AHI 131 !! - Help me understand my SleepStudy & CPAP results

Hello everyone, I’m Kenwood and I’m very new to the CPAP world. I’ve been on my BiPAP for a week now. I’ve had snoring issues for a long time now. I’ve woken up with headaches and migraines. I nod off watching TV with the family at night. I’ve fought sleepiness while driving and at work. The wifey has complained that I stop breathing all night long. The snoring has gotten so bad; one of us always has to sleep on the couch. I just got tired of sleeping ALONE. So I went to have a Sleep Study for my wife, as I missed sleeping with her. I was shocked with the results when my doctor said she has never seen AHI numbers that high before. My AHI was very severe at 131.1 with oxygen saturations less than 90% for 44% of the sleep time. Even more disturbing was that I never got into REM sleep (Zero R3/R4)!!! No wonder I’m a zombie.

I’ve been reading this forum trying to understand and educate myself. I’m using a PR System One 650 BiPAP pro with Humidifier and a PR ComfortBlue full face mask. My pressure settings are 18/13 and humidity at 3. I’ve had sinus issues what seem like forever with two sinus surgeries back in 2003. One nostril mostly works and I’m a mouth breather at night, so that’s why the FF mask. Before using my CPAP, I was thinking that it was time for another sinus surgery, but I’ve noticed a major change in my sinus – with both being open most of the time. I’ve been able to breath using my nose every night using CPAP. Why? I have been having issues with massive leakage with my mask. Wakes me up a times trying to fix it. I think my mouth is open sometimes as I wake up with dry mouth/tongue.

I have noticed a major difference since I started using CPAP. Every morning, I feel awake and my sinuses are open. It feels like a “fog” has been lifted (does that make sense?) The wifey has returned to the bedroom and says she doesn’t hear any snoring. But looking at my SleepyHead numbers, it looks like I am snoring.

Can the forum members help me understand my Sleep Study and CPAP SleepyHead results? (Pugsy?)
Thoughts and comments would be appreciated?

SLEEP STUDY RESULTS

NO BiPAP



WITH BiPAP







Here is last night’s SleepHead results





LAST WEEK’S RESULTS

Welcome! You're off to an EXCELLENT start!

The snoring that your machine can detect is quite minimal as compared to what your wife can detect. The machine is detecting what can best be described as lower level snorting that occurs as the airway tissues begin to collapse. The noise your wife used to hear was full-on collapse, and probably very scary gasps. She probably lost as much sleep as you did!

The machine takes that information and, combined with other information, might choose to increase the pressure gradually (assuming it's an auto-bipap) to prevent apnea events before they occur. Otherwise (if it isn't auto) the information is there so that when you DON'T feel good and look at it, you can make decisions on how to improve the situation.

Feeling good in the morning and like a fog has been lifted is what many (most?) xPAP patients experience, but not usually as quickly as you have. You're quite fortunate in that regard!

khauser wrote:The machine takes that information and, combined with other information, might choose to increase the pressure gradually (assuming it's an auto-bipap) to prevent apnea events before they occur. Otherwise (if it isn't auto) the information is there so that when you DON'T feel good and look at it, you can make decisions on how to improve the situation.

On my BiPAP machine, I just press "Therapy".....should I press "BiPap" option each night as my SleepyHead "Pressure" charts are straight lines across the board? I stopped using the Ramp feature several nights ago.

Thanks for the warm welcome!

Welcome to the forum. AHI of 131 is indeed scary but the great news is your machine is doing a great job.
No REM...that's fairly common with AHI like that. You had so many apnea events that you likely would have an awakening with the events and never could get into REM sleep. I had that happen to me only REM is where my OSA is worse and every time I would go into REM stage it would only take a couple of minutes and I would wake up so then we get to start the sleep cycle progress all over again.

