AHI consistently high after starting to use nasal pillow

[deadEternally]

My sleep study had shown a mild AHI of 11.0. I started with full face mask and the AHI shown was 1 to 3 generally. I switched to nasal pillow because there would be unfixable leak of air hitting the eye in the middle of the night every night. Ever since I started using the nasal pillow I could not sense any air leakage but the AHI is always very high, 9 to 11. I just looked at last night's SleepyHead data which I have also uploaded here http://s289.photobucket.com/user/spider ... sort=3&o=0 The leak rate is 5 at 95% which is minimal but my AHI is shown as 9.77. Clear airway 4.19, Obstructive 2.02, Hypopnea 3.57, RERA 0.00. The min pressure setting I use is 8. Why would this happen? The machine is brand new, so machine fault is not to blame. Any thoughts are much appreciated.

With the nasal pillow when I wake up in the middle of the night (which is every night and is not due to CPAP) I would notice it would be making air gushing noise (with still no perceivable leak) which wasn't there when I went to bed, I assumed it was because of the pillow getting moistened due to contact with the skin, so yesterday I switched to the smaller size pillow and this one didn't even make the air gushing noise when I woke up in the middle. And yet the AHI is shown so high.

[OkyDoky]

What make and model of machine are you using? Do you have a screen shot of when you were using the FF mask? On your sleep study what was the AHI categories that made up your 11 total?

[Pugsy]

On your image you have included the pie chart and the calendar and omitted the AHI bar graphs.
Your image didn't stay on photobucket long...really quickly I get an ad that I can't get out of.
I use imgur for my images...photobucket used to be a great place but now it's overwhelmed by ads.

How to use imgur to organize your graphs
https://sleep.tnet.com/resources/sleepyhead/shorganize
How to use imgur for hosting images
https://sleep.tnet.com/reference/tips/imgur

Examples of the format that we like to see
viewtopic/t103468/Need-help-with-screen-shots.html
Try to embed the image instead of using a link...my internet doesn't do those links very well.
See above thread for what I mean about embedding.

About your AHI...it looks like roughly 1/2 of it is Clear Airway....are you spending much time awake during the night with the mask/machine on?
Do you take any medications of any kind? If so what?

[Pugsy]

I suspect you need a little more minimum pressure.
We need to try to figure out if those CAs/centrals are real or sleep/wake/junk though.
Any history of centrals on your sleep studies??

[deadEternally]

What make and model of machine are you using? Do you have a screen shot of when you were using the FF mask? On your sleep study what was the AHI categories that made up your 11 total?

Philips Respironics REM star auto A-flex. I don't have the screenshot for when I was using the FF/nasal mask because I was renting the machine at the time and I only got a summary report in the end. If it will help I can wear the nasal mask tonight and post the data tomorrow. On my sleep study:
Apneas, Total 5 Index 0.8
Hypopneas, Total 64 Index 10.8
Apnea + Hypopnea Total 69 AHI: 11.7
RERAs, Total 22 Index 3.7

[OkyDoky]

You said you wake up in the middle of the night. Do you feel you are sleeping well the rest of the night or is the nasal pillows mask new and you are still fiddling with it at night, due to movement, leaks, etc.?
You didn't have any centrals on your study and I suspect these are S/W/J but it is something that needs to be monitored over time for changes.

[deadEternally]

Try to embed the image instead of using a link...my internet doesn't do those links very well.
See above thread for what I mean about embedding.

About your AHI...it looks like roughly 1/2 of it is Clear Airway....are you spending much time awake during the night with the mask/machine on?
Do you take any medications of any kind? If so what?

Embedding doesn't seen to work. This is the image link: http://imgur.com/ECzkY3X

Only today I encounter the term Clear Airway. I don't have sleep onset insomnia but I have maintenance insomnia, I always wake up 2 to 3 hours after falling asleep, and then a few more times at regular intervals. I don't usually have a problem falling back asleep although I believe my sleep architecture might be impaired and not sufficient deep sleep let to occur other than before the first awakening. Last night I hit bed around 12:10 am, fell asleep soon, then woke up around 3:30 am, fell back asleep, then woke up again at 5:30 am, then fell back asleep, then woke up with alarm at 6:45 am.
To help with maintenance insomnia I take Doxepin 10 mg 2 hours before bed although it doesn't help much. My sleep performance is roughly the same with or without this medication but I continue to take it only hoping that chronic intake might normalize the HPA axis.

You said you wake up in the middle of the night. Do you feel you are sleeping well the rest of the night or is the nasal pillows mask new and you are still fiddling with it at night, due to movement, leaks, etc.?
You didn't have any centrals on your study and I suspect these are S/W/J but it is something that needs to be monitored over time for changes.

I have been waking up in the middle of the night since many years, since long before I started using CPAP. I always feel fatigued because of the multiple awakenings, see more details above in my reply to Pugsy. The nasal pillows are a baby and are not the cause of my awakenings. In my sleep study, only OSA was seen, not Central or mixed.

I suspect you need a little more minimum pressure.
We need to try to figure out if those CAs/centrals are real or sleep/wake/junk though.
Any history of centrals on your sleep studies??

I have previously tried with even higher pressure, upto 10.5, but even then the AHI was quite high, so I stopped setting the min pressure that high wondering if the high pressure was triggering a Central apnea.

[Pugsy]

I have previously tried with even higher pressure, upto 10.5, but even then the AHI was quite high, so I stopped setting the min pressure that high wondering if the high pressure was triggering a Central apnea.

