AHI seems up and down

[beautifuldreamer]

Been using the Auto CPAP for a month now, and only about four times have I been below 5. Seven times I have in between 5 and 6.
Six times between 6 and 7.

Last night was 9.8 and the night before was 8.9 - and mostly Clear Airway events, I think mostly when I am awake and trying to get back to sleep. I am very aware of the breathing and the sound of the air flow.

Overall AHI average is 7.59 since I started, 7.06 for the last 30 days, and 7.61 for the last 7 days.

Should I be satisfied with these numbers? I wonder if the Bella Loops is not quite right for me, and last night when i was having trouble falling back asleep, I switched over to the regular Swift FX for her headgear.

[Otter]

Overall AHI average is 7.59 since I started, 7.06 for the last 30 days, and 7.61 for the last 7 days.

Not until you've explored a bit.

AHI is too general to be of much use unless it's very low. How much of that is OA, CA, and hypopnea? If you can import your data into SleepyHead, Encore Basic, Onkor, etc and post screenshots, we can get a better idea what might be going on.

[johnthomasmacdonald]

I never get any consistency from one night to the next no matter how much I try to keep everything the same. I've used straight cpap, auto cpap, bilevel, auto bilevel and ASV - all plus and minus a $1000 custom made dental appliance that forces my lower jar forward to prevent airway closing. all seem to work equally poorly or successfully. for example saturday night with the resmed adapt asv i had an ahi of 2.1, lasy night with the same machine and same settings I had an ahi of 16.8. no clue why and i don't feel any different - no more or less rested. It's been the same story for me for 7 months

[Wulfman...]

Been using the Auto CPAP for a month now, and only about four times have I been below 5. Seven times I have in between 5 and 6.
Six times between 6 and 7.

Last night was 9.8 and the night before was 8.9 - and mostly Clear Airway events, I think mostly when I am awake and trying to get back to sleep. I am very aware of the breathing and the sound of the air flow.

Overall AHI average is 7.59 since I started, 7.06 for the last 30 days, and 7.61 for the last 7 days.

Should I be satisfied with these numbers? I wonder if the Bella Loops is not quite right for me, and last night when i was having trouble falling back asleep, I switched over to the regular Swift FX for her headgear.

That's probably why your numbers are high and inconsistent. I would guess that your pressure settings are rather wide-open, too. Too many events occur before the pressure can rise to where it's needed.
If you want more consistency and lower AHI numbers, you're going to need to use a narrower pressure range or straight-pressure CPAP mode.


Den

.

[Pugsy]

Last night was 9.8 and the night before was 8.9 - and mostly Clear Airway events, I think mostly when I am awake and trying to get back to sleep.

You have to mentally remove any awake events from the calculations to be able to get an accurate idea as to what is going on while asleep. The machine doesn't know if you are asleep or not..it just calls them like it sees them. It's common for the machine to flag centrals while awake. Large clusters while awake will totally mess up your real AHI numbers and not give you an accurate AHI for the sleep hours.

[Wulfman...]

What are your machine settings?
Are you using software to analyze your nightly data?
What do the other statistics look like.......particularly the leak numbers?

Did you ever see or get a copy of your sleep study?
Did it show any Central Apneas?

If not, I'm wondering if the machine is confusing mouth-leaking with "Clear Airway" events and flagging them as such.

It would help to see some reports.

Den

.

[VikingGnome]

I never get any consistency from one night to the next no matter how much I try to keep everything the same. I've used straight cpap, auto cpap, bilevel, auto bilevel and ASV - all plus and minus a $1000 custom made dental appliance that forces my lower jar forward to prevent airway closing. all seem to work equally poorly or successfully. for example saturday night with the resmed adapt asv i had an ahi of 2.1, lasy night with the same machine and same settings I had an ahi of 16.8. no clue why and i don't feel any different - no more or less rested. It's been the same story for me for 7 months

That's actually quite ironic. Our PAP titrations are based on one single night (or half night in split study). You end up with pressure too high or too low depending on what kind of night you had at the sleep clinic.

[beautifuldreamer]

I am going to try to put some data here (the past 3 nights, plus the overview of stats)- hopefully it works Also, I generally wake around 2 AM (sometimes a little earlier and sometimes a little later), and it takes a couple of hours to rest enough to get back to sleep.

Here is a link to see some of the data - I hope it works
https://picasaweb.google.com/lh/sredir? ... feat=email

[Pugsy]

The nights that are rather ugly are primarily centrals in some big clusters...looks like a lot of sleep wake junk is getting flagged.
Those big clusters of centrals/clear airway events I suspect you were awake....laying there trying to get back to sleep and maybe even doing a little tossing and turning.

