help w/interpreting SleepyH results

Hi all,

Thank you in advance for your help. I just finished my first week on my first Cpap, and the AHI (and how I feel) seem to be worsening. Following are my recent AHI results starting with my first night: 11.48, 6.78, 7.01, 8.14, 8.86, 9.98. Also, the hours of sleep on the machine have reduced each night as well. After my first night of improvement, I have steadily worsened so I am wondering how to read the most recent result, and what can I do to improve?

What did your sleep study show for AHI?

Initial sleep study result was 36, then first night home 11, second night home 6, then I have been climbing steadily back up since. And also sleeping fewer and fewer hours with machine!

Were you awake during that first cluster that is showing during ramp time? Or did you fall asleep right away?
Are you waking often during the night?
So you sleep on your back at all?
Why sleeping fewer and fewer hours with the machine?

I was awake for that first cluster, I had a hard time falling asleep. Consistently, I have not woken up at all for the entire week until I get my 5 or so hours in on the machine. After that I cannot seem to fall back to sleep with the machine, especially if I get up for a moment, so I just remove the mask and turn off the Cpap.

I sleep exclusively on my back and seem to fall asleep best that way. The full mask seems to keep me on my back.

I would love to know why I am not only sleeping fewer hours, but the AHI is rising, and I just feel more tired the next day???

There are two main reasons for when we see clusters of events like you are seeing (not counting the one while you were awake and if you were asleep during the others we count them) and that is because the pressure is not sufficient to prevent the airway collapse...why some parts of the night and not others...2 main reasons...supine sleeping and REM stage sleep.
Since you are already on your back then that leaves REM stage sleep and the cluster pattern pretty much goes along with when we would normally expect to see the normal REM sleep cycles.

This would be where it would have been nice if you had the auto adjusting machine (like my 760 model in my profile) so that it could only increase the pressure during the time we see these clusters...so you could use higher pressure part of the night instead of all of the night.
REM sleep is where my OSA is worse (documented in sleep study) and where I often will see the machine want to go higher to prevent the airway collapse and sometimes pretty darn high.

Sleeping on your back could potentially be a partial culprit meaning if you were on your side you might not need as much pressure and those clusters might not have happened. I say partial culprit because not everyone will see a dramatic pressure change need with supine sleeping. I didn't. I did a 3 week experiment where I built a wall so that I absolutely had no chance of rolling over onto my back and I still saw the big pressure changes with REM sleep. So it was going to happen in my situation no matter what position I slept in.

Now are these clusters maybe a big enough problem to disturb your sleep and be a potential factor in your not being able to stay asleep longer? It's possible. We don't know for sure but it's possible.
When we have rather large clustering of events it's much more stressful on the body to have 10 events in 10 to 15 minutes than it is to have 10 events spread out over 4 hours. Especially if those 10 events in 10 minutes had some duration to them beyond minimal 10 seconds.

Usually for OA clusters when using bilevel (or really single pressure) therapy we look at the minimum pressure being not quite optimal..and in your case that would be the EPAP pressure.

Looks like you are using 15 EPAP and 19 IPAP....will 16 EPAP break up the clusters? It might be enough....we don't know until we try.

The CAs...they seem to correlate with the OAs which makes me wonder if the OA clustering is causing arousals and those CAs (centrals) might either be simply Sleep/Wake/Junk arousal central or a sleep stage transition central due to maybe going in an out of sleep after the OAs cause a maybe arousal.
A lot of maybes because we can't really tell for sure what is going on with the data available but it's an idea that is far from impossible and in fact very possible.

If it were me I would try to break up the clusters ....either maybe try side sleeping if at all possible (and that's easier said than done) or most likely just try a little more EPAP and if 16/19 wasn't comfortable then try 16/20 and see what happens.
If you had the Bipap Auto we could just give the machine a little room to roam around a little and wouldn't have to use so much pressure all the night...but you don't and hey...16 might do the trick and you sleep quite well at those pressures.

I didn't think I could adjust my own pressure since it was set by the Dr., is that true?

Well...at all depends on how comfortable you are setting your own pressure.
Can you do it? Sure, it's easy. Should you do it? That's your call. If you aren't comfortable doing it then don't. Run it by your doctor as to what you see on the reports and see what he says if you aren't comfortable doing it.
There's no law that says you can't change things but just because you can doesn't mean you should if you aren't okay with doing it.
You can go here and request the clinical manual for your machine and it explains how to make changes..would be a good idea to get one even if you aren't comfortable because there's a lot more useful information in it about your machine.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

I know what I am comfortable doing but I am not you...but someone should probably do something because your therapy is not quite optimal and you are feeling it. It's close but not quite there yet.
If you have a good relationship with your DME you might run your reports by them and see what they say...they still can't change anything without the doctor (their hands are tied by rules but yours aren't) but they could maybe run interference for you.
Or if you have a follow up visit scheduled soon with your doc you could bring it up then.