Rise in AHI, and Accurate Way to Determine AHI

[JTB1987]

Hi All,

Second post on this site. Hope you are all keeping well.

If it's ok, could someone please advise in a couple of areas?

I've used a CPAP Dreamstation for the past 2.5 years now. But recently, my AHI has increased from an average of about 3 to now about 5-6. All with machine usage of 5+ hours. I use a Dreamwear nasal pillow and haven't always breathed easy through the nose so I presume this may be a factor. However I then switched to a full face mask - the results were equally as bad. Pressure Minimum is between 4.5 and 5.5 normally. And I vary between CA and OA significance. Hypopneas account for more than OA and CA combined.

Can someone please tell me the most common reason for why my sleep has gotten worse?

Second, I use both Sleepyhead and my DreamMapper mobile app to review AHI. However I have just noticed that while the mobile app allows for mask-off time to calculate the AHI, Sleepyhead doesn't. Last night mobile app AHI: 9.8. Last night SleepyHead AHI: 5.24. And yet I read that SleepyHead is the preferable tool to use!?

I'm 31 and I am due to see sleep specialists this month as well as a cardiologist, following some worrying dizziness and palpitation spells that I fear may be apnea related.

Any advice here welcome - and I'm happy to share screenshots as required.

Best wishes.

James

[Julie]

Have you tried raising your min. pressure setting to 7 or 8? It can make a lot of difference and your present setting is very low. Have you possibly gained even a little bit of weight in the interim - can also make a surprising difference. And if yuo have SH, use it, post here (see the stickies at pg top for info how) as it's way better than the other(s). Your new mask may not be ideal for you, or just be the wrong size, wrongly fitted, etc... most of us go through at least a few before finding the right one.

[Pugsy]

SleepyHead takes all its data from what the machine writes to the SD card. 99.9999999% of the time it matches Respironics Encore Pro software results.
DreamMapper....not so trustworthy it seems. I would need to see the exact reports from both to maybe figure out why the discrepancy.

So your numbers have worsened....how do you feel? How would you rate your sleep quality? Been waking up a lot for some reason or other. When my numbers worsen....almost always the increase in events is because of more SWJ sleep/wake/junk or not real asleep events getting flagged by mistake. In my case my sleep worsened because of something unrelated to sleep apnea...remember lots of things can affect our sleep besides sleep apnea.

Go here and read and watch the videos...you can then learn how to look at those events and see if they are real or not.
If not real...they don't count.
http://freecpapadvice.com/sleepyhead-free-software

If it's determined that they are indeed real and you were asleep when they were flagged....any number of things could cause them to increase. Most common is maybe more supine sleeping or more REM sleep and you simply needed more pressure baseline than you had and the machine couldn't increase fast enough to meet the needs.

Any change in medications? New meds, drop old meds, change dosage?

I wouldn't necessarily go changing pressures until I figured out if what I was wanting to kill could be killed ...and needed to be killed...with more pressure. Not everything can be killed with more pressure.

[JTB1987]

https://imgur.com/a/zkp9KUY

[JTB1987]

Julie thanks. I have sent a link to Imgur for latest SleepyHead stats. Is that ok? Also I have played with pressure - it seems that higher pressures actually make me worse. But I will up to about 6 in this case and see. I agree about weight gain - a lot of it is invisible.

Pugsy - thanks. I was trying to get across that DreamMapper accounts for the mask off times. So last night my DreamMapper AHI was over 9. But my SleepyHead AHI was just over 5: the reason being because SH didn't account for the mask off hours (I took it off in the middle of my sleep) and instead based it on the duration that the machine was switched on. So AHI here is more accurate with DreamMapper.

I will watch those videos, thanks.

I haven't been on any meds but know that supine position plays a big role. I will think of new ways not to roll over! But my point was that I haven't done anything consciously different; instead I feel worse from having higher AHIs and I'm trying to work out where they're coming from.

Thanks a lot. And I can post more SH data if required.

James

[Pugsy]

Turn the auto off feature on your machine to ON....this will let the machine turn itself off after a minute or so...and eliminate those big mask off periods that are messing with the numbers.

SleepyHead just reports what the machine is reporting..no way around that.

Do you know how to access the setup menu area where you can turn on the Auto Off feature of your machine?

I do think you would benefit from an increase in minimum pressure. You need to give it a bit of a head start...it tried the first part of the night but didn't the last part of the night. I am thinking around 7 cm minimum...if that's too big of a jump comfort wise...try 6 first and see how it feels and what happens with your results.
Why it didn't even really try the second part of the night...dunno...something was missing in the auto adjusting algorithm to cause it to try harder.

I don't care what the AHI really is...way too many obstructive related stuff going on in your reports. Sub optimal therapy even if there wasn't that big black spot messing with the overall averages.

[JTB1987]

screenshot-20181205-150258.png (122.31 KiB) Viewed 804 times

[Pugsy]

The CAs/centrals you see...good chance they aren't real and are instead miss flagged arousal pauses in breathing because of the sub optimal pressure allowing too many events and you are waking up (you may or may not remember waking up).

Fix the stuff you can fix with more pressure....and lets then see what happens with the central numbers.

[JTB1987]

Thank you Pugsy.

I don't know how to change the Auto ON function, no.

I am not familiar with any of the metrics on SH other than the basic ones - OA, CA, pressure, etc. What do we mean by Flow Rate, and what other metrics should I be keeping an eye on if not just AHI?

And thanks - I will talk to my sleep dr this week and probably increase the pressure.

[Pugsy]

Go here and request a copy of the clinical/provider manual for your machine.
https://www.apneaboard.com/adjust-cpap- ... tup-manual
via email...read it...some good stuff in it besides the secret handshake for getting into the clinical set up menu area where you can turn Auto Off ...to the on position. Factory default is for it to be turned off.

The secret handshake for getting to the setup menu area is nothing more than pushing a couple of buttons on your machine at the same time...explained in the manual.
This is a different manual from any user manual you might have received...this one has the good secret stuff in it.

Flow Limitations and snores and RERAs....also a factor in effectiveness of therapy..they aren't part of the AHI but they are part of what the evaluation process...so it's more than just AHI numbers.
Snores and flow limitations are very important...early warning signs that the airway is trying to collapse and the auto adjusting algorithm will try to kill them.
Problem being...sometimes they happen before the machine can get the pressure up high enough to prevent them from growing up into OAs or hyponeas.....yours are growing up.
To help the machine out we just give it a bit more head start to get to where it needs to be to reduce the chance of minor airway collapses growing up to be full grown adult OAs or hyponeas.

The machine can't increase the pressure in big increments very quickly...not blink of an eye quick and sometimes these events just happen so fast the machine can't respond quickly enough...so the fix is to use more pressure baseline and try to prevent the collapse in the first place. They actually do their best work in the prevention aspect and not trying to fix it after the fact.