is it normal to have more AHI during asthma exacerbation

Hi everyone
My name is Izzati. I am from Malaysia
This is my first post here. English is not my first language , sorry if my language is bad
I've had sleep apnea since dec 2013 on AUTO cpap
also have bronchial asthma since childhood that worsen after chronic pulmonary embolism in 2010
i weigh 56kg height 155 cm

two months ago , ive been hospitalized 3 times in 5 weeks for asthma exacerbation.and was unwell since then
my ahi prev is good (2-3) on this apap
but since 2 months ago it has increase to most 36ahi
for example
yesterday i sleep with ahi of 7.36 . sleep for 6 hours
cheyne stokes respirations 2 events
clear airway 3 events
flow limitation 2 events
hypoapnea 12 events
obstructive 30 events
pressure pulse 36 events
RERA 6 events
VS@ 18 events
vs 6 events
my pressure is currently 8.5 - 17

my question is : is there anything i can do with the settings? should i go and use the fixed pressure or should i just maintained the apap settings
is it normal to have more events when you are unwell with asthma?
i still have 3 weeks more to wait for my respiratory physician appoinment.

It's good that you have an appointment with your resp. doctor as he or she knows your full history and can include it in helping you for the future.

I think it's important to get your asthma medication sorted out and stabilized, so you can know where you stand with it, and then see how Cpap fits in.

Hopefully once that's better, your apnea/AHI experience will be better as well. It's difficult to advise from here because we don't know all about your medications and are not doctors in any case. Please let us know how things go after you see the doctor and maybe someone will have some suggestions.

Weight is not important - many people who are not overweight have OSA due to anatomical features rather than weight. And I would be careful about comparing your OSA and results to others because even if they have asthma, your test results, med. history, medication and experience on Cpap are going to be different.

izzati wrote:my question is : is there anything i can do with the settings? should i go and use the fixed pressure or should i just maintained the apap settings

You can use Sleepyhead software, and forum members will help with setting adjustments, if needed. See https://sleep.tnet.com/resources/sleepyhead

hi everyone


I had an appointment with my respi dr 3 days ago
and informed him about my cpap trouble and constant sleepiness with high ahi

He has got no answer yet as my asthma currently was really bad
My fev1 is 0.84L only ( about 30% predicted), it was 2.56 L in 2014,
and he wants me to be on the expensive Xolair

this sunday on 27th i will be admitted for a week in the ward to settle a lot of things'
my asthma and the sleep apnea
they want to do daily spirometry and chest physio and look at my machine

any one here has been on Xolair ?
does it work?
Does it help the sleep apnea as well?

Do you think Xolair (asthma med) helps your OSA?

Certainly if you're going to be investigated in the hospital, there is very little we could possibly add from here, but would be interested to hear results of your testing. Were you ever diagnosed with COPD (chronic pulmonary problems, likely related to smoking)?

I do think though, that if you're having problems with asthma (any cardiac issues?) your Apap reports could look different than usual.

Asthma, generally speaking, is airway restriction due to inflammation and mucus buildup. The inflammation can occur anywhere along the airway. It prevents proper function of the lungs, often reducing oxygen.

Sleep apnea is a generalized term that includes several possible breathing disorders during sleep.

For obstructive events, asthma may make those more common or frequent, the inflammation caused by the asthma may reduce the airways that may be collapsing during the obstructive event.

For central, cheyne stokes, and other disordered breathing events, there is some evidence that suggests a complex interplay between blood oxygen and carbon dioxide levels and these events. Asthma can compromise your ability to exchange oxygen in your lungs (inflammation and mucus buildup inside the lung airways), which would change how your brain and body responds to these levels while sleeping.

So the answer is that asthma may affect your sleep apnea (and vice versa, I believe), but there are a variety of asthma responses, and a variety of sleep apnea types, and each person is different anyway, so there's no easy answer as to whether you are experiencing greater AHI due to the asthma or not. You'll have to be treated for the asthma, get it under control, and then see how your sleep apnea responds.

I also suggest you take control of your sleep apnea. If you are experiencing complex sleep apnea, you might want to push for a machine that is more than a simple cpap or apap. Then, using a program like sleepyhead, monitor your actual data and adjust your machine to maximize the therapy. While I'd suggest the asthma is of greater concern (since it affects breathing all day, while apnea is just while sleeping), there's no reason to not try and bring both under control at the same time, rather than hitting one at a time.

Once the asthma is under control you'll probably want to watch your sleep apnea data again and make adjustments. Going through this process should give you an idea of how interrelated these two conditions are, and then the next time you start having asthma problems you can be proactive about it with your apnea therapy as well.

They are now finding out that asthma can be caused by GERD and LPR (2 types of acid reflux). Since I have been using CPAP, I no longer experience severe respiratory problems in my sleep. My doctors thought that the acid reflux reflux I experienced only at night should be treated on it's own. I did not agree. I read a book by Dr. Steven Park that explained how sleep disordered breathing can cause acid reflux during REM sleep, that in turn can cause bad respiratory symptoms like asthma. I ignored most of what my doctors were saying. I actually took some of their GERD medicine for a very short time that did not work. Dr. Park recommended CPAP therapy for these problems. As an aside a Dr. Johnathan Wright wrote a book called "Why Stomach Acid Is Good For You" that explained why the medicines on the market for GERD are dangerous. So I got a doctor to let me try CPAP and so far it has worked for my asthma and allergy symptoms as well as my acid reflex.

I have nothing but contempt for a lot of doctors - the arrogant ones who think they know everything. 3 years ago I had surgery for Hyperparathyroidism. This is another condition that can cause bad subtle symptoms in a patient. I did research and discovered that 3 doctors (including my own husband) did not know how to correctly read my blood tests for this condition. So I ignored my doctors and contacted an Endocrinologist in Tampa named Dr. Jim Norman. I sent him my labs, he agreed that my doctors were wrong and I traveled to Tampa for surgery. It was confirmed that I did in fact did have Hyperparathyroidism. This is another condition that can be misdiagnosed as Fybromyalgia, which is what my doctors thought I had. After the surgery, my Fibromyalgia symptoms went away.

PEF... it's always good to read a success story, whether it be related to sleep apnea or other issues. Amazing you had to travel to Tampa to have this surgery, but once again being an advocate for your own health is what seemed to work for you. Very happy to know you no longer have Gerd or Fybro symptoms. Tell your husband to get with the program!

izzati wrote:this sunday on 27th i will be admitted for a week in the ward to settle a lot of things'
my asthma and the sleep apnea
they want to do daily spirometry and chest physio and look at my machine

Hi Izzati-- hopefully a short stay in the hospital will answer most of your questions. Good luck to you and let us know how it goes.

Thanks, Lucyhere - yes I am very pleased with my CPAP success.

I have severe asthma. I haven't noticed changed in my AHI during flares, but I'm on Auto BiPAP now with a wide open range, and my typical settings are much higher than my titrated pressure, so I think I'd have to be very constricted to actually start having break through apneas through these settings. My AHI is typically 0, and always below 2. I definitely tolerate Auto BiPAP better than APAP.

I used to be on Xolair. I had an anaphylactic episode with the second dose, requiring epinephrine. I wasn't on it long enough to see if it made a difference. Anaphylaxis is a known risk with it. I was told I had to carry an epipen when I was on it. If you weren't told this- be sure to ask about it.

There have been a lot of secondary things I've had to address to get my allergies under control. Allergies have been a big issue for me. If Malaysia is anything like here, it's allergen season, and I wonder if that's causing your increased symptoms? I take Allegra, Singulair, Patanol eye drops, Azelastine nasal spray, and Qnasl for allergies. Obviously if they're recommending Xolair, you have an allergy component. I also tried allergy shots for awhile, but that made things worse.

I can't have any Aspirin or NSAID products without major flares.

And, as previously mentioned, GERD can be an issue. I notice a HUGE difference in my asthma control when I take Prevacid twice a day.

Ultimately, I ended up having Bronchial Thermoplasty. My flares overall have been milder and have come with more warning since then. I need systemic steroids less often. It was a hard thing to go through, but I'm glad I did it.

What meds are you on now? I hope you get some answers, soon!

I was told that during an asthma exacerbation, using my rescue inhaler before bed would help with the CPAP because the airways would be more open and relaxed. I haven't had to do this in many years since the CPAP really calms down my asthma at night, but I do recall it helping in those early days.

Don't do this without checking with your doctor, first.

Hope you get it all sorted out soon. You'll be lucky if you are in a hospital setting where the staff taking care of you actually know anything about the CPAP machine.