Update: Weight Loss and Increasing AHI

Hi Folks,
So as you might recall from previous threads, I've been tracking an increasing AHI over the past 4 months as I've slowly lost 25-30 lbs.\
Earlier thread here
viewtopic.php?f=1&t=101402&p=946981&hil ... hi#p946823
I tried raising my pressure to 14 constant, tried setting it at 14-20 Auto Pap. But the AHIs are still high for me (ranging from 5 to 10..current average is 6.
Right now I am set at my original prescription pressure of 10-20 Auto Pap.

So here's the update. I saw my Dr.'s nurse practioner. She looked at my sleepyhead data (which I posted here previously) and said she didn't see any clear
pattern that would suggest why my AHI has increased and she did not have an answer to why weight loss might be associated with it.
However, she said she did not see any reason to be too concerned so long as I am feeling rested and not having sleepiness during the day.
She said that since my sleep study showed ahi-36 before therapy, the 5-10 AHI i am now seeing is still a big improvement.
She encouraged me to keep tracking and let them know if I have any other subjective symptoms that indicate the apnea is a problem.

I'm writing today to ask what the rest of you think of her conclusion that this AHI is not a big deal to worry about, despite it being a noteable change from my past AHI numbers
which were always below 5 for the last 4. years.

Any thoughts?

Thanks

So...are you still feeling less rested like you mentioned in the other thread?

If you are feeling great...I wouldn't worry but if not feeling so great...if I had those reports and wasn't feeling so great I wouldn't be happy with the numbers I see.
Is the AHI still primarily OA and hyponea and are you still seeing increased FLs and RERAs?

Pugsy wrote:So...are you still feeling less rested like you mentioned in the other thread?

If you are feeling great...I wouldn't worry but if not feeling so great...if I had those reports and wasn't feeling so great I wouldn't be happy with the numbers I see.
Is the AHI still primarily OA and hyponea and are you still seeing increased FLs and RERAs?

Lately, i am feeling pretty well rested. The AHI is till primarily OA/Hyponea. There are still increased RERAs too.

It's a tough call. To me your reports just have "clutter" which I sort of think of as signs of not so great sleep...especially the FLs and RERAs.
But increasing the minimum that you tried didn't really make any huge difference in the "clutter" like we would expect to see...especially when you went to the 14 minimum.

To use more than 14 cm minimum...that can also disturb sleep quality because you are getting up there in the pressure range where that can also disturb sleep. Kinda damned if you do and damned if you don't and even if you do there's not a HUGE improvement at the higher pressures. Might be worth trying to adjust to if there was remarkable change but there wasn't.

Are the reports you are seeing lately more in the AHI 5 ish range or 10 ish range?
If they are 5 to 6ish...and 1 or 2 of it is Clear Airway...that brings it down to 4 ish range for the obstructive side of things and if you are feeling decent...probably not a big deal.

Always remove the central component mentally when you are evaluating the AHI...they may or may not be real but we don't treat them with more pressure anyway even if they are real and with the clutter and RERAs there's a good chance those are either SWJ centrals or normal sleep stage transition centrals.

I posted this as a separate thread
viewtopic/t101729/Leaks-and-Mouth-Breathing.html

I have noticed very dry mouth some mornings. I figured it couldn't be due to mouth breathing since my leak numbers are not too bad.
But, now I'm wondering if mouth breathing might be registering in a way that could increase AHI?

I don't see the mouth breathing being responsible for the obstructive components of the AHI but if you were congested a lot (thus the cause for the mouth breathing) maybe the congestion is fooling the machine into thinking some obstructions are happening....going way out on a skinny limb with that big maybe

So the mouth breathing itself probably isn't a factor but what might be causing the mouth breathing might be a factor if that makes sense to you.

Also...if you are waking frequently during the night because of the dry mouth it's possible that some of what is showing on the reports is simply SWJ (Sleep/Wake/Junk) because the machine can be fooled by awake breathing irregularities. Maybe that's why they didn't seem to want to reduce/respond to the increase in minimum...because they aren't real.

It doesn't take much mouth breathing to dry out the mouth. I personally have woke up with massive dry mouth and for sure mouth breathing but when I go look at the reports full expecting to see a big prolonged massive leak I get a big surprise and sometimes can't even spot the mouth breathing leaks and once when I did for sure know when the mouth breathing was going on...it barely registered on the leak graph.
Not all mouth breathing equals the therapy being in the toilet like people might think.
I have an example where I woke up and I was mouth breathing but breathing very gently without massive amounts of therapy pressure exiting out my mouth ....it was at the time I would normally wake up any way so I just continued to breathe like that through my mouth for about 10 to 15 minutes so that I could for sure document awake mouth breathing on my leak report just to see how bad it got...

I circled the known awake mouth breathing time...S9 report...so my baseline is 0.0 which would be different baseline with your machine but I think you can see what I mean...dry mouth and mouth breathing doesn't always mean massive leaks are happening.
The 3 AM leak....I slept through it so I have no idea what happened..if it was mouth breathing..I don't know it but I suspect it was.
The known awake time that I circled is right at the end of the night 7:30ish

If you have dry mouth, you mouth breathing. That means you can't breath through the nose. Why can't you breath through the nose? Those few AHI you mention might be transitions from your nose going shut to mouth breathing. It don't take much for the nose to swell shut.