NEWBIE! Inconsistent AHI, Long event times, is this normal?

Ok. I don't even know where to start! . I have been on PAP therapy for about 2 months. My attitude toward PAP is very positive because I have seen how much it has helped my mom. I have used my machine religiously since I got it.

My prescription is 8cm. I have not seen a complete report from my study, but I know I had an AHI of 14 and my oxygen level got as low as 80%.

A little info so far:
I started with my Resmed 10 Autoset in CPAP mode, set at 8, as prescribed. I was still getting nightly overall AHIs ranging from 4-10 according to Sleepyhead. I was having obstructive events that lasted 70 seconds. After reading through all the threads I could find on here, I put my machine on APAP mode and started adjusting the minimum pressure. I started with a range of 8-15, and it wanted to go higher, so I put it on 8-20 and it would occasionally go pretty high. After about 7 days, I noticed that if my pressure went below 14 or so, I would get more events (mine are obstructive for the most part). So I set the pressure to 14-20. Even with that, I would still get nightly AHIs around 4-5, and had obstructive events lasting 60-70 seconds.

Currently (for the last week) my pressure has been set at 17-20 with EPR at 3. I have finally had my first few nights below AHI of 2 and I have had 2 nights where I woke up and actually felt refreshed. But I am still having inconsistent AHIs ranging from 0.83 to 7.85. I am also still having multiple events over 60 seconds, and 1 last night that was 93 seconds! These events even happen when my pressure line is at 19cm.

I guess my questions are:

1) Should I expect my AHIs to ever be consistent and low? I know it's more about how you feel, than numbers, but my body seems to be taking its time on feeling better!

2) Is it normal to have events that last 60-90 seconds? This is absolutely terrifying to me

3) Am I going too high with my minimum pressure? It doesn't bother me at all. I don't even notice except for when my mask leaks. I'm just not sure if going too high can have negative effects.


Thanks so much in advance.

Don't pull any punches with responses. I'm very eager and motivated to get this stuff under control and all figured out.

Welcome to the forum. Many of your events sound normal from untreated sleep apnea, but should not happen like that with good treatment. Especially the longer events.

Can you post some of the graphs showing the events. That will help us give better advice on what to work on.

You seem to be approaching this the right way. You don't mention leak line. How is it?

Assuming the leak line is good, my wild guess is that your inconsistent AHI is from position changes while sleeping. When you sleep on your back (where OSA is usually the worse) for longer parts of the night, your AHI is higher. (That's just a guess.)

You are using a high pressure. Many of us have been able to use lower pressures and achieve reduced AHIs by wearing firm foam cervical collars. I use this one - https://www.walmart.com/ip/DMI-Universa ... e/23057188

zoocrewphoto wrote:Can you post some of the graphs showing the events. That will help us give better advice on what to work on.

+1

Wide pressure changes usually either from sleeping on your back or REM stage sleep or maybe combination of both.
It's common to have increased pressure needs for either.
I have seen wide changes because of REM sleep. My OSA was documented 5 times worse in REM than in non REM.
It's very common.

If the higher pressures aren't causing aerophagia (air in the belly) issues and your AHI is primarily OA and hyponeas with a rare central/Clear Airway thrown in...it won't hurt you.

What is the event category breakdown of those higher AHI nights...very many CAs???

Also..are you having very many wake ups during the night where you are wearing the mask while the machine is on?
If so some of those flagged events might not be real and instead just be the machine misinterpreting awake breathing irregularities as some sort of apnea event. Awake events don't count and have to be mentally removed from the evaluation process.

brad_r wrote: I started with my Resmed 10 Autoset in CPAP mode, set at 8, as prescribed.

Was that pressure arrived at with an in-lab study? Wondering why the wide disparity between that number and your actual needs. Maybe there was no time captured on your back while in REM and the pressure of 8 was enough outside those scenarios. At any rate, getting a copy of the report (not just the summary letter) is always a good thing to have on hand. Questions may arise that could be answered there. Your attitude toward treatment is refreshing.

zoocrewphoto wrote:Can you post some of the graphs showing the events. That will help us give better advice on what to work on.

I will have to look through the threads about organizing sleepyhead and using imgur, then I will get some screenshots up!

ChicagoGranny wrote:You seem to be approaching this the right way. You don't mention leak line. How is it?

Assuming the leak line is good, my wild guess is that your inconsistent AHI is from position changes while sleeping. When you sleep on your back (where OSA is usually the worse) for longer parts of the night, your AHI is higher. (That's just a guess.)

You are using a high pressure. Many of us have been able to use lower pressures and achieve reduced AHIs by wearing firm foam cervical collars. I use this one - https://www.walmart.com/ip/DMI-Universa ... e/23057188

My 95% Leak rate is usually below 4. I have had 2 nights with extended periods of large leaks because I was still trying to get my full face mask fitted correctly (I started with a nasal mask, but it was waking me up when air would come out of my mouth, chinstrap did not help!). So leaks are never really a problem, although, there are times when a tiny bit of air leaks through the sides of my mask, making a high pitched farting noise LOL. This usually wakes me up, I have to wipe off what I believe is drool, then go back to sleep....I have noticed that the leak line spikes right after an obstructive event.

Pugsy wrote: If the higher pressures aren't causing aerophagia (air in the belly) issues and your AHI is primarily OA and hyponeas with a rare central/Clear Airway thrown in...it won't hurt you.

What is the event category breakdown of those higher AHI nights...very many CAs???

Also..are you having very many wake ups during the night where you are wearing the mask while the machine is on?
If so some of those flagged events might not be real and instead just be the machine misinterpreting awake breathing irregularities as some sort of apnea event. Awake events don't count and have to be mentally removed from the evaluation process.

There were a couple mornings where my lungs felt a little sore, but I had the EPR set at 1. After changing the EPR to 3, that went away. I have noticed (my wife has noticed as well!) that I am a little gassy in the morning.

As far as event breakdown, 2 nights ago, I had a 7.85. (this was with pressure at 17-20, 3 EPR)

Large Leak 0.01%
Clear Airway 1.57
Unclassified Apnea 0.00
Obstructive 5.93
Hypopnea 0.35
RERA 0.17

July 28th was my highest AHI with 10.86 (this was with prescribed pressure of constant 8, 3 EPR)

Large Leak 0.11%
Clear Airway 0.48
Unclassified Apnea 0.00
Obstructive 8.93
Hypopnea 0.95
RERA 1.07

CAs have been 2.4 at the highest, but are usually around 1 or below.

xxyzx wrote: ========

check your data for that long apnea
was it a central?
a cpap cant fix that
if it was obstructive then you might need still more pressure

did they titrate your pressure to a fixed 8? or expect the apap to handle the changes and set it wrong??
spO2 of 80 is bad but really depends how long it was that low
a minute or more at 80 is in the bad range
a few seconds would not be significant

The long events that I have are always obstructive. The longest CA events that I have are around 20-30 seconds.

They set my machine to a constant 8 after my in lab study. It was doing nothing for me. Not sure on how long I was at 80% o2. I still need to get the full report. All I have is the summary.

kteague wrote: Was that pressure arrived at with an in-lab study? Wondering why the wide disparity between that number and your actual needs. Maybe there was no time captured on your back while in REM and the pressure of 8 was enough outside those scenarios. At any rate, getting a copy of the report (not just the summary letter) is always a good thing to have on hand. Questions may arise that could be answered there. Your attitude toward treatment is refreshing.

It was an in lab titration study. Strangely enough, I slept on my back the entire night. This was really uncomfortable because I usually sleep on my stomach or side. I remember waking up during the study a couple times and wanting to roll over, but the tech had told me that the results would be better if I were on my back. I was determined to get the correct results, so I stayed on my back. Not the best night of sleep I have ever had .

I am also shocked at the difference in my prescribed pressure and the pressure that I'm using. That's part of the reason I posted. I will have to take a while to try to get some screenshots up to show yall my graphs from having a fixed 8 pressure, then 8-20 so yall can have a look and see what you think. I'll also try to get some current ones up with the pressure of 17-20, including a few of the events that are 60, 70 and even 90 seconds. They even happen when my pressure line is at 19 wtf!!


Sorry if this got a little lengthy! I appreciate the input! Give me a little while to read the screenshot threads so I can try to get some put up.

brad_r wrote:screenshot threads so I can try to get some put up.

https://sleep.tnet.com/resources/sleepyhead
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

I would need to see the detailed report to see when the pressures are increasing to offer any idea about why but your AHI is primarily obstructive (OA, hyponeas) so you need more pressure to reduce those numbers.

Most likely you are either rolling over onto your back or you are in REM sleep...those are the 2 most common reasons for wide pressure variations.

If you had a copy of your sleep study that might also cement the cause because it usually shows AHI in so and so position and non REM vs REM AHI.

Usually fairly easy to figure out and then implement a plan depending on the cause of the higher pressures.

I am betting you have clusters of events...periods of time where not much gets flagged then periods of time where it gets really ugly. It's those times that the pressure needs to go up and can't get up either high enough or fast enough to hold the airway open and prevent the collapse.

Once we can actually see the detailed report we will have a better idea as to what plan of attack to make.

Ok, here we go. I hope I get this right. Thanks in advance to anyone who views these! I really do appreciate it

I'm going to give a couple examples of a few different pressure settings I have tried, along with some close ups of some of my longer obstructive events.