Is this wake at 2 AM and have trouble getting back to sleep common for you (happened before you started cpap)?
Do you also have a little trouble falling right to sleep when you first go to bed?

Your pressures aren't roaming wildly all over the place though goes from 10 to 13 or so some of the time and at other no movement.
If you think that the pressure variations are maybe a contributor to wake up or poor sleep...wouldn't hurt to try either a really tight APAP range or cpap mode.
If you change to cpap mode you lose Flow limitation data though...that mode doesn't even bother to flag it but you could use APAP mode with a really tight pressure range that would mimic cpap but still give you Flow limitation data.
Tight like 0.5 or 1.0 range...essentially minimal movement in pressure.

[beautifuldreamer]

The nights that are rather ugly are primarily centrals in some big clusters...looks like a lot of sleep wake junk is getting flagged.
Those big clusters of centrals/clear airway events I suspect you were awake....laying there trying to get back to sleep and maybe even doing a little tossing and turning.

Is this wake at 2 AM and have trouble getting back to sleep common for you (happened before you started cpap)?
Do you also have a little trouble falling right to sleep when you first go to bed?

Your pressures aren't roaming wildly all over the place though goes from 10 to 13 or so some of the time and at other no movement.
If you think that the pressure variations are maybe a contributor to wake up or poor sleep...wouldn't hurt to try either a really tight APAP range or cpap mode.
If you change to cpap mode you lose Flow limitation data though...that mode doesn't even bother to flag it but you could use APAP mode with a really tight pressure range that would mimic cpap but still give you Flow limitation data.
Tight like 0.5 or 1.0 range...essentially minimal movement in pressure.

Yes, I think those big clusters are mainly when I am awake. Earlier on (my first week), I noticed that when I would wake up in the middle of the night, I would turn the CPAP off, and saw that my AHI would be below 5, and then when I would put the mask back on and turn the machine back on, the number would be higher (from the wake time trying to get back to sleep).

This waking up has been a habit for quite awhile, before CPAP, and I am working on trying to break the habit by just staying in bed instead of doing anything like getting up and internet or whatever. Once I wake up in the middle of the night, it is difficult because when I am trying to fall back asleep, the sound of the CPAP seems loud, and it feels like my breathing is working against the CPAP.

Generally I fall asleep pretty easily (before CPAP), but with CPAP, it takes me a little while but not long, to fall asleep with getting used to the device and mask. . . And it has always been difficult to fall back asleep after waking up in the middle of the night (with or without CPAP).

A few weeks ago, when I had a visit with the Respiratory Therapist about some of the initial high numbers, the RT felt that the range should be not be limited to 12, that there were times when I needed at least 13 - (Prescription was 7 for the low and 12 for the highest), so she switched the highest to 20. She said something like being capped at 12 was causing some of the problem, that there were times when it needed to be at least 13? She said she would send a note to the Sleep Doctor (the sleep doc is in San Jose, and the RT was in Martinez- Kaiser).

Do you think I should ask to see the RT again or just wait awhile longer and see what happens . . . the last time I had an appointment scheduled, it seemed like things were getting better as time came for the appointment . . .

[beautifuldreamer]

This morning I woke around 330 AM instead of the 2 AM ish time frame. I was wearing the Swift FX for her instead of the Bella part (i.e., head gear). The breathing against the CPAP did not seem as difficult while awake, and AHI was 3.8

I finally turned off the CPAP around 4 AM, because I didn't think I would fall back asleep before it was time to wake up.

I added the new data to the link to my data.

[Pugsy]

Can you turn off the AHI graph in SH (Preferences/ graph tab..remove check mark by AHI) so we could maybe see leak line at the bottom? The AHI graph is redundant information.

Did you know that you can click and drag just the beginning of the time asleep to right at 3 AM time frame and the AHI on the line above Flow rate graph and below events graph will change just to include beginning time until 3 AM and omit the time after 3 AM where you were likely awake? So you just highlight and look at a specific time frame and evaluate the AHI for that time frame alone without the clutter of the awake events being included.

You know it's possible that cluster of stuff (none of it in horrible numbers though) starting around 1:15 and lasting about 45 minutes and the associated increase in pressure may have been a disturbing factor in sleep quality. Was it the events or the increase in pressure? No way to know for sure which came first. If this had showed up at 2:45 instead of an hour earlier I might be inclined to be more definite about the events causing the awakening at 3 AM.

