Increased AHI after large weight loss

[ladylyzar]

Hello everyone,

I'm writing on behalf of my husband since he is not into forums much!

He was diagnosed with OSA last year and started therapy in October with a Dreamstation. After a period of getting used to the machine, he was doing very well on it and started feeling refreshed again.

Over the last four months, he has dropped about 40 pounds due to diet and exercise. However, his AHI has gotten much worse, and he also has to wake up several times a night to burp. The more weight he has lost, the worse his sleep has gotten.

He spoke to the sleep lab tech in May about the pressure feeling too high, and the tech adjusted the max IPAP pressure down. That helped temporarily, but he has lost more weight since then and is right back where he started with regards to sleep discomfort. His doctor said he should visit a sleep specialist, but an appointment isn't available for almost two months.

It's gotten so frustrating that he is considering building a robot to mash the ramp button every 15 minutes (he's a EE), as that's the only way he can sleep comfortably. That's not an ideal solution and he wants to keep using the machine as intended since it helped so much initially.

Has anyone else been in this situation? Any ideas on what could be causing it, and what has helped you?

I have imported his data into SleepyHead. Let me know what you'd like to see, if any, and I'll be happy to upload any information requested.

[Pugsy]

Welcome to the forum.
See this thread for what to start with in terms of reports.
viewtopic/t158560/How-to-post-images-for-review.html

Just pick a recent typical night.

[Julie]

It's very possible all that weight loss has made his mask fit badly and leak - he may need either another mask entirely, or at least a diff. size, or readjustment, but don't just make it tighter as that can cause new problems.

[ladylyzar]

Thanks for the welcome!

He did replace his mask and headgear recently but it was the same make and model. It did take a few nights to get it to fit exactly right, so some leakage was occurring at that point. However his AHI was rising well before that went into play.

A typical night is sort of all over the place in terms of AHI rate. However on average it's much higher. The rate I have here was almost unheard of and now it's fairly middle of the road. The other night he had an AHI of 10.

In this one you can see where he woke up in the middle of the night to burp and had to ramp it up again. At this point he's starting to feel that he sleeps better without the machine, which is definitely what we don't want.

[Pugsy]

His AHI isn't all that bad but to improved it more pressure is needed and more pressure is very likely going to make the belly issues worse.

See this
wiki/index.php/Aerophagia

Only thing I can think of is change the settings because right now they are essentially fixed pressures but the apnea events seen are in clusters. Probably REM stage sleep or maybe supine sleeping.

If the minimum pressure was lowered so that only time it went higher was when needed (and if it was allowed to go a little higher when needed)...the lower pressure for the parts of the night when maybe not so much is needed might be enough to relieve the belly issues.

[ladylyzar]

I know it's not considered "bad" as it were - according to his provider, anything under 5 is "OK" but he's miserable.

The belly issues were a thing when he started getting used to the machine, but they largely went away until recently. It's incredibly painful for him. He does normally sleep on his back. Even if he falls asleep on his side, he wakes up on his back most of the time.

He did have some relief with using a travel neck pillow on top of his regular pillow.

[Pugsy]

Bad aerophagia can sure make a person miserable.
The usual fix is going to a bilevel machine but he's already on a bilevel machine.

If he is that miserable I would work on the aerophagia first and maybe let the AHI slide a little.

If my husband... I would give the bilevel a range and let it maybe use lower pressure enough of the night so that the aerophagia gets reduced.

Like EPAP minimum down to 9 from the 12...leave PS and Max IPAP alone for now. I like to make only one change at a time whenever possible so the results can be more easily evaluated.

[ladylyzar]

He dropped the EPAP down to 9 last night and slept on his back with the neck pillow holding his chin up. The machine stayed at low pressure all night, so that's something. He was only able to sleep 5.5 hours, but at least it was good sleep.

Hopefully we're on to something here!