AHI has doubled

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lwieland11
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AHI has doubled

Post by lwieland11 » Fri Jul 28, 2017 7:25 am

I just replaced the cushion on my Simplus mask. I expected to be able to sleep longer now without all the leaks caused by a cushion that needed to be replaced. That happened. I went from 4 hours a night to about 7. However, in the process my AHI has doubled...from 5-6 nightly to 16-17. Any thoughts as to why this is happening? Thanks.

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robysue
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Re: AHI has doubled

Post by robysue » Fri Jul 28, 2017 12:02 pm

lwieland11 wrote:I just replaced the cushion on my Simplus mask. I expected to be able to sleep longer now without all the leaks caused by a cushion that needed to be replaced. That happened. I went from 4 hours a night to about 7. However, in the process my AHI has doubled...from 5-6 nightly to 16-17. Any thoughts as to why this is happening? Thanks.
How many nights in a row are we talking about? One or two, and it might just be a fluke. Five or six, and we need to do some trouble shooting.

My first guess, however, is that if you went from sleeping 4 hours with the machine to sleeping 7 hours with the machine, then you're getting a lot of REM sleep in the second half of the 7 hour nights. And you might just need to have a pressure adjustment. But to turn that "guess" into a real suggestion, I'd need to see some data.

Let us help you:

What is the exact make and model of the machine you are using?

What are your therapy settings?

Do you have software that allows you to examine all the data recorded by your machine?

Does your machine distinguish between obstructive apneas (OA) and central apneas (CA)? If so, what's the break down of event types? Lots more OAs and hypopneas? Or lots more CAs?

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Pugsy
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Re: AHI has doubled

Post by Pugsy » Fri Jul 28, 2017 12:13 pm

robysue wrote:What is the exact make and model of the machine you are using?
She's using the AirCurve 10 ST. History of CompSA (pressure induced if I remember right). History of bad aerophagia issues with the higher pressures need to deal with the obstructive stuff which might be why they went with the ST instead of ASV.
I don't remember what pressures she is using now but I think both EPAP and IPAP are in the teens... but she is using ST mode with backup rate.
Unfortunately the AirCurve 10 ST doesn't distinguish between central apneas and obstructive apneas. They all go in the "general" apnea basket but there is a hyponea basket.
So she only gets Apnea index and hyponea index.
My bet would be the AHI is primarily obstructive and for some reason she needs more pressure (more REM which goes along with sleeping more hours or supine sleeping) but her fixed bilevel pressures won't/can't adjust and the aerophagia monster makes it a tough decision if she were to increase EPAP and IPAP to deal with the obstructive stuff (assuming the increase is in obstructive stuff).

I still wish that ResMed hadn't opted to not distinguish between centrals and obstructives with these machines...geez..the very people who might need to know can't have it.

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Re: AHI has doubled

Post by robysue » Fri Jul 28, 2017 3:16 pm

Pugsy,

Thanks for the summary. Given the history of aerophagia and a need for EPAP in the teens, the OP is going to have some hard choices to make in trying to balance out the needed pressure on the one hand with the aerophagia on the other.

You are right: It was a stupid decision on Resmed's part to not distinguish between OAs and CAs on the VPAP ST. Or is that because the Resmed FOT for determining OA vs CA is somehow interfered with how the backup rate functions? Any idea if the PR BiPAP S/T machines distinguish OAs from CAs?

I admit that I don't know much about the ST mode, so pardon me if this is a really dumb question: If you're running in ST mode, isn't the machine supposed to step in an start triggering inhalations if your RR drops below the back up rate? How many breaths do you have to miss before it starts triggering inhalations?

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lwieland11
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Re: AHI has doubled

Post by lwieland11 » Fri Jul 28, 2017 4:32 pm

robysue -

It's been like this for 3 nights. I think you're right about the REM sleep...doc said the same today...I asked them to up my pressure by 1 to 17...and they did this afternoon. Tonight, I will see how it goes.

Re: data. I use ResMed.my air for the basics. I have tried using Sleepyhead and found it to be rather complicated. I can always try again.

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Re: AHI has doubled

Post by lwieland11 » Fri Jul 28, 2017 4:36 pm

xx -

Mask cushion is nice and tight and not leaking. Mask seal is good. I am certain that I am mouth breathing. I have a full face mask so that I can do that. I have tried using chin straps but they don't seem to keep my mouth shut. Too many straps. Too uncomfortable with both mask and chin strap.

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Re: AHI has doubled

Post by lwieland11 » Fri Jul 28, 2017 4:57 pm

I cannot seem to get Sleepyhead to post the current data from my SD card. Not sure why. Thoughts?

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Pugsy
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Re: AHI has doubled

Post by Pugsy » Sat Jul 29, 2017 12:57 am

robysue wrote: Any idea if the PR BiPAP S/T machines distinguish OAs from CAs?
Haven't ever seen a report from the PR S1 BiPap S/T machines but I know first hand that the 960 did because I used to have one.
I would assume the S/T does also.

