Help-NEW AHI going up as I lose weight. Data inside

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milesleroy
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Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Fri Oct 10, 2014 10:21 am

Hi,
I have been on CPAP since 2009. And, generally my weight remained the same (overweight). My AHI numbers have always been good and my pressure on my PRS1 is set at auto 10-20.
Recently, I've lost about 30 lbs (since June) and have noticed my AHI increasing. Yesterday, my AHI was over 10.
I am not very familiar with reading the data charts, but as far as I can tell, the AHI has been climbing over the past two months and I don't see any indication of leakage.

If anyone would be willing to look at the data below and share your thoughts or opinions about what might happening? I'd appreciate hearing from you. And, yes, I did put in a call to the Dr but haven't heard back yet.

Images of my last week's worth of data linked below
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Wulfman...
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Fri Oct 10, 2014 12:26 pm

It's not hard to figure out.
Lots of people who lose weight find that their CPAP pressure "needs" actually INCREASE.
The two main things that trigger pressure increases in Auto CPAP machines is Flow Limitations and Snores.
You're having numerous events (Apneas and Hypopneas) that are "frank" (out of nowhere without precursor events) and they're happening without the benefit of the machine being able to respond. Maybe you were having more precursor events before the weight loss and the pressure increases were preventing the Apnea and Hypopnea events.


Den

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milesleroy
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Fri Oct 10, 2014 12:40 pm

Den, Thank you for the detailed explanation. So, would raising the range of the auto pressures help lower the AHI?
Also, I'm having trouble understanding why losing weight would result in an increased pressure need? I have seen that said elsewhere but I'm curious if anyone can explain it to me.

I'm curious what others think too.

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Wulfman...
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Fri Oct 10, 2014 12:52 pm

milesleroy wrote:Den, Thank you for the detailed explanation. So, would raising the range of the auto pressures help lower the AHI?
Also, I'm having trouble understanding why losing weight would result in an increased pressure need? I have seen that said elsewhere but I'm curious if anyone can explain it to me.

I'm curious what others think too.
Yeah, you're going to need to increase your minimum to prevent the events.
Like I said, you may have been having more snores and flow limitations before, which bumped up your pressure to prevent the apneas and hypopneas. Your current reports are showing numerous "frank" events, so there are no precursor events to tell the machine to increase pressure.

I can't tell you exactly WHY the weight loss would do that (unless it's the loss of fat or other tissue which caused the precursor events), but over the years, there have been MANY, MANY of these stories about it happening.


Den

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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by chunkyfrog » Fri Oct 10, 2014 1:02 pm

@milesleroy; I suspect you are looking for an explanation of why the pressure goes
the opposite direction from what you expect.
As any woman who has lost weight can tell you, it comes off wherever it chooses--
It leaves the boobies first, belly last.
Following Murphy's law, excess adipose likes to remain where you least want it to.
Losing excess weight, anywhere, is a good thing.
We take what we can get, and work around it.

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milesleroy
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Fri Oct 10, 2014 1:45 pm

Thanks again Den.
So, what would be a good minimum pressure to raise it to? is 15 a good start? What about raising the max pressure too?

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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Fri Oct 10, 2014 2:05 pm

milesleroy wrote:Thanks again Den.
So, what would be a good minimum pressure to raise it to? is 15 a good start? What about raising the max pressure too?
I'm confused about what your maximum pressure is set to. The Sleepyhead report seems to show it's set to 20 cm.
I also see it shows your minimum is at 10 cm.
If these aren't correct, let me know.

But, I think I'd start moving the minimum up one or two centimeters at a time for a few days at a time.
You may try the minimum at 12 for a few days, then up to 13 or 14 for a few days, etc. Of course, evaluate the results each day. Even though you've reached higher pressures during the night, sometimes it can be a little hard to get to sleep at a higher pressure than what you've been used to.......so, use your judgement on that.......whether you want to go up one or two centimeters at a time.


Den

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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Guest » Fri Oct 10, 2014 2:24 pm

yes 10 min and 20 max currently

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Wulfman...
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Fri Oct 10, 2014 2:30 pm

Guest wrote:yes 10 min and 20 max currently
So, on a CPAP machine, the maximum could NOT be increased since it's already at the maximum.


Den

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(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Pugsy » Sat Oct 11, 2014 6:49 pm

It's the minimum pressure that is the most critical pressure for holding the airway open and preventing the collapse of the airway or at least having it high enough to get to any events that it senses may happen.
In your case it doesn't really matter that the maximum is at 20...it never goes above 15 ish.

Your snores and flow limitations shown on the events graphs..along with the OAs and hyponeas point to the machine not being able to prevent the airway collapse. In your situation the machine isn't responding very aggressively for some reason or another. Doesn't really matter why except to satisfy curiosity I suppose. The end result is that you need a little more minimum pressure...most likely 1 or 2 cm would get the job done. It's not like the report is horribly horrible...it's just a little bit ugly.

Also remember that we remove the Central (Clear Airway in SleepyHead) Index when evaluating pressure needs because we don't treat centrals with more pressure with your type of machine. You don't have enough centrals to warrant concern IMHO.
Instead with the FLs, the snores and the RERAs along with maybe borderline higher OAs and hyponeas (higher than we would like to see anyway) all these point to the airway wanting to collapse even if those FLs and snores don't actually progress to the point that they earn an OA or hyponea flag because they don't quite meet criteria to earn one of those flags.
Mainly what I call "clutter" on a report.

As to why you need more now than in the past and you expected to maybe need less....who knows. Maybe related a little bit to sleeping position and saggy airway tissue.
You know how people who are obese and they lose a lot of weight and their skin gets floppy and saggy because the fat that had previously stretched out the skin is gone so everything looks like a balloon that was inflated and the air let out... and they end up cutting that sagging skin off? I don't know if this extra sagging is what is going on within your airway. It's just a theory that I have being that the airway tissue ends up like the sagging underarms or belly of an obese person who has lost a lot of weight.
More sagging can mean more pressure is needed. Or at least it seems plausible to me. I could be all wet too.

It is what it is though. You pretty much have to deal with whatever the cause happens to be.

I know more pressure wasn't what you wanted to hear but if you remove the CAs from the AHI then it isn't quite so ugly and you might get lucky and just 1 cm more pressure will clean up the clutter enough so that the things look like they used to look for you.

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milesleroy
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Thu Oct 16, 2014 8:42 am

Update: Raised pressure and posted new data here:
viewtopic/t101402/Help-with-Weight-Loss ... pdate.html

Still having problems.

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Wulfman...
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Thu Oct 16, 2014 11:22 am

After reviewing those nights of data, I would recommend setting your minimum and maximum pressure to 14 cm.
That was the night you had the "best" (lowest) AHI and least variation in your pressure.

Anyway, I would suggest trying that single pressure setting (min. & max. the same) for a few nights and see what the data looks like and how you feel.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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milesleroy
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Thu Oct 16, 2014 11:34 am

Den,
Thanks for the reply. I will try the 14 min/max setting.
But, I am curious why you think the max setting might be an issue? I don't really understand how the machine works, but I was assuming it only goes as high as it needs to and then goes back down. How might the high pressure create higher AHI? (Just curious)

Thanks
Wulfman... wrote:After reviewing those nights of data, I would recommend setting your minimum and maximum pressure to 14 cm.
That was the night you had the "best" (lowest) AHI and least variation in your pressure.

Anyway, I would suggest trying that single pressure setting (min. & max. the same) for a few nights and see what the data looks like and how you feel.


Den

.

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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by Wulfman... » Thu Oct 16, 2014 11:59 am

milesleroy wrote:Den,
Thanks for the reply. I will try the 14 min/max setting.
But, I am curious why you think the max setting might be an issue? I don't really understand how the machine works, but I was assuming it only goes as high as it needs to and then goes back down. How might the high pressure create higher AHI? (Just curious)

Thanks
Wulfman... wrote:After reviewing those nights of data, I would recommend setting your minimum and maximum pressure to 14 cm.
That was the night you had the "best" (lowest) AHI and least variation in your pressure.

Anyway, I would suggest trying that single pressure setting (min. & max. the same) for a few nights and see what the data looks like and how you feel.


Den

.
In looking at those reports, I picked the one with the least events (and lowest AHI) and looked at about where your pressure was most of the time where the least events were (mostly flat pressure lines).......and pulled that number out of my "backside".........

Well, it's sort of a "semi-logical" criteria I've developed over the years. It may not be totally accurate, but it's a place to start fine-tuning.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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milesleroy
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Re: Help-NEW AHI going up as I lose weight. Data inside

Post by milesleroy » Fri Oct 17, 2014 6:27 am

Wulfman... wrote:After reviewing those nights of data, I would recommend setting your minimum and maximum pressure to 14 cm.
That was the night you had the "best" (lowest) AHI and least variation in your pressure.

Anyway, I would suggest trying that single pressure setting (min. & max. the same) for a few nights and see what the data looks like and how you feel.


Den

.
Another update - last night, I set the machine to min 14.5 and a max of 17. And, i slept on my side most of the night.
AHI was over 9 when I checked it this morning, with the largest issue being centra apneas (which is unusual for me).
Also, some leaks that were high.

Any thoughts?

Thanks
Last edited by milesleroy on Mon Oct 20, 2014 9:48 am, edited 1 time in total.