Do you have copies of your sleep studies? If not get them. If you have them..does it mention anything about supine sleeping maybe being worse or REM stage sleep being worse? ...being worse meaning more events happening at those time when compared to other sleep positions or non REM sleep.

I think your machine is doing a good job of treating your OSA. I think that the prolonged wake time is making your AHI look worse than it is because you are getting some SWJ Sleep/Wake/Junk getting flagged because the machine is flagging awake/semi awake breathing irregularities.

I think that the biggest problem right now is your insomnia. A little bit of both sleep onset (falling asleep that would be the inability to go back to sleep at 3 AM) and sleep maintenance (the difficulty staying asleep). Since you had this problem prior to the beginning of the cpap therapy we aren't as likely to totally blame cpap therapy itself (though it could be a contributing factor now). We would like to have been able to totally blame it on the sleep apnea events themselves and of course then hope that effective therapy would prevent the awakenings and thus prevent the problem going back to sleep in the wee hours of the morning.
I don't think we can place all the insomnia blame on the untreated sleep apnea events (though they probably contributed to the problem) as much as we would want to because treating sleep apnea events is so much easier than treating insomnia.

So what do we do? First of all...try not to dwell on the AHI itself right now. Your report from last night was really quite acceptable. That little 45 minute cluster around 1:15 to 2 AM wasn't horrible by any means. You are going to have to sort of try to look at only the time you were asleep because looking at the AHI that includes awake time is not an accurate reflection of your actual therapy. Do the click and drag and zoom thing on the times you are pretty sure you were asleep and you will see the AHI change to reflect only the time during what you have highlighted and I think that will reassure you about your therapy itself.

Secondly...we need to try to figure out what changed to cause the events at 1:15 to start up. Not because they were so horrible because they weren't but because they may have been a factor in the wake up. If you hadn't woke up and told me you slept right through the night and felt good...we would shrug our shoulders and move on.
I am wondering if the pressure changes themselves were a factor. Some people are just simply more sensitive to pressure changes than others. I sleep right through pressures going from 10 to 19 myself...never know they occur till I see the reports but some people will have their sleep disturbed by even a 2 cm change in pressure.
If you had told me that you never had the problem of waking up in the middle of the night prior to cpap therapy I would take a really strong look at the possibility of pressure changes being a strong suspect but since you had it prior...it isn't such a strong suspect but it is still a possible factor.
So this is where we look at the reports to see if maybe you changed position around 1:15 or maybe it was simply REM stage sleep.
It's very common to have more events and/or need more pressure during both. I happen to be a REM stage person myself. Supine sleeping not making any difference but it is common for people to have one or the other as a factor or some people have both as a factor.
At some time you may want to look at maybe a really tight range (like 1 cm) of pressures in APAP mode to mimic cpap mode (I like to keep apap mode because it offers FL data that cpap mode doesn't) just to see if the pressure changes themselves are causing sleep disturbances.

Finally...we look at the insomnia itself and start doing the usual detective work to see if we can spot anything else that might be a contributing factor. The list is long but we start with the usual suspects.

Sleep Hygiene (do you do any of the no nos that go along with bad sleep hygiene)
Caffeine intake
Meds even OTC
Bed comfort
General body aches and pains
Other health issues
Anything that might affect sleep quality

Laying in bed worrying about going back to sleep is generally considered the worst thing to do. The brain becomes hyper vigilant and every little thing is going to make the mind race...any noises will seem louder. Usually it is better to get up after 20 minutes and go do something quiet (no TV, no computer) and try again when you get sleepy. Clock watching is a no no..makes the brain go into worry mode.

One of our forum members Robysue battled insomnia...in her situation part of it was because of the cpap therapy but some of it was just life long tendency to have insomnia.
http://adventures-in-hosehead-land.blog ... omnia.html

Couple of books you might look at
Sound Sleep, Sound Mind, by Dr. Barry Krakow
Sleep Interrupted, by Dr. Stephen Park

Lots of work to do...some soul searching too. Take a good hard look at things.
One worry you can set aside...when you are asleep the machine is doing its job very well.

[beautifuldreamer]

Thanks Pugsy for your feedback. It was very helpful and encouraging.

I went ahead and re-did the screen shots without the AHI graph on the daily charts. Also, I took screen shots of my overnight sleep study. I remember waking up pretty early and decided that instead of trying to get back to sleep, I wanted to get home to wash up and get ready for work (no shower at the sleep lab).

I tried highlighting the data to try to focus on the time before waking, but not quite adept at doing that yet . . . The only terminology I have some understanding of is the AHI.

Last night I wasn't aware of waking at the earlier time frame. I think I do have less AHI on my side than on my back. I think on my back it was 30.1, and on my side it was 12.7. Generally I am more of a back sleeper, but sometimes will sleep on my side, usually the right side. Last night I remember waking and being on my left side.

Yah, I think I shouldn't have kept watching the time last night- not so good to do!
I don't do caffeine, no meds, generally healthy person, no body aches, bed is comfortable, etc. I think part of my worry lately especially when I was struggling with the breathing during the wake up in the middle of the night, and being aware that the AHI was going higher the more I struggled during the wake/trying to sleep time. I agree, for me to not worry so much about the AHI, and realize that there are lots of AHIs that really aren't AHIs being added in. (I tend to be competitive and want the best numbers, hahaha).

Yes, I need to stop the clock watching- although it will be hard to determine how long 20 minutes is without looking at the time, to not stay in bed for more than 20 minutes without sleeping.

Also, I think going back to the regular headgear on the Swift FX for her instead of using the bella loops might be the way to go for me, since it seems like I don't struggle as much with the breathing part during that night wake period.

Thanks for commenting that the CPAP is doing it's job. Overall, I do have more energy, especially during times when I used to be extremely tired. Sometimes I still fall asleep during inactive moments at meetings/events, and I try to get up and walk in the back of an event or meeting where it is mainly sitting and listening to the speaker to help me stay awake.

[Pugsy]

Yes, I need to stop the clock watching- although it will be hard to determine how long 20 minutes is without looking at the time, to not stay in bed for more than 20 minutes without sleeping.

Estimate...go on how you long you feel it has been.

I wish I could show you the click and drag thing...it's hard for me to explain....do you know how to click and drag to highlight something or copy something...it's the same mechanism. Put the mouse cursor on the flow rate graph chart on the left side where you think you likely were asleep...left click mouse and hold it down and drag it to the right and stop right before the cluster where you were likely awake...released the left click and see if that works for you.
This little trick can be done on any of the graphs but I just mentioned the flow rate because the clusters are easily seen there.
You can even do it with a small cluster and look at each individual event.
This ability to manipulate the graphs so easily is a nice feature. ResScan won't let you omit the clusters in its calculation though it does have a way to zoom in.
If you could turn your machine off then back on and create a new session there is a setting in SH that allows for ignoring short sessions and it works great for 15 or 30 minute sessions but not so great when we are looking at 2 hour sessions but we could do that if you get up after your estimate of 20 minutes or so...it doesn't have to be 20 minutes...it can be more or less and for sure it doesn't have to be by the clock accurate...it's all on what you feel. The idea is to get you to not worry about the time at all.
There's a setting to eliminate short sessions but to have a session the machine has to be turned off briefly so that when turned back on it starts a new session.
It's under Preferences..Import tab which is the first tab that comes up in Preferences...second line..a little slider bar to set the number of minutes you want to ignore.

I understand competitive...we all like to brag. It's normal way to feel especially when you see people with less than 1.0 AHI and 0.0 leaks. Try not to compare yourself negatively to the others. CPAP therapy comes with the YMMV sticker on every aspect of it.
You have some insomnia issues that are just going to make your overall AHI look worse than it really is. Accept it for now and just use your energy on working to reduce the insomnia problem. It would need work even if you didn't have OSA.

Have you and your doctor discussed RX meds, OTC meds that might help you get to sleep and stay asleep?
What are your and his feelings about getting some help? Maybe some short term help till you get used to having an alien stuck on your face to help at least eliminate that culprit in the brain being hyper vigilant????

Talk to your doctor about a little pill that I take to help me...Amitryptiline only 10 to 20 mg at bedtime. It helps me stay get to sleep and stay asleep with minimal morning hangover if I take it about 3 hours before bedtime. Non habit forming..non narcotic...won't make the OSA worse because it doesn't do anything to the airway tissues. Originally given to me to help me sleep through the arthritis pain that I have. It really isn't a pain pill in the normal sense but it helps me sleep just a little "deeper" so that minor movements in bed don't wake me up. It doesn't really make me hugely drowsy like a sleeping pill (like Ambien) does but it does have a little drowsiness side affect but more importantly it helps me stay asleep with minimal awakenings.

[beautifuldreamer]

Pugsy, thanks again for your input

Maybe you can do a video clip of yourself highlighting and such

Honestly, I don't want to take meds if possible for sleep. But I did do some melatonin to try to get myself over that hump of waking up in the middle, and it was helping and then I stopped using it because i didn't want to use it so much

so, i will try Melatonin again, to see if it can help me through the night, I just don't want to be overly dependent on taking stuff to help me sleep . . .

Anticipating a great night of sleep tonight