The PR S1 BiPap Pro model 650 is a fixed bilevel pressure machine. It won't auto adjust the pressures for you. If you did have an auto adjust feature it would likely respond to those snores.
While the snores look ugly on the report they don't seem to be growing up to be full blown apnea events since your AHI is quite acceptable.

If you normally sleep on your back then supine sleeping could be a contributing factor to the snores. You might try staying on your side if you can and if you are sleeping on your back.

You may need just a little more EPAP pressure if you want to reduce those snores and changing sleeping position doesn't do the trick. I doubt that you would need much. Probably 0.5 increase in EPAP.
Something to talk over with your doctor if this persists.
If your wife isn't hearing them then they are likely very low level snores and if you are sleeping well, feeling decent there is no urgent need to do anything with them but people tend to want to "clean up" their reports in an effort to get the best results they can. It's human nature.

One thing I will ask because I had it happen to me. You don't happen to have a pet that sleeps with you that snores do you?
I had some really ugly snore reports like yours that would pop up some nights and have no snores other nights. Couldn't figure out what was going on until one night I realized the machine was hearing my little Pug dog snore when he was up on the pillow with his chin resting on my shoulder. So now I always ask because I know the machine can pick up other noise beside what we produce.

Ignore the clear airway events and the green PB time for right now. It can take several weeks for things to stabilize.
If this were my report the only thing I would think about doing anything for would be the snores if I saw them on every report and I couldn't make them go away with side sleeping (it isn't always so easy to stay on your side) and I would just think about increasing that 13 EPAP to 13.5. I don't think you will need much pressure to reduce the snores to a not so quite an ugly report.

You are new to this therapy and a lot of people are comfortable with making adjustments like this but don't do it just because I suggest it if you aren't comfortable doing it. By all means talk to your doctor about it.

Oh....one other thing...your leak line number on that leak graph to avoid is 80 L/min. That would be the top number on the leak line. Large leak territory on your machine starts around 85 to 90 L/min. Above 100 L/min the machine can't even record events accurately. So work on the leaks....that's a never ending battle.

Thanks Pugsy!!!!!

Pugsy wrote: If you normally sleep on your back then supine sleeping could be a contributing factor to the snores. You might try staying on your side if you can and if you are sleeping on your back.

I can't sleep on my back, never could. I'm mostly a stomach sleeper, but I can't do that with this damn mask, so I sleep on my left side now.

Pugsy wrote:One thing I will ask because I had it happen to me. You don't happen to have a pet that sleeps with you that snores do you?

No pets....but the wifey snores!

Kenwood wrote:No pets....but the wifey snores!

It's possible the machine is picking up on her snores...can't say impossible because I know first hand the machine can be fooled.
It depends on how close she is to you and your machine.
Might try one more night with someone sleeping on the couch and I hate to say it...it should be her. If you were to sleep on the couch you may not get good relaxed sleep and so might not even have the snores so you might get a false negative result and think it was her.

Have you looked at the cpap pillows with cut outs on the side edges so we can be on our side or our stomach and the mask rests in the hole so it doesn't get pillow pressure on it which of course messes with the mask seal.

Also...don't be afraid to try a different mask in an effort to find one that will allow you to sleep in the position that you prefer.

Pugsy wrote:

Kenwood wrote:No pets....but the wifey snores!

It's possible the machine is picking up on her snores...can't say impossible because I know first hand the machine can be fooled.
It depends on how close she is to you and your machine.

Might try one more night with someone sleeping on the couch and I hate to say it...it should be her. If you were to sleep on the couch you may not get good relaxed sleep and so might not even have the snores so you might get a false negative result and think it was her.

We have a king size bed and we each sleep close to the opposite edge with my machine on my night stand

I went back and looked at each day from the past week and I DO show snoring right before my alarm goes off....and the wifey was already up before me.

Okay, wife is eliminated as possible snoring source so you know who is left.

you've already learned the critical factor in sleep apnea - "PUGSY"

Here are come more results.....good and bad nights

BAD Night



GOOD night

Kenwood wrote:I have noticed a major difference since I started using CPAP. Every morning, I feel awake and my sinuses are open.

