AHI creeping worse using CPAP few years

[ack_241]

Hello All,

I have been using F&P Sleepstyle (no model nr avail) from mid 2018. I have full mask.

Results have become worse from the beginning.
Have been now one week in normal day schedule after 3 weeks vacation (yes it is luxury).
Been very sleepy for first few awake hours in the morning, feeling that not had enough sleep.

AHI has been from 6 - 13 average. When I started in 2018 I remember it being like 3-5.

Yesterday also found blood on throat mucus in morning.
Throat is usually very dry especially in the morning, also need to drink lot of water during the day.
Throat mucus has not been white/clear but has some colors on it yellow/ brownish as long as I remember.

Increased myself pressure from 10 to 12 few days back but looks no change in AHI.
For last night I increased humidity from 3 to 4 to see if it helps with throat. Too early to tell that.

My main concern is increased AHI value, if anyone who understands stats from OSCAR is able to comment would be really great.
There are two reports bad day and normal day.
Apologies if format is not good as I have not been following forum lately

Pressure is fixed at 12.
Links for pics:

https://ibb.co/qgMpYDg
https://ibb.co/svGppsS

Cheers

[Julie]

Hi, first thing - considering what's been going on 'out there' lately, have you seen a doctor for your symptoms, which could be worrisome even if you don't feel sick - or do you 'test' everyday? Not everything's about Cpap.

Second, are you using a humidifier in your room?

Why aren't you on Apap?

AHI being high is not always a big deal by itself, but how you feel, how much is different from usual, etc etc. With not a lot else to go on, can you answer the above Q's?

Are you on any meds?

[ozij]

I agree with Julie - you have to discuss your symptoms with a doctor.

That said - the numbers and graphs on your report are bizzare:
The AHI number on top of the table on the left side shoud be the sum of the different types of apneas -- but it isn't.
The central apneas don't even appear in the panel - that stands out especially on your bad day.
Your 'median leak' is 0.40 == whatever that number means
And I have no idea what that double leak line in the graph is telling us.

Which is whyI wouldn't trust anything from OSCAR with your machine at this point.
Contact the OSCAR team about those data discrepancies.
Try to get an F&P program that will show you your results.

Based on your symptoms you may be dealing with mouth leaking - but let me repeat: Have you mouth and your throat checked by specialists.

Have you changed your mask since you started?
Have you tried a full face mask?

[Pugsy]

That said - the numbers and graphs on your report are bizzare:
The AHI number on top of the table on the left side shoud be the sum of the different types of apneas -- but it isn't.
The central apneas don't even appear in the panel - that stands out especially on your bad day.
Your 'median leak' is 0.40 == whatever that number means
And I have no idea what that double leak line in the graph is telling us.

OSCAR compatibility is iffy at best with F & P machines. Even OSCAR will tell us that compatibility is far from perfect with F & P machines.
I don't think F & P machines even separate central apneas from obstructive apneas so OSCAR can't do what the machine doesn't do.
And as for leak...F & P machines report like the Respironics machines....total leak and an approximation of excess leak.
You are seeing total leak (top line) and excess only leak (bottom line and it's not exact) on that leak graph. Large leak territory is going to be way up there as well. So while the leak graph does look a bit ugly it really isn't all that ugly. Large leak territory is going to be somewhere much higher than what we see here like up around 90 to 100 L/min total leak.

My best guess with this report and the worsening AHI is that for some reason the fixed cpap pressure is no longer able to do a good job preventing the airway from collapsing. Either position related or simple aging process that can make OSA worse.
I am unsure if the machine being used will even offer apap mode. This might be the base model machine....fixed cpap is only mode available...maybe.

F & P does have their own software but patient use of that software isn't promoted and the software is hard for the end user to get a hold of and use.

[ozij]

I don't think F & P machines even separate central apneas from obstructive apneas so OSCAR can't do what the machine doesn't do.

I can't get to the images now ("bad gateway error") but I distinctly remember central apneas flagged on the charts, and the AHI being large, yet the sum total of the indexes not getting even a bit close to that AHI. It's as though OSCAR were reading parts of the data, and not understanding others.
That why I said "bizzare".

[Pugsy]

I can't get to the images now ("bad gateway error") but I distinctly remember central apneas flagged on the charts, and the AHI being large,

I can still get the image. This below is the "good" night. Still not good obviously.
Apnea and hyponea are the only event categories pertaining to apneas anyway.
Maybe in your illness you were seeing things??? I don't remember ever seeing any F & P report that showed centrals separately.

[Pugsy]

Is the above image a SleepyHead or OSCAR software report? I can't tell but OSCAR now defaults to the calendar being hidden so that is what makes me wonder which software generated the report.

Use imgur.com or even the forum attachment feature (it seems to be working at the moment) instead of where you hosted the first images.

[ozij]

I can't get to the images now ("bad gateway error") but I distinctly remember central apneas flagged on the charts, and the AHI being large,

I can still get the image. This below is the "good" night. Still not good obviously.
Apnea and hyponea are the only event categories pertaining to apneas anyway.
Maybe in your illness you were seeing things??? I don't remember ever seeing any F & P report that showed centrals separately.

I can get the image again, and you're right. No central apneas. I was going by color and thought I was seeing the CA's purple. I was wrong.
But the numbers for the bad day still don't sum up, not even remotely.

Edited to correct typo

[ack_241]

OSCAR compatibility is iffy at best with F & P machines. Even OSCAR will tell us that compatibility is far from perfect with F & P machines.
I don't think F & P machines even separate central apneas from obstructive apneas so OSCAR can't do what the machine doesn't do.
And as for leak...F & P machines report like the Respironics machines....total leak and an approximation of excess leak.
You are seeing total leak (top line) and excess only leak (bottom line and it's not exact) on that leak graph. Large leak territory is going to be way up there as well. So while the leak graph does look a bit ugly it really isn't all that ugly. Large leak territory is going to be somewhere much higher than what we see here like up around 90 to 100 L/min total leak.

My best guess with this report and the worsening AHI is that for some reason the fixed cpap pressure is no longer able to do a good job preventing the airway from collapsing. Either position related or simple aging process that can make OSA worse.
I am unsure if the machine being used will even offer apap mode. This might be the base model machine....fixed cpap is only mode available...maybe.

F & P does have their own software but patient use of that software isn't promoted and the software is hard for the end user to get a hold of and use.

Thanks Pugsy and all for replies.

Machine can't do APAP, It is basic which does only fixed pressure. In graphs pressure was 12 as I wanted to see if lifting up helps.
It did not do any change so i went back to 10.

Last night F&P own phone app shows following, at office now so can't import to OSCAR to see what it shows.
Detail for Mask Leak showed just 34l/min. Is that lot or not?
Now attaching screenshot in forum worked. In initial message got error message like 'Failed to attach' .
F&P screenshot attached.

Is there any point to try install SleepyHead and see stats on that?

@Pugsy Do you mean me aging or device aging for making OSA worse? I believe me aging.
If its machine then I could try to get it checked or replaced.
For me aging can't do anything

[Pugsy]

I meant you aging and 34 L/min leak is normal if you are talking about total leak.

[ozij]

Is there any point to try install SleepyHead and see stats on that?

OSCAR is the newer version of Sleepyhead. ("Sleepyhead" under a new name with other developers).
You're running the newest version of OSCAR: 1.4

In graphs pressure was 12 as I wanted to see if lifting up helps.
It did not do any change so i went back to 10.

How long did you stay at the higher pressure?
What was your sleep quality?
Why 12 and not 11?
Except for the normal effect of aging, have you gained or lost weight during those years?

[ack_241]

Is there any point to try install SleepyHead and see stats on that?

OSCAR is the newer version of Sleepyhead. ("Sleepyhead" under a new name with other developers).
You're running the newest version of OSCAR: 1.4

In graphs pressure was 12 as I wanted to see if lifting up helps.
It did not do any change so i went back to 10.

How long did you stay at the higher pressure?
What was your sleep quality?
Why 12 and not 11?
Except for the normal effect of aging, have you gained or lost weight during those years?

I stayed few days, maybe a week.
sleep quality has not been good for last 1 1/2 weeks, before that on leave so slept longer which helped on sleepiness.
I thought step from 10 to 11 would be not big enough step.
I have not gained weight rather lost some, which may be because eating less and getting rid off white bread/rice. Also exercising few times per week.

[ozij]

I thought step from 10 to 11 would be not big enough step.

No real reason to think that, in principle; it's not as though the more apneas, the more pressure.

I have not gained weight rather lost some, which may be because eating less and getting rid off white bread/rice. Also exercising few times per week.

Hmm... for some people, weight loss means they need less pressure.
I'd try changing the pressure - up or down, can't tell you now which is better - by 1 cm. - and sticking to it for a week or even two.
Of course, if you decide on a drop, and things are much worse, don't stay there for a week. But don't move from -1 to +1. Get back to your regular, and then try the +1. (Same if you decide to make the first change a +1 from your regular. Go back to regular before you go further down).

[ack_241]

Hi again,

Tested pressure at 9 from 22nd Jan so one and half week.
I have not seen enhancement in AHI values, also same sleepiness. I need though keep better eye how I feel in the morning.
I have added two graphs:
- 1 pressure 9, I would say this was normal value during pressure 9. Don't recall how I felt in this morning
- 2 sleepy, this morning, I felt very sleepy from waking up and it then continues thru the day
Regarding this graph, I checked clock around 6am and tried and managed to go back to sleep. It shows lots of AHI after that.
Is this telling anything I should be ware of?

F&P values for those days were as reference
1: AHI 15.5
2: AHI 8

I plan now go back to pressure 10 as lowering did not help.
I'm bit lost what to try next.
Is there any indication that CPAP is not for me and APAP would suit better?
I'm so tired being tired so often.

I have forgotten to mention that I had nasal scan in July 2019. I did it because of apnea.
Result then was ,copy from report:
... The nasal septum deviates to the right and there is a small right-sided spur
which distorts the right inferior turbinate. There is a right middