AHI jumping to scary levels with new machine.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
SleepingBetterCPAP
Posts: 26
Joined: Tue Nov 18, 2008 9:27 am

Re: AHI jumping to scary levels with new machine.

Post by SleepingBetterCPAP » Thu Apr 12, 2018 10:24 pm

Pugsy wrote:
Thu Apr 12, 2018 7:53 pm
Ron AKA wrote:
Thu Apr 12, 2018 7:38 pm
That would be bad news then. The machine is maxed out on pressure and flow. I thought the machine may be up to the job, but not when it is feeding leaks.
It's not feeding the leaks. These machines don't feed leaks and in fact Respironics machine reduce pressure if it senses a large leak (remember it's the machine's large leak territory it uses).

The machine isn't up to the job at this point because obviously 20 cm isn't holding the airway open well enough.
Now why it seems to now not be working well when in the past it did work quite well...that's an unknown at this time.
It's too long of a bad cluster to blame it on REM since most REM cycles don't last for 2 hours.
Something changed...don't know what changed but something changed.

If it can't be sorted out with something simple...like maybe a cervical collar or making absolutely sure no supine sleeping...he's going to for sure need to see his doctor.

I suggested the cervical collar because its cheap and easy and sometimes it works...and it's a lot cheaper than a doctor visit, a new sleep study which I pretty much can guarantee the doctor will want to do and the cost of a new machine.

Will it work? I have no idea but it's worth trying because it's obvious this isn't working.
I suspect he will eventually need to be seeing his doctor but this is one situation where I hope I am wrong. Nothing would make me happier to find out that a $10 cervical collar makes a huge difference.
Don't have a dr, I have a nurse practitioner who comes to my house. I'm semi-homebound. I'm on medicare but they won't cover cpap stuff for me without a new test. Had an in-home test done but they required 6 hours straight of sleep to qualify for a test and I woke up with chest pains after 2. So basically I'm screwed on that end. I am very overweight and need to lose weight but when I'm so zapped for energy it's very hard.


I thought I did write about using a cervical collar. I searched around for things I could do on the cheap and that was something I've seen mentioned a ton. I also know I am a mouth breather and also noticed waking up with my chin on my chest. The cervical collar did almost completely get rid of my apneas the first night, I believe.

I think this was with the cervical collar and the Liberty Hybrid Nasal Mask. I was having a lot of leak issues with this mask with my congestion and possibly/probably the cervical collar?

Image


This was the next night
Image

What alarmed me here was moving from obstructions to a lot more hypopneas and periodic breathing.


Here's a night with only 1 OA recorded.

Image

Beyond doing the cervical collar and getting new equipment out of pocket, I've also been trying to do a bunch of these exercises. No idea how effective they could be but I figured they couldn't hurt to do.

http://www.sleep-apnea-guide.com/tongue ... apnea.html


P.S. Thanks for all the thoughtful and excellent replies. Surprised to see this is 3 pages but I noticed there was some drama going on. Hope all is good now. I truly appreciate the insight provided here.

_________________
MachineMaskHumidifier

User avatar
Pugsy
Posts: 43989
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: AHI jumping to scary levels with new machine.

Post by Pugsy » Thu Apr 12, 2018 10:39 pm

Yeah....just ignore the drama.
Keeps things lively around here and this isn't the first and won't be the last. Strong personalities butting heads and all that.

So you say you already tried a cervical collar? One of the new posts you shared? If so, which one?

Can you do me a favor please....look back in your reports and find me a report that look nice and normal before the AHI went to hell.
Hide the calendar....and turn off the Pie Chart (Preferences/Appearance tab and remove check mark for show pie chart)
Doing this will bring some of the statistics up into view that are off screen last night.

Build a wall that will ensure you won't roll on your back. We need to rule in or out supine sleeping being a problem.
You need to be able to say...went to bed on this side and never move.

If we simply can't get things to improve...you need a machine that will go higher with the pressure. There are ways to get it done without docs and insurance and even a lot of money.....or at least find one you can at least try and see what happens and go from there.

Let's try the easy stuff first. Might get lucky. If no luck then we can go to Plan B...we find you a different machine.
I may have to RISE but I refuse to SHINE.

User avatar
palerider
Posts: 18552
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).
Contact:

Re: AHI jumping to scary levels with new machine.

Post by palerider » Thu Apr 12, 2018 10:40 pm

Pugsy wrote:
Thu Apr 12, 2018 9:56 pm
I am still here scratching my head as to what changed to give such a drastic difference in results so quickly and isn't it obvious what changed.
There are a couple of other medical conditions that could maybe be involved but I don't want to go there until we exhaust ruling out all the other usual culprits.

Anyway, crossing my fingers that dumb luck might just drop by and bless us here so that we can stumble on the cause and maybe an easy fix.
I'm waiting on answers to my questions... what was the old machine, when was it replaced... We could guess, but you know how I hate doing that... Wrong guesses are bad.

_________________
Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto

SleepingBetterCPAP
Posts: 26
Joined: Tue Nov 18, 2008 9:27 am

Re: AHI jumping to scary levels with new machine.

Post by SleepingBetterCPAP » Thu Apr 12, 2018 11:44 pm

Pugsy wrote:
Thu Apr 12, 2018 10:39 pm
Yeah....just ignore the drama.
Keeps things lively around here and this isn't the first and won't be the last. Strong personalities butting heads and all that.

So you say you already tried a cervical collar? One of the new posts you shared? If so, which one?
Yep, the three charts I posted above were all with a cervical collar.
Pugsy wrote:
Thu Apr 12, 2018 10:39 pm
Can you do me a favor please....look back in your reports and find me a report that look nice and normal before the AHI went to hell.
Hide the calendar....and turn off the Pie Chart (Preferences/Appearance tab and remove check mark for show pie chart)
Doing this will bring some of the statistics up into view that are off screen last night.
Image

This from October of 2017 and was during a month where my AHI was under 1 for the month.
Pugsy wrote:
Thu Apr 12, 2018 10:39 pm
Build a wall that will ensure you won't roll on your back. We need to rule in or out supine sleeping being a problem.
You need to be able to say...went to bed on this side and never move.
I will look around for threads on this (I assume there are some). I try to take good records but I guess I need to be more vigilant. Mark down nights with collar on and what not.

_________________
MachineMaskHumidifier

Jas_williams
Posts: 132
Joined: Tue Dec 19, 2017 2:12 pm
Location: Somerset UK

Re: AHI jumping to scary levels with new machine.

Post by Jas_williams » Fri Apr 13, 2018 1:03 am

The notes tab of sleepyhead is useful for recoding how you feel and did you use a cervical collar et.

_________________
Mask: AirFit™ F10 Full Face Mask with Headgear
Additional Comments: Using sleepyhead and a pressure of 9-16 Resmed S9 Adapt SV

User avatar
Barb (Seattle)
Posts: 588
Joined: Wed Aug 03, 2005 6:41 pm

Re: AHI jumping to scary levels with new machine.

Post by Barb (Seattle) » Fri Apr 13, 2018 7:21 am

palerider wrote:
Thu Apr 12, 2018 7:12 pm
Barb (Seattle) wrote:
Thu Apr 12, 2018 6:54 pm
should have said ya'll (meant just the one person) as opposed to you all...I was saying it different in my head.
Actually, y'all, which is short for "you all", a collective noun. ;)

Pale, in Texas, where y'all is part of the lexicon.
:oops: :oops:
DreamStation
21 years on CPAP

User avatar
Pugsy
Posts: 43989
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: AHI jumping to scary levels with new machine.

Post by Pugsy » Fri Apr 13, 2018 7:44 am

SleepingBetterCPAP wrote:
Thu Apr 12, 2018 11:44 pm
Yep, the three charts I posted above were all with a cervical collar.
Well crap...you know I really didn't want to hear that...I wanted to be able to hold out some inkling of hope that it might have helped.

My gut tells me that you are going to need a different machine that can go higher if need be...again why it now needs to go higher...I don't know.
Without a doctor it creates additional hurdles. Is it you don't have a sleep doctor?? It doesn't have to be a sleep doctor to get you some help...just has to be a doctor that is willing to help.
Tell me again your insurance situation...I know you mentioned it already but it's lost in this thread.

Can you please go back and review the various questions you have been asked by myself (about meds, congestion, etc) and Palerider about machines and settings, etc...so that we can get a more complete picture of your situation.
The more complete picture we have...the better chance of coming up with something to maybe help or something to try.

I suppose we probably should also verify that those flagged OAs are real and not SWJ.
If I tell you to zip/compress the SD card contents.....would you know how to do that?

Supine sleeping element....sometimes when we are on our backs the airway just collapses more and it's harder to hold open thus the need for more pressure.
It's not always the culprit for situations like yours but we need to rule it out or in.
That's why the suggestion to build a wall that won't move to force you on your side all night so we can see what the machine wants to do if it back sleeping isn't involved. It's easier said than done...staying off one's back.
You can build a wall and the wall moves during the night...been there and done that myself.

I also want to rule in or out the possibility of the nasal congestion being much of a factor...hence all the nosy questions about the congestion and how bad it is and what are you doing about it.
At this point...in all honesty...grasping for straws in hopes of figuring out what changed and what we can do about it short of a different machine that can go above 20 cm.
I may have to RISE but I refuse to SHINE.

User avatar
Ron AKA
Posts: 133
Joined: Mon Apr 02, 2018 10:36 pm
Location: Canada

Re: AHI jumping to scary levels with new machine.

Post by Ron AKA » Fri Apr 13, 2018 7:59 am

Pugsy wrote:
Thu Apr 12, 2018 7:53 pm
It's not feeding the leaks. These machines don't feed leaks...
If the machine does not feed the leaks where does the leakage air come from?

User avatar
Pugsy
Posts: 43989
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: AHI jumping to scary levels with new machine.

Post by Pugsy » Fri Apr 13, 2018 8:09 am

Ron AKA wrote:
Fri Apr 13, 2018 7:59 am
If the machine does not feed the leaks where does the leakage air come from?
Mask vent rate...intentional leak...it's needed so we don't kill ourselves with the carbon dioxide thing.
The use of the mask itself requires it. It's just the way it is...more pressure equals more vent rate..all masks and all machines.
It's a factor even with your ResMed machine...you just don't see it being reported because of how ResMed reports leaks.
ResMed is the only brand that only reports excess leaks.
Take a look at the mask paper work and the graphs for intentional leak....see it go up as the pressure goes up.

You can call it "feeding the leak" if you wish but that's not the most accurate term and it's misleading.
Most of us think of "feeding the leak" as increasing the excess leak with more air flow to try to fix a leak that is above the intentional vent rate and these new machines don't do that.
Years ago it did happen...the machine would increase the pressure in an effort to get the pressure more stable and where it was supposed to be but the end result was more pressure...more excess leak...more pressure...even more excess leak...that's feeding the leak that most of us think about when we hear that term. These newer machines don't do that. They reduce the pressure when there's too much excess leak in hopes of backing up and regrouping and letting the mask seal. Then they try going back up if the situation with the airway seems to need it.
I may have to RISE but I refuse to SHINE.

User avatar
Ron AKA
Posts: 133
Joined: Mon Apr 02, 2018 10:36 pm
Location: Canada

Re: AHI jumping to scary levels with new machine.

Post by Ron AKA » Fri Apr 13, 2018 9:01 am

I raise the issue because I have anecdotally seen an association between leaks (not major one) and a high frequency of flagged events. Yesterday for example I tried my best to make a Mirage Quattro work for me without leaking. Used it for 35 minutes, and got leak after leak, although the A10 did not report any major leakage. It gave me an AHI score of 26 for the period. Pressure ratcheted up way higher than it normally does. See the screen capture below. The nap in on the far left of course. The overnight sleep is on the right using my normal AirFit P10. They are totally different. From a distance that afternoon nap graph looks a lot like the OP's graph later in the night. My conclusion at least with the ResMed is that leaks do affect flagging and of course flagging OA's drives pressure up. If you keep driving pressure up sooner or later you max out the machine. That said, some expanded detail is needed to see what is going on when all the events are occurring.
screenshot-20180413-085201.png
screenshot-20180413-085201.png (128.74 KiB) Viewed 103 times

prodigyplace
Posts: 385
Joined: Mon Mar 27, 2017 5:45 pm
Location: Central Virginia

Re: AHI jumping to scary levels with new machine.

Post by prodigyplace » Fri Apr 13, 2018 10:55 am

Why are you using pillows with the machine set to full face mask?

That will throw your leak flags off for sure!

_________________
Machine: AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: ClimateLineAir Heated Tube & Sleepyhead software

User avatar
palerider
Posts: 18552
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).
Contact:

Re: AHI jumping to scary levels with new machine.

Post by palerider » Fri Apr 13, 2018 11:14 am

Ron AKA wrote:
Fri Apr 13, 2018 7:59 am
Pugsy wrote:
Thu Apr 12, 2018 7:53 pm
It's not feeding the leaks. These machines don't feed leaks...
If the machine does not feed the leaks where does the leakage air come from?
Making up phrases doesn't further effective communication.

_________________
Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto

User avatar
palerider
Posts: 18552
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).
Contact:

Re: AHI jumping to scary levels with new machine.

Post by palerider » Fri Apr 13, 2018 11:17 am

Ron AKA wrote:
Fri Apr 13, 2018 9:01 am
I raise the issue because I have anecdotally seen an association between leaks (not major one) and a high frequency of flagged events. Yesterday for example I tried my best to make a Mirage Quattro work for me without leaking. Used it for 35 minutes, and got leak after leak, although the A10 did not report any major leakage. It gave me an AHI score of 26 for the period. Pressure ratcheted up way higher than it normally does. See the screen capture below. The nap in on the far left of course. The overnight sleep is on the right using my normal AirFit P10. They are totally different. From a distance that afternoon nap graph looks a lot like the OP's graph later in the night. My conclusion at least with the ResMed is that leaks do affect flagging and of course flagging OA's drives pressure up. If you keep driving pressure up sooner or later you max out the machine. That said, some expanded detail is needed to see what is going on when all the events are occurring.
Classic failure to understand cause and effect.

Also, " How is this post helpful to the original posters questions?"

Though, once again, a perfect example of why Ron shouldn't be offering suggestions, when he is failing at his own therapy.

_________________
Machine: S9 VPAP™ Auto BiLevel Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Vpap Auto

User avatar
Ron AKA
Posts: 133
Joined: Mon Apr 02, 2018 10:36 pm
Location: Canada

Re: AHI jumping to scary levels with new machine.

Post by Ron AKA » Fri Apr 13, 2018 11:20 am

prodigyplace wrote:
Fri Apr 13, 2018 10:55 am
Why are you using pillows with the machine set to full face mask?
That will throw your leak flags off for sure!
One of the quirks of SleepyHead. That screenshot was with all four sessions for the day switched to on (little black green bars in bottom left beside each session). Only the first session used the full face. With them all turned on, SleepyHead seems to report the machine settings for the first session. If I turn the first session off (switch red) then the machine settings change to pillows. For sure I had them set right. The programmer can only select one set of conditions to display, and obviously chose the first session that is turned on. It is actually quite a nice feature of SleepyHead.

User avatar
Pugsy
Posts: 43989
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: AHI jumping to scary levels with new machine.

Post by Pugsy » Fri Apr 13, 2018 11:35 am

Ron AKA wrote:
Fri Apr 13, 2018 9:01 am
My conclusion at least with the ResMed is that leaks do affect flagging and of course flagging OA's drives pressure up. If you keep driving pressure up sooner or later you max out the machine.
And I don't agree with your conclusion and I don't know anyone else who would.
But you won't listen to me so I won't bother trying to explain why.

And please ...let's try to limit interjecting our own reports in threads like this one (meaning don't do it again) which should be devoted to the OPs problems or questions.
I see why you did it but it just makes thing more difficult and really doesn't help the OP.
Even if he used the same machine at the same settings with the same mask and if you were correct in your assumptions...it's irrelevant because no 2 people can expect same results.
And in this situation...all the parameters are totally different...different machine, different pressures..etc.
I may have to RISE but I refuse to SHINE.