Bumps in the Road After a Smooth Patch :(

[RichCee]

Hi guys, I seem to be hitting some bumps in my therapy after about a year of good results. During most of that time, I saw an AHI range of 1.5 to 3.0 at pressures of 12 to 15. This spring, I began to feel a little more tired during the day and saw more variability in the AHI. This seems to have gotten worse as the summer has progressed. Both OA and CA look more volatile to me. In early July, I bumped the pressure range up to 13 to 16 thinking that since I gained some weight, maybe I needed a little more pressure. I also tried moving the pressure relief comfort setting (forget the right name) down a notch to 1, but reversed this after several nights.

I am linking to a 6-month historical view below and a chart from last night (fingers crossed).

I've always had great help from the folks here, and I am hoping you guys can help me get back on track. Thank you!



And here is a link to last night's results AHI of 5.8:

[Julie]

Hi, sorry you're having problems, but I will be brutal... from personal experience if nothing else... the smallest amount of weight can make a huge difference and if you can get it off in any way, do it. I think you'll be amazed at how much of a difference it makes. What I will advise though is not to bump your pressure any higher now as it's not a good idea at all... and only if, after consultation with experts, would I consider it and/or another machine. Good luck!

[Pugsy]

On last night's report half the AHI is Central/Clear Airway. We can't fix centrals with more pressure using your machine and I am not so sure that you need to fix them anyway.

If we remove the central index from last night's AHI then the obstructive part (OA and hyponeas) is 2.90. Not a horrible AHI by any means. If you want to try to reduce those...a little more minimum pressure might do it but I don't know that there is a critical need...but if you want to try ...maybe just 1 cm more minimum pressure...I wouldn't do anything with the maximum at this time.

Some questions for you that might help us help you better.

Do you know if your OSA happens to be worse when on your back or during REM sleep? This information is usually available on sleep studies...do you by chance have a copy of yours?

Do you take any medications? If so, what?

Aside from the weight gain has anything else changed? Medication dosage, sleeping position change maye?

Do you wake often during the night or pretty much sleep straight through with maybe a handful of wake ups?
Ever spend much time awake in the middle of the night with mask and machine on?

Can you get me a zoomed in picture of the CAs?
Got to the events tab...click on the Clear Airway Event category..scroll down till you see the grouping of CAs being flagged between 6:00 and 6:30 AM.....pick a CA right in the middle of the cluster...highlight it and then click on it. Your graphs on the right will change and zoom in at a scale that I want to see. Get another screen shot with the graphs zoomed in at that level.
We might be able to figure out if those CAs are awake breathing or asleep breathing by looking at the pattern.

I don't need or want time at pressure graph...so omit that one and just let the other 5 graphs resize to make them a little easier to see and evaluate.

The pattern of the OAs...might be REM related..might be supine sleeping related (do you ever sleep on your back) or might be a combination of both.

[RichCee]

Thanks guys. Pugsy, I am putting the two graphs you requested below. To answer some of your questions:

Not sure about whether OSA is worse on back or in REM. I suspect it would be on the back however.
No medications
No other changes really (aside from gaining about 20 pounds of weight over the past year to 220 lbs total)
My sleep pattern is fairly regular -- I often find myself waking around 2am and roll over/adjust, and then often around 5am
When rolling over at those times, I feel an intense need to stretch my legs as if I am not moving enough (?)
I am usually awake for the day around 6:30am, and sometimes in and out of sleep 30-45min before that
I use a buckwheat pillow and typically (80% of the time) sleep on my side

[Pugsy]

You didn't follow my instructions..you zoomed in on the entire CA cluster and it's not zoomed in enough.
Please pick one single event in the middle of the cluster and click on it and then get the screen shot.
It's totally impossible to tell anything about the CAs at the level of zooming you did. Sorry.

Needs to look like this so that I can see each individual breath. If you follow my instructions it will.
http://pugsy52.imgur.com/all/?#2

[robysue]

What was going on between 6:00 and 6:30 when all those CAs were scored? Do you think there's a good chance that you were awake or very lightly dozing bouncing back and forth between light sleep and wake? Or do you think you were sound asleep when that cluster of CAs happened?

Since you've put on some extra weight AND since the summary data chart shows that on other days, there has been a noticeable increase in your OAI (the light blue part of the bars), it could be that your pressure needs have increased. You might just need to keep the current settings (13-16) and give your body time to adjust. Or, if aerophagia has not been an issue in the past, you might want to use 13-20 for a few days to run an autotitration to find out just where the machine would like to take the pressure to. (But note: Given that you are NOT running at 16 for any length of time, so it's not clear the machine will go much above 16 anyway.)

Final question: Do you have seasonal allergies? And are they worse this year by chance? In my case my AHI can show a lot more variability and be higher than it should be on some days when my allergies are acting up.

[RichCee]

Apologies, I think this should help:

[RichCee]

Thanks robysue, yes I believe I was in and out of sleep around 6-6:30am. Since adopting the CPAP about a year ago, it's rare for me to sleep past 6:30. No seasonal allergies.

[Pugsy]

Yes, thank you, the image now let's me see what I needed to see.
Looks a bit like SWJ (sleep/wake/junk) to me.
See this thread
viewtopic.php?f=1&t=114600&p=1110933#p1110933

Goes along with your history of being awake usually at that time.
If you are awake then we have to mentally remove that portion of the AHI from any evaluations. Awake stuff don't count.

[RichCee]

Thanks, Pugsy does that pressure range of 13-16 still look appropriate to you?

[Pugsy]

taht link said empty album

The album isn't empty...I just used the link and I see the entire album but then I am logged in but it wasn't the link I thought I got.

I meant to get this one.

[Julie]

His pressure is already on the high-er side and there were other questions... read the other notes here.

[Pugsy]

does that pressure range of 13-16 still look appropriate to you?

It does to me especially if we can remove some of the obstructive stuff as being SWJ and we have to remove the central stuff because we can't fix those (if they are real) with more pressure anyway and after you remove the central stuff the AHI isn't all that bad even if all those OAs and hyponeas were real and not SWJ.

Up to you if you want to change anything but there's no urgent need to do so.
If you do decide to try more pressure I would just try maybe 1 cm more minimum pressure or reduce EPR by 1 (if you are comfortable with 1 cm less EPR). I don't think you will need much more pressure to get a little drop in that obstructive part of the AHI if those are real and not SWJ.
I don't see any need to add more max unless you just want to. The machine barely kisses the max for very brief times. It's not likely to go higher no matter what you set the max.

[RichCee]

Thanks for the help!