Newbie a bit freaked about AHI

[Beechyboy]

Firstly, Hi everyone! I'm new to most of this but have found a lot of info here already so thanks to you all for that.

So, I've been on CPAP for just over a month now. I'm well over weight and according to the initial test done I was having up to 80 apneas an hour! Was quite shocked at that.
So I've been given a Philips Respatronics dreamstation and I'm using a full face mask. Generally I'm a mouth breather, my dentist says it's due to my jaw, had an accident as a kid so now it sits slightly open but I've found I can force myself to nose breathe when wearing the mask.
So for the month or more that I've used it, on the whole I feel so much better, I'm alert and not getting dopey in work .I'm an IT Analyst in an internal call centre on evening shifts and it gets quiet for the last hour, I'm not even feeling tired then.
My average 7 day Ahi is 2.2 and 30 day is 3.7. And mask fit is pretty much 100% all the time, worst it's been is 98%.
A vast majority of my results are in this range or lower but on two occasions they have been around 7, at one time 12 and last night it shot up to 19.
I still feel rested, and the 30 day average (as far as I understand)is okay.
Do others here occasionally have the occasional spike? Should I worry?

Also I apologise if my replies are few and far between, busy day ahead but I do appreciate any help!

-edited- said mask leak not fit

[Hopeful50]

And mask leak is pretty much 100% all the time, worst it's been is 98%.

I hope you mean mask SEAL rather than leak?

A vast majority of my results are in this range or lower but on two occasions they have been around 7, at one time 12 and last night it shot up to 19.

Are you talking about your AHI here? If you post some Sleepyhead data the folks here who know more than I do would be able to help you out.

[Beechyboy]

Ah yeah sorry, meant it's seal/fit is 100%. My bad.

And also yup that's my AHI readings on the dream station.

[Hannibal 2]

Welcome to the forum!

Sounds like you're doing brilliantly to me if you've only been on CPAP for a month and achieving these AHI's, well done you! I wouldn't expect too much consistency especially so early in therapy. It could be that you're sleeping on your back more on the nights your AHI is higher. When you get time, post some Sleepyhead data so folk here can see what's going on and make suggestions for you.

[AliClick]

Fellow newbie here, and I agree with the above - it sounds like you're doing great. The average AHI numbers you're seeing are very close to what I'm seeing now (started treatment 3/27/17). I still get the occasional outlier high figure (6-7+, generally not as high as what you're getting occasionally), and can usually attribute that to one or two cocktails too many, or sleeping on my back (often both). I'm starting to get a very good sense of what kind of number I'm going to see when I wake up, which I take as a sign that I'm feeling better rested. The fact that you're definitely feeling more well rested, and are functioning better at work, are the most important part. I'm actually coming along a little slower in that regard, but I feel it's getting there. Rome wasn't built in a day, etc.

Definitely post your sleepyhead results here - doing so helped me make some tweaks that have improved my score/restfulness. Good luck!

[Beechyboy]

Thanks for the feedback guys really appreciate it! I'm still feeling alert hours later, I think I just panicked a bit too much this morning, feeling a bit more reassured now
Sorry I was late getting back to you all, long day in work!
Also didn't know about sleepyhead, but I'll look into that for future reference.

And agree, Definetly need to drop the weight, I've got a bad back and have been battling depression and anxiety (hence me freakinf out about the ahi) for so long now, but with the cpap treatment I am feeling far more positive about the future.

Would also like to say good luck Aliclick! Hope your treatment goes well and great choice in avatar picture.
Take care folks!

[Beechyboy]

Hi all, I'm back.
Didn't want to start a new post only a short while after my first, and its the same issue anyway.

I am still freaking out a bit, the night after I first posted my AHI was up again to 23! It dropped down to 7 on Saturday night, and its gone up to 11 last night.
No idea whats going on.
I generally sleep on my back but the night my AHI was 19 I slept on my side. I have tried using less pillows and adjusting my position so my neck is a bit more stretched out.
Cleaned the filter on the CPAP machine.
I am in the process of getting ready to move from my rented house back to my parents for a while (money/work related), but not exactly feeling stressed out about it.
The nights my AHI were 23 and 7 I was in my parents house. The mattress is currently on the floor (waiting for a new bed) but I was comfortable.

I have also noticed that I do not move in my sleep when using CPAP. I used to wake up in all sorts of pretzel like positions with sheets and pillows everywhere.

Managed to get sleepyhead data, posted below, standard and monthly view (not sure what you need to see).

Any advice greatly appreciated! thank you folks

http://imgur.com/ITmcs6Q
http://imgur.com/cnPDREX
EDIT - adding two more links

Results on a good day
http://imgur.com/vcJ21CI

Worst results
http://imgur.com/bBI1F8V

[Beechyboy]

Should add, only two changed physically but one may be related.

One, I had a beard, now clean shaven, the mask fits fine and I don't notice any leaks when I go to bed. Maybe it's slipping at night? But leak results on the device and iPhone app looked okay.

Two, the important one, I sneezed violently whilst lifting something heavy almost two weeks ago and did something to my side. I was in agony and could not move for two days but my ahi was fine then. I still get a sharp pain in my lower ribs when sneezing/coughing or over stretching my right side. it hasn't bothered me at night except when turning over to my right. I haven't been able to go to the doctors, had so much time off work I feel guilty.
But a few people think I may have cracked the cartilage in my rib, I'm not sure. It isn't tender to touch, just when moving it too much.

And yup this would've been good info earlier, sorry. New to all this.

[ajack]

I don't know but I didn't see that the auto is on
you would want it min 6 max 20 normally, but in your case I would be 15min 20max
I saw you had min 4 max 0 a couple of times.

going by your numbers, I would increase the pressure till the OA were better,,,, read some posts about neck braces and such too

Auto-Trial

The DreamStation Pro features and auto-trial mode which can be used for up to 30 days. During this period, the machine will function as an auto-adjusting machine that will automatically adjust pressure during the night to provide optimum pressure on a breath-by-breath basis. After the auto-trial is complete, the machine will provide the pressure the user was at or below 90 percent of the time. Please Note: This is not an auto-adjusting machine. Once auto-trial is complete, the machine will not adjust pressure during the night.

[Beechyboy]

Hi Ajack, thanks for the advice, will look into the neck braces and the pressure.

Got to be honest I have woken up some mornings feeling like the pressure is much lower than it felt when I put the mask on.

I dont think I can change it at the moment though, the settings on the dreamstation are locked.

I am seeing the specialist a week tomorrow though, so hopefully they can change that for me.

[Beechyboy]

in addition, just found another post, I didnt consider it but it could be my pain killers.
although I havent taken any in the last 2-3 days, I was taking Ibuprofen and Paracetamol to ease the rib pain.
Just read that Ibuprofen can cause sleep disruptions!
Learning a lot this week.

[ajack]

I would ask the doctor why the auto titrate wasn't used, he may have a valid reason.
It could be the Ibuprofen, all sorts of things can mess up out numbers.

waking up feeling no pressure is part of getting use to cpap, the pressure doesn't bother you anymore. I'm running 15-20
in your first chart, the 'changes to prescription settings' showed 2 days that I've referred to min4 max0, these would have felt strange

[Pugsy]

You have chosen the wrong machine in your equipment profile...you need to choose the "DreamStation Pro CPAP" .
The Pro part of the model name is pretty important.

As to why some nights good and some nights not so good....look at sleeping position as a possible factor.

The 2 most common reasons for changes in pressure being needed are sleeping on one's back or REM stage sleep.
REM stage doesn't normally last as long as what you are seeing on the "worst" night that you posted so I tend to think you started out probably on your side or something and later on rolled over onto your back.

Is that your normal routine ....to start out on your side or something and sometimes you end up on your back and sometimes you don't?

Your pressure of 14 seems to work pretty good sometimes but not all the time. You might be a good candidate for a machine that would auto adjust the pressure...use lower when lower works and would automatically adjust higher when higher is needed.
As it is right now you probably are going to need a lot higher than the 14 and that's not going to be comfortable all night long.
You need more pressure for some parts of the night and not other parts...or figure out for sure if the increase in pressure needs is for sure related to sleeping on your back and learn to stay totally off your back (which is easier said than done) and if it is related to REM sleep there's nothing you can do about it except use more pressure.

[Beechyboy]

Thanks both!

I actually tend to sleep on my back all the time, all my good results were from sleeping on my back, the one bad result was due to sleeping on my side.
Before CPAP I used to move around a lot in my sleep, since using the machine (even on the bad nights) ive woken up in the same position I went to sleep in.

Im going to try sleeping on my side tonight, try and sort my pillows out properly to prop my head up and stretch my neck as best I can.
Wouldnt complain if I did need more pressure, although I was doing really well on the current setting until recently.

appreciate all the info guys, hopefully will get back to normal soon!


Will get the model changed as well.

[Pugsy]

Cervical collar might help keep the airway is a more "open" position no matter what sleeping position.

If some of the good stuff is when you are on your back...and some of the "bad" stuff is when on your side then something is likely altering the airway in some way.

REM might be a partial factor but REM doesn't normally last half the night. REM sleep stage is usually in short segments.
See hypnogram for examples of duration and frequency.
https://en.wikipedia.org/wiki/Hypnogram