Then you probably need to be having a chat with your doctor.
It's very possible that the bulk of your AHI is nothing more than awake/semi awake breathing irregularities getting flagged.
These machines don't know if you are awake or not...they can't measure sleep. They just measure air flow and our awake/semi awake breathing is often very irregular and the machine mistakes the irregularity for an apnea event of some sort.

Unfortunately it is a bit difficult to ascertain asleep breathing from awake/semi awake breathing on the data that the machines gather.
Some people are good at zooming in on the breath by breath air flow and can get it figured out for the most part.
It would require your learning about what each breath means and how to spot it and how to zoom in on the breaths.
Sometimes awake breathing is easy to spot...sometimes it isn't.

Did you have an in lab sleep study where cpap was used or were you just given the apap machine after the diagnostic sleep study?
I doubt that you are seeing pressure triggered centrals...and BTW it doesn't have to be a high pressure...it can happen with as little as 4 or 5.
Usually if a person is going to have central apneas brought on by cpap pressure it will show up during the titration sleep study.

We have a few threads where sleep/wake/junk examples are shown and some fairly recent. I don't have the time to go hunting them down right now but forum members Robysue and Jay Aitchsee have had some discussion about SWJ. You might do a forum search for their posts and see if you can find those threads or maybe someone has a link handy for them.

If the bulk of your AHI is indeed SWJ...it doesn't count and doesn't matter except that it points to poor sleep quality which is of course unwanted but the AHI during SWJ...isn't sleep apnea AHI and thus we ignore it.

[deadEternally]

Unfortunately it is a bit difficult to ascertain asleep breathing from awake/semi awake breathing on the data that the machines gather.
Some people are good at zooming in on the breath by breath air flow and can get it figured out for the most part.
It would require your learning about what each breath means and how to spot it and how to zoom in on the breaths.
Sometimes awake breathing is easy to spot...sometimes it isn't.

Did you have an in lab sleep study where cpap was used or were you just given the apap machine after the diagnostic sleep study?
I doubt that you are seeing pressure triggered centrals...and BTW it doesn't have to be a high pressure...it can happen with as little as 4 or 5.
Usually if a person is going to have central apneas brought on by cpap pressure it will show up during the titration sleep study.

I know what time it was each time I woke up during sleep but the sleep graphs show events occurring even during the times I knew was asleep. CPAP was not used during my sleep study. Like you I too care only about the sleep quality in the end.

[Pugsy]

You still need to try to figure out if that stuff is SWJ or not.
Just because you don't remember awakening doesn't mean an arousal didn't happen. We do it all the time...have a little "mini arousal" where we wake up and go back to sleep and don't remember it. Just because we don't remember waking up...doesn't always mean we didn't wake up.

I don't have the time to look at your flow rate in close enough detail to offer an opinion and I admit that I am probably not the best at looking at that stuff under the microscope unless the difference is blatant and so obvious a blind person could see it. It would involve my getting a copy of your entire SD card and running the software and doing a lot of microscopic looking and I just don't have the time right now. Maybe someone else here who is good at this sort of stuff could find the time....

I found this
viewtopic.php?f=1&t=113409&p=1095199&hi ... k#p1095199
where there are some decent examples shown.
See if it helps you decide if you were for sure asleep or not.

[deadEternally]

Yesterday I raised the min pressure to 12 and the AHI went upward with it to 10.7. This always happens with me.

[OkyDoky]

Yesterday I raised the min pressure to 12 and the AHI went upward with it to 10.7. This always happens with me.

You went from 9 to 12 minimum? That's a pretty big jump. If the increase in the AHI was in the Clear Airway category, I would talk to your doctor. Especially since they did not use CPAP in lab to titrate. Increased pressure will not help CA's and may make them worse.

[deadEternally]

Yesterday I raised the min pressure to 12 and the AHI went upward with it to 10.7. This always happens with me.

You went from 9 to 12 minimum? That's a pretty big jump. If the increase in the AHI was in the Clear Airway category, I would talk to your doctor. Especially since they did not use CPAP in lab to titrate. Increased pressure will not help CA's and may make them worse.

Both Clear Airway and Obstructive events increased. What can a doctor do? These contradictions must be as confusing to them as they are to us.

[OkyDoky]

Yesterday I raised the min pressure to 12 and the AHI went upward with it to 10.7. This always happens with me.

You went from 9 to 12 minimum? That's a pretty big jump. If the increase in the AHI was in the Clear Airway category, I would talk to your doctor. Especially since they did not use CPAP in lab to titrate. Increased pressure will not help CA's and may make them worse.

Both Clear Airway and Obstructive events increased. What can a doctor do? These contradictions must be as confusing to them as they are to us.

With an in lab titration, a sleep doctor can see if they are pressure induced centrals and if a different type of machine is needed to treat the centrals.
If you believe they are totally due to the difference between the mask types go back to your full face mask. Cut out a liner from an old tee shirt and see if that helps with your leaks. Then monitor your data to see if you are getting therapy without large leaks and what events you have.

[Pugsy]

To be able to fix a problem a person has to know exactly what the problem is in the first place.
Any other way and we are just making WAGs (wild ass guesses).
No one ever said that figuring out exactly what the problem is would be easy.
If those events aren't sleep apnea events but instead they are SWJ events...it's not a pressure issue..it's a sleep issue.
The fact that they don't respond in a logical manner...like OAs reduce with more pressure make one wonder if they are real or not.

If higher pressures seem to cause more problems...and someone just has to try some sort of WAG...back up and start all over with lower pressures and see what happens.