PROGRESSIVE RECENT INCREASE IN AHI & PERIODIC BREATHING

[Pugsy]

Do comfort settings influence the AHI? C-Flex+3 is what I have it set to now.

It can affect the AHI because it drops the pressure a little but upon exhale and that drop sometimes allows the airway to collapse.
Not always but sometimes...and when it does what we do is just increase the pressure a little to help compensate for that drop.

What is the significance of PB? Is there a normative range like with AHI?

We are never told a "normal" range of acceptable PB. As I explained above. Unless the PB flagged breathing is chocked full of apneas...it actually doesn't mean much of anything at all.
Perhaps this is something you need to be asking your doctor about if it bugs you this much.

[mcs2015]

What can I do about frequent dry mouth with increased pressure? I already have the highest settings for humidification.

[Pugsy]

So what is causing the dry mouth?
It's not just an increase in pressure either....something else is going on.
More pressure itself doesn't cause dry mouth.
Now does it cause more mouth breathing or something along those lines...possibly but pressure changes themselves alone...don't cause dry mouth.

Most common causes of dry mouth.

1....Medication side effects.

2....If using cpap....mouth breathing and it doesn't really matter if someone uses a nasal mask or full face mask. The humidifier wasn't ever designed to re-hydrate the mouth...it was designed for the much smaller nasal cavity. Even with a full face mask at max humidity it can't cure dry mouth.
It takes very little mouth breathing to dry out the mouth BTW....sometimes as little as 5 or 10 minutes.
If someone is using a nasal interface mask...there is no way the humidity setting is going to help out the mouth issues anyway. The humidified air shouldn't ever be in the mouth to start with unless there ends up being mouth breathing going on and then it's a mouth breathing issue.

3...other health issues...there are other health problems than can cause dry mouth

[mcs2015]

The only thing is that I had no dry mouth at lower pressure which makes me think it's from the increase. Maybe the increase is causing me to mouth breath? Only way to know is to go back to using mouth tape or a chinstrap.

[Miss Emerita]

Another observance which I know can be related but not certain is that around same time the jump in AHI, my PVCs started increasing. I am fully aware that ectopic beats can go hand-in-hand. I am also experiencing late day/early evening energy dips where I just fall asleep at the computer.

From what I'm researching, an increase in periodic breathing could be an indication of CSA which has me concerned. I've never been dx'd with CSA before, only mild-moderate OSA.

I do not drink alcohol, don't smoke, and have not changed any meds (blood pressure, thyroid), supplements or diet. The only thing I did add was prescription growth hormone to help recover from hand surgery which coincidentally is when I started observing a more sudden increase in AHI and ectopic beats.

mc2015, I've put some things in red that I'd recommend you review with your primary care physician, who is responsible for coordinating and overseeing your specialist care. I note that some kind of BP meds can mess with sleep, that growth hormone can cause fatigue, that patients are urged to mention if they have apnea before being prescribed some kinds of growth hormone, that it is worth understanding why the PVCs are increasing, and that it is worrisome you're falling asleep at the computer.

I hope everything is resolving now, but honestly, I'd do some more follow-up in your place.

[mcs2015]

Update:

Going from AutoCPAP to CPAP made the difference. The question is what pressure is best. My sleep doc didn't like the fact I experimented with different pressure settings to see if the AHI dropped. It did. Dramatically, as you can see here:



Doc wants to stick to the titration results which showed a CPAP of 8.0 was sufficient enough (see below results).

But at a pressure of 8.0, my AHI was still higher than I'd like @ 5.54.

The good news: I'm noticing less palpitations/PVCs and better blood pressure readings

Doc says in order to change from 8.0, we'd need another titration at the higher level. His chief concern: higher CPAP pressure setting could induce pressure-induced CSA.






Here is my daily data @ the 9.50 setting (this is the best AHI I've had in months):
CA is indicated as CLEAR AIRWAY in the Oscar software which from doing my research is synonymous with CENTRAL APNEA. That being said, can we rely upon these CAs to track and detect CSA to help determine the most effective pressure setting? Doc does not in any way rely on any of this data saying it's inaccurate.

[Dog Slobber]

Your doctor is full of crap.

Your improvement did NOT come from changing from APAP to CPAP, it came from increasing your minimum pressure from 6.5(ish) to 9.

Something you were encouraged to do in this thread, but wouldn't.

You don't need an in-lab titration, setting your pressure and observing over a few days is a titration and it's a better one than an in-lab titration where they set a pressure and observe for minutes (in a foreign bed and environment).

His concern about pressure induced centrals is completely unfounded. Yes, a small percentage of CPAP patients can experience pressure induced centrals, but there is nothing in your history that suggest you are a candidate.

Last session with a pressure of 9 (the highest it's ever been) your CAs were 0.38, lower than the were over the last week, 30 day periods and comparable to the last 6 month and year.

Your doctor is just irritated that you've made adjustments without his approval, and now you're paying the price.

[Miss Emerita]

+1 DS. You can see with your own eyes that your current setting is better and that you are not having a sudden onslaught of centrals. You'll want to see how things go over a longer term -- one night does not a trend make -- but it seems you're doing much, much better now.

Yes, you can rely on the machine/OSCAR to show you when you have central apnea/clear airway events.

If things continue to go well and your doctor continues to hassle you, ask him politely whether he would agree you are objectively doing better on these revised settings. You might also note that the results you're getting are over much more time than the short interval you spent at 8 cm during titration -- and are thus much more reliable as an indication of your ideal settings.

[mcs2015]

Your doctor is full of crap.

Your improvement did NOT come from changing from APAP to CPAP, it came from increasing your minimum pressure from 6.5(ish) to 9.

Something you were encouraged to do in this thread, but wouldn't.

You don't need an in-lab titration, setting your pressure and observing over a few days is a titration and it's a better one than an in-lab titration where they set a pressure and observe for minutes (in a foreign bed and environment).

His concern about pressure induced centrals is completely unfounded. Yes, a small percentage of CPAP patients can experience pressure induced centrals, but there is nothing in your history that suggest you are a candidate.

Last session with a pressure of 9 (the highest it's ever been) your CAs were 0.38, lower than the were over the last week, 30 day periods and comparable to the last 6 month and year.

Your doctor is just irritated that you've made adjustments without his approval, and now you're paying the price.

Thanks for the input. Actually, my pressure was 9.5. My only problem now is the dryness the increased pressure is causing.

[mcs2015]

Spikes in PB are still a problem. Here, we see it increase with testing out increased pressure last night. 


I did not show CSR or CSA on my titration from last month.

I assume that CSR is the same as PB on the titration study?

I don't what to make of these findings.

I go in for another titration tomorrow to determine whether BIPAP or ASV will better serve me than what I've already tried and now seem to not be stabilizing (APAP, CPAP). 

[Pugsy]

Periodic Breathing is a waxing and waning of the breaths.
CSR is a form of Periodic Breathing but it isn't the only form of PB. Not all PB equals CSR which is Cheyne Stokes Respiration.
CSR is a very definite pattern of PB.

[mcs2015]

Follow up titration study.
Compared to last study:
- PLM index and arousals increased
- sleep efficiency improved
- hypopnea and apnea + hypopneas improved