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Increasing AHI despite fewer leaks - Aife - 08-24-2024
Hello,
I am a 72 year old woman who was diagnosed with sleep apnea about 5 months ago, although I've probably been suffering from it for years if not decades. I started using a CPAP machine (a Resmed Airsense 10 with the F20 full-face mask) about 4 months ago, and getting used to it was very difficult for me. It's only in the last 6 weeks or so that I've managed to usually wear it for more than 6 hours a night with less than 5L/min leaks. Still, for a few weeks I was feeling hopeful that I was finally on the right path, until about 3 weeks ago my AHI started increasing, despite the leaks being around 1L/min. I've talked to my therapist about this and before sending me to the doctor she suggested trying turning off ramp time (which was set to 15 minutes) and EPR, which I have been doing for the last 5 days. However, this has only increased my AHI so far and it has also increased my leaks. My therapist refuses to send me to the doctor before having tried no ramp time and no EPR for a month, but I can feel I'm not well rested at all and I'm getting worried. I would appreciate any help or advice you can give me very much!
I've attached 3 screenshots in chronological order, the first 2 from before I turned EPR and ramp time off, the last one after I turned them off.
RE: Increasing AHI despite fewer leaks - staceyburke - 08-24-2024
You are having positional apnea. You can see positional apnea where either H or Oa events are clustered together. Getting rid of as many as you can will lower your AHI. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
Some of your Central Apnea could be positional also. The machine tries to determine if it is an obstruction or a central but it is hard for it to determine without all of the wires and belts used in a sleep study. The machine just gives little puffs of air and tries to detect if air is blocked or goes through. So it may miss identify the type of apnea.
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
RE: Increasing AHI despite fewer leaks - Aife - 08-24-2024
Hello, thank you very much for the reply!
That I'm having positional apnea is surprising to me, because my original sleep apnea diagnosis came from two apnea tests, one done while sleeping on my back (which is my normal position), and the other while sleeping on the side (which doesn't come naturally to me, I had to wear a sleep noodle on my back), and both showed the same number of AHI (29 and 30, respectively),with low central apneas per hour (1 or 2).
I haven't changed my sleeping position recently (I always sleep on my back), and I've had the same pillow for ages. Nevertheless, I'll try a much flatter pillow tonight.
Thank you again. If you have any additional advice to share based on the information I've provided above, please feel free!
RE: Increasing AHI despite fewer leaks - HalfAsleep - 08-25-2024
You may have had positional apnea in your tests, but this is not something they tell you about. Sleep doctors lump all OA’s together, no matter how they’re caused.
The simplistic summary sheet your doc gets has no mention of positional apneas and their place in the AHI number. Nor does your DME. And the only number they care about is AHI. It’s gotta be lower than 5.
Post another Oscar after you give it a few days on your new pillow. If that doesn’t work to minimize your positional apneas, there are more tricks!
After that gets sorted, it will be easier to address your settings.
Keep working on those leaks. All these items are interacting on your chart and giving you very disrupted sleep.
RE: Increasing AHI despite fewer leaks - staceyburke - 08-25-2024
The main reason for positional apnea is chin tucking where your chin drops to your sternum and can happen in any sleep position, side or back. You may be able to experience this while you are awake. Just sit there and move your head down to where your chin rests on your chest. You may (or may not) feel it harder to breath. If it is harder to breath that is the partial blockage that causes the flow limits.
RE: Increasing AHI despite fewer leaks - Deborah K. - 08-25-2024
1. After five months you don't need ramp and should turn it off. You get no real therapy during ramp, and any time you get up and go back to bed ramp starts again, robbing you of therapy.
2. Your pressure range is wrong. You should set 8-17 for now because you quickly shoot up to higher pressure from the beginning.
3. I completely disagree with turning ramp off. You need more pressure support than your machine can provide, certainly not less. You may have to switch to a bi-level machine to achieve your best therapy. At least for now, turn EPR back on full-time, set at 3.
4. Your positional apnea is bad and needs to be corrected. Conquering that will drop your AHI quite a bit. Do what Stacey said.
5. Did you have a lot of CAs in your sleep study? If not, your CAs are treatment-emergent and will lessen as time passes, and as Stacey said they may not all be actual CAs.
6. Don't worry about your therapist for now. Make these changes and see what happens and how you feel.
Best of luck!
RE: Increasing AHI despite fewer leaks - Aife - 08-26-2024
Hello again,
my first night with my (very) flat pillow didn't go very well, in fact it was my worst yet. Screenshot attached below.
Note that I still had EPR turned off. I'll try again with the flat pillow and EPR turned on tonight, unless you guys tell me I should try something else.
I've ordered a Caldera Releaf Neck Rest, but it won't arrive for a few days.
RE: Increasing AHI despite fewer leaks - Deborah K. - 08-26-2024
You really do need to use EPR full-time, set at 3.
Also, your pressure is set far too low. Look at your newest pressure chart and you will see that your pressure shoots almost straight up each time you return to therapy. Set your pressure to 8-18 for now. You will need to raise it a couple more times until your beginning pressure is about 11.
I'm glad you have ordered the collar. That will help lower your AHI.
RE: Increasing AHI despite fewer leaks - Aife - 08-27-2024
Well, last night didn't go so well. I used my flat pillow again, with EPR, 8-18 pressure range. Huge leaks, and like I apparently do every night I took off the hose, even though I never remember doing that (except when I briefly go to the bathroom, but that only happens once a night and should only show a 5 minutes interruption at most). Is there a different explanation for those many pressure and flow rate interruptions?
Also, I don't understand why some nights I have huge leaks and others I don't. For a few weeks the report displayed on the machine showed 0 or 1 L/min, I thought leaks were fixed, and I haven't played with my mask since then at all, so why do I have these leaks now?
And the flat pillow doesn't seem to be helping my AHI, either.
I really don't understand what's happening.
RE: Increasing AHI despite fewer leaks - Deborah K. - 08-27-2024
The flat pillow is not solving the positional apnea problem, showing that you need to wear the cervical collar as soon as it arrives.
So you are removing your hose without waking up. I suggest you put tape holding your hose to your mask so you can't easily remove it in your sleep.
The leaks are higher due to the increased pressure. But you need the extra pressure, so you need to find a way to attach your mask that will stop the leaks. Some folks attach their mask too tightly, which can cause leaks instead of preventing them. The mask should sit gently on the skin. Then when the air flows in, it fills the mask, pushing the mask against the skin.
Another solution is to use a nasal pillows mask. They leak the least of the various types of masks. If you have mouth leaks, it's easy to solve by wearing mouth tape.
I hope this helps you.