I don't know why ResMed opted to no separate the centrals from the obstructives on the S/T. The ASV I could maybe understand because it simply kicks in and breathes for you right away since it is auto but the S/T doesn't have any auto capabilities. I wish that the OP in this thread had been given the ASV model instead of the S/T. That faster response for both OAs and Centrals could maybe have let her use less pressure except for the times she really needs it and thus maybe help ward off the aerophagia monster. Similar to why I just happen to like ASV better.
robysue wrote:If you're running in ST mode, isn't the machine supposed to step in an start triggering inhalations if your RR drops below the back up rate? How many breaths do you have to miss before it starts triggering inhalations?
I don't know the answer to that one. Since I got my S/T AirCurve I have just been using it in S mode since I don't need a back up rate and I never bothered to do any reading up on the back up rate stuff.
When I have time tomorrow I will see if there is anything in the manual that might answer the question. I would assume that it wouldn't be very many though.

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lwieland11
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Re: AHI has doubled

Post by lwieland11 » Sat Jul 29, 2017 1:45 am

Interesting, Pugsy. Sounds like a better machine for me. As I mentioned, they upped the pressure by 1 late yesterday in an attempt to lower my AHI. They eliminated(or forgot to add)the ramp up so I began tonight without it. Hard to adjust to adjust but I did. Then, was awake for almost 3 hours as the air kept trying to leak out underneath the outside edges of the mask. Pop. Pop-pop. Pop. Every time I started to doze off, pop. How does one sleep with that going on? So frustrating. Now, I'm sitting here at 3:38 a.m., stomach full of air and miserable. There's got to be a better way. I thought the Simplus mask was one of the ones that could handle the higher pressures. Not on me for some reason. I had it on pretty tight.

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Re: AHI has doubled

Post by lwieland11 » Sat Jul 29, 2017 2:18 am

I've switched over to the Amara View now to see if it's better with the higher pressure and it just might be. This is encouraging.

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Re: AHI has doubled

Post by Sheriff Buford » Sat Jul 29, 2017 5:10 am

Give it more than 3 nights and see what happens. Sometimes the time in the cpap world is very slow.

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Re: AHI has doubled

Post by ajack » Sat Jul 29, 2017 6:04 am

you really need to post some charts to see what the st is doing and what leaks you had with the old and new mask. My guess is that is where the AHI is.
The st can be titrated fairly well. In ST mode it doesn't matter whether it's oa or ca, everything gets treated and shown as UA. In cpap mode it should have FOT and show CA and OA

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lwieland11
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Re: AHI has doubled

Post by lwieland11 » Sat Jul 29, 2017 10:31 am

I'd like to use Sleepyhead to show some charts but cannot seem to load the current data from my SD card into it. Not sure why. Could use some help with that. Then I'll be happy to produce some charts. Thanks.

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Re: AHI has doubled

Post by robysue » Sat Jul 29, 2017 11:13 am

lwieland11 wrote:Interesting, Pugsy. Sounds like a better machine for me. As I mentioned, they upped the pressure by 1 late yesterday in an attempt to lower my AHI. They eliminated(or forgot to add)the ramp up so I began tonight without it. Hard to adjust to adjust but I did.
Go into the settings and set the ramp up the way you want it set up. Since you have aerophagia problems AND you need very high pressures, it sounds to me like you NEED a correctly set up ramp in able to get to sleep before the stomach winds up with too much air in it for you to be able to sleep comfortably.

Then, was awake for almost 3 hours as the air kept trying to leak out underneath the outside edges of the mask. Pop. Pop-pop. Pop. Every time I started to doze off, pop. How does one sleep with that going on? So frustrating. Now, I'm sitting here at 3:38 a.m., stomach full of air and miserable. There's got to be a better way.
My guess is that you missed the ramp a lot more than you think you did. Get that ramp set back up and use it.
I thought the Simplus mask was one of the ones that could handle the higher pressures. Not on me for some reason. I had it on pretty tight.
In theory almost any mask should work with higher pressures. It could be that you had the mask on too tight rather than too loose. Review the fitting instructions carefully and see if you can find some fitting videos on-line.

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ajack
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Re: AHI has doubled

Post by ajack » Sat Jul 29, 2017 2:25 pm

lwieland11 wrote:I'd like to use Sleepyhead to show some charts but cannot seem to load the current data from my SD card into it. Not sure why. Could use some help with that. Then I'll be happy to produce some charts. Thanks.
there could be so many reasons, it would be hard to pick one.
Have you been able to use sleepyhead before?
a faulty software or sd card could be the cause.
I would get another sd card, you probably have one around the house in a camera or something. If you still have problems, i would uninstall and reinstall sleepyhead

for real problems I would go to the other forum, only a few come here to post.
http://www.apneaboard.com/forums/index.php

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