, waking most hr's and at time was quite few times nightly to urine and most of this addressed.

I Now feel quite comfortable with the APAP at time check to see it on and of opinion should be time to now be on top with continual lower AHI average constantly well under 5AHI but stiil alternatives ranges between 2-10 and average 6AHI ?

Can you help by looking at some charts of suggestions to improve.

Medical
Arrhythmia, Atrial fibrillation & Flutter, "Nil symptoms"   2 daily Metoprolol & Flecainide
Chronic Asthma mostly winter time taking Symbicort  2 doses twice daily,  but often dont worry about taking.

[ShaunBlake]

G'day maite!

Nope, sorry, but I can't give you suggestions to help improve your AHIs.  (If you've read any of my posts you will appreciate why not!)  I will say that I'm impressed that you've adapted to the PAP so well, and overcome those issues you mentioned.

I think it would help if you posted a few sequential SleepyHead charts from the past few days so that the gurus can perhaps see a pattern.

Also your history looks very good – averaging AHI below 5; should let you focus on tweaking your therapy (which you're doing here) and continuing your progress.  Soon the gurus will be chiming in with good advice.

[JesseLee]

I notice that you your first 2 charts with lower AHI are when you have a lower minimum pressure of 9.5 and 10.5. There is a lack of central apnea at the lower minimum pressure which suggests a pressure induced central apnea. I think this is evident in your last chart where your minimum pressure is 12 and you began to experience centrals. If I missed something, let me know, but why the increase in minimum pressure?

[ICEMAN]

Yes  agree  Jesse,  same thoughts, but monitoring  shown different pressures AHI at times both up or down the AHI  good &  bad for both CA & OSA. At times I have  played around times for  weeks and  get all frustrated, then all sudden good numbers  2-3 AHI, yeah and this keeps going good, I get excited, patting myself on back YES YES, I'am the Best, it all sorted . Then F@$#% overnight AHI shoots back up 2  or 3 times higher, cross fingers just a bad night, Hm will it stays high ? and doesn't  settle back to the lower AHI.  So I replay again  like Bull at gate play with pressure with often little improvement, weeks on then again 1 morning  back to low AHI ? and get on egg shells will it stay ?  I get it into my head the machine not actually treating the Apnea's or Do people often  have machines calibration? or wondering about related  to Medication for Paroxysmal Arrhythmia , Asthma puffer ? who knows ?

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[ICEMAN]

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[ICEMAN]

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[ICEMAN]

Please See   last night 3 screenshots of overnight total @ 4.56 AHI,- Then the  1st &   2nd/3 rd  of the night =3.21 AHi & the last 3rd of Night 7.62 AHI Any Suggestions ?????????  
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Cheers Iceman is simmering

[JesseLee]

I notice that the last night you had very little sleep. Given the short period of sleep you didn't have a lot of uneventful time to get the AHI back to less than five. This article  may help in your understanding of how AHI is calculated.

[JesseLee]

Some meds will cause an increase in apnea in some people. Specifically opioids and benzodiazepines are big violators. There are others as well.

I went back again and looked at your charts and (my eyes) dont see a pattern that would cause me to say specifically what you should do to change the chaotic results.

The only thing for certain I can note is that you experience central apnea when you get higher pressures. The only combat for this that i know of is a different mode of therapy, and i dont feel comfortable suggesting that you need that yet.

[ICEMAN]

Hi Jesse,  Thanks for your time to have the look, I did use to thing the see CA at Higher pressures and try keep pressure down, but  still scratch head as the more detail looks to me is adhoc  also leveling at both lower and higher pressures.

Also often the CA at the lower Minimal pressure of the higher pressures setting, also times at the lower pressure will see High CA and also in addition higher also H & OSA. I question if is not actually refection of pressure   If is just myself on the day, the issues effecting my sleep and or if is junk CA? I read people talk about in but I cant tell, I read threads say about shoulders of sleep and clutters  but to me I only guessing and parroting and rely on the others with more educated understanding of the chart to decipher as I endevour to gain clarity and deeper understanding.
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