Hi,

I had exactly the same thing happen to me. I was plugged up every morning for years. It would take hours for my sinuses to open up. Once I started on CPAP, my sinuses would be clear most of the time. Once I changed to a nasal pillow mask, all of my sinus issues disappeared.

I have two theories on this. First off, I have a lot of dust and dander allergies. I was sleeping with my nose in my pillow, which I rarely every changed out or washed. On CPAP, my air comes from the machine, which has a filter, and not from my pillow. Second, the airflow when running these high pressures, especially with a nasal pillow mask, tends to keep me clear. I suspect that the cleaner air is the bigger factor, and the airflow with the machine humidity is icing on the cake.

Even if CPAP didn't help me sleep, the sinus effect alone would make it worth using. It is amazing how much better life is with clear sinuses.

-john-

Pugsy wrote:

Kenwood wrote:No pets....but the wifey snores!

It's possible the machine is picking up on her snores...can't say impossible because I know first hand the machine can be fooled.
It depends on how close she is to you and your machine.

Might try one more night with someone sleeping on the couch and I hate to say it...it should be her. If you were to sleep on the couch you may not get good relaxed sleep and so might not even have the snores so you might get a false negative result and think it was her.

The wifey has MASSIVE coughing fits where she can cough for over a minute, sometimes coughing all the air outta her lungs and can't breath in- cause her body is still trying to cough. Once she gets a cold - it's six weeks of it. She's gone to the Dr for it, but....thats a long story.

So last nite, she had really bad coughing fits and tried sleeping in bed with me from 4pm to 4:30pm before she went back downstairs to sleep on couch. So those snoring stats are MINE as I was alone in bed. Not to mention, I had some bad stats from 5:20am to 7am and then again from 8am to 8:30am?? WTF

Kenwood wrote: had some bad stats from 5:20am to 7am

My first suspect would be REM stage sleep at that time frame. You probably need more EPAP pressure to prevent those events.
This is where it would be nice if your machine was the auto adjusting model. It would have increased the pressure in an attempt to prevent the unwanted events that likely need more pressure. I am the poster child for REM events sometimes needing more pressure. We typically have more REM stage sleep in the wee hours of the morning and it lasts longer so often reports are the ugliest in the wee hours of the morning.

See this link and the hypogram down just a little bit below the sleeping kid on the right side to see the normal stages of sleep and how we have more REM in the wee hours
http://en.wikipedia.org/wiki/Sleep

Kenwood wrote:then again from 8am to 8:30am??

This one might have been REM and REM was interrupted but it also might have been where you were sort of semi awake.
This happens fairly often. The machine mistakes awake/semi awake breathing irregularities for some sort of apnea event.
It doesn't know if you are asleep or not so it can be fooled. Normally when I see this type of ugly stuff right before I get up I chalk it up to semi awake clutter and just shrug my shoulders unless I know for sure I was awake...then I know for sure.
We don't always remember every little awakening.

I still think that more EPAP is going to be needed. In your situation having the Auto version of your BiPap would have maybe been nice.
I will look back at my old reports to see if I can spot a good example of my sometimes needed higher pressures and how my BiPap auto responds.

I found this BiPap report showing a sort of increase needed in IPAP and EPAP
It isn't as remarkable as some of my others.

Pugsy wrote:I still think that more EPAP is going to be needed. In your situation having the Auto version of your BiPap would have maybe been nice. I will look back at my old reports to see if I can spot a good example of my sometimes needed higher pressures and how my BiPap auto responds.

First off....THANK YOU SO MUCH for following my thread

I see looking at your info/graph, you have the System One 750P BiPAP AUTO with Bi-Flex. Who would I talk to (ie bring my SD card) to to review my stats to see if they could get me a different machine (if they think warranted): Sleepy Study place, My Family Doc, or DME company As I'm only 8 days into this and within that 30 day grace window.