::Ok, so after typing, there are quite a few screenshots, so be prepared ::

So here was my best night (numbers-wise) with my prescribed pressure of constant 8cm.



Here was my worst night with prescribed constant 8cm.



Here was a night where I opened the pressure to 8 min-20max. I had more CAs than normal (for me) on this night



Here is an example of an average night after I slowly bumped my minimum pressure to 14 with max still at 20.



I have had a few good nights where I felt refreshed and had AHI below 2 (I ask myself how I feel before turning off the machine and looking at AHI)..with pressure at 17-20 cm...But here are two recent shots of bad nights with pressure at 17-20.





The next few will be zoomed in on some of my long events. They are all from the previous screenshot night, Sept 5 with 7.85 AHI.

Here is a close up of a 93 second isolated event at 18.35 pressure. You can also look at the sidebar and notice how long some of my other events get up to. Is this normal?



Here is a 73 & 59 second back to back event at 18.20 pressure.



An 81 second event at 18 pressure.






Thanks again for taking a look. Please let me know if the screenshots don't work or if there is anything else I should post. I am hoping I can get rid of the longer events, get my AHI consistently low, and most of all feel refreshed after waking up instead of rubbing my eyes and yawning for 2 hours. Even if this is as good as it gets, I'll stick with it because I am terrified of what it would look like with no machine .

What position do you sleep in normally? Spend much time on your back?

I assume no change in any medications????

8 cm obviously worked quite well and it does make a person wonder what changed. Something changed though.
Either sleeping on your back or you are now getting more REM or maybe both.

Have you requested official copies of your sleep studies...both the diagnostic and the titration? If not, get it done.

If meds haven't changed that really only leaves sleeping position and/or REM or both.

I usually sleep on my stomach or side.

I don't have any medications, so no changes there.

I will have to call today and ask for copies of both reports. Thanks for the advice on that. I wouldn't have thought to get the report on the titration.

I will try to be more aware of the sleeping position I am in when I wake and adjust throughout the night. I know that last night I woke up and I was on my back 2 or 3 times, so I know I was on my back for a good portion of the night.

As for REM sleep, for what it's worth, not sure if it is related or not...but since I started using my machine, I have been dreaming like every night. I used to never dream before the machine. But now I am having movie-like dreams where I can remember them.


At this point, should I try to lower my minimum pressure back down some? Not sure where to go from here.

brad_r wrote: At this point, should I try to lower my minimum pressure back down some? Not sure where to go from here.

What I would do if it were me is try to fix up something so that I couldn't roll over onto my back at all and see what happens with the events.
You have to figure out something that won't move out from underneath you (and it's hard to prevent that from happening).
I don't agree with the idea some people say with putting tennis balls in a back pack or in something on your back so that when you roll over onto your back it is uncomfortable and you wake up and turn back on your side.
The idea being that eventually the body will learn that it not so comfortable on its back...but that can take months and will totally trash an already fragile sleep.

I prefer to figure out some way to build some sort of wall that won't move and will keep me on my side and won't wake me up a gazillion times a night.

If the AHI drops and the ugly clusters go away...then reduce the pressure while using the wall and see where you end up in terms of pressure needs.

Dreaming...we can dream in all the sleep stages...not just REM.
The fact that you are remembering a lot of dreams is not a good thing because it means you are waking up during the dream.
Otherwise we don't remember dreams. The brain can't formulate a memory of a dream unless you wake up or have and arousal (and you may or may not remember the awakening or arousal).

clustered without preceding flowlimitations - try a soft cervical collar.

xxyzx wrote: often i find my mind is aware, not awake, while i am sleeping as if some of the senses had not turned off

everyone(!) on this board can attest to that (just for xxyzx)! - although for you I would say: your mind can be asleep while your body is posting. (no other way to explain 99% of your posts)

Guest wrote:clustered without preceding flowlimitations - try a soft cervical collar.

ChicagoGranny wrote: You are using a high pressure. Many of us have been able to use lower pressures and achieve reduced AHIs by wearing firm foam cervical collars. I use this one - https://www.walmart.com/ip/DMI-Universa ... e/23057188

I will look into trying these for sure. Thanks for the tips.

Pugsy wrote: What I would do if it were me is try to fix up something so that I couldn't roll over onto my back at all and see what happens with the events.
You have to figure out something that won't move out from underneath you

Last night I added a pillow under my stomach/hips while I slept on my stomach. I was sorta using the "falcon" position that I have seen posted before. It was much more comfortable with the pillow under the hips, felt like I slept much better. Graphs looked nice, too. I woke up on my back 1 time, but rolled back over. During my last 3.5 hours of sleep, I only had 2 CA events, nothing else.

Thanks for all the input, tips, and ideas yall. I'll keep trying and see how everything looks over the next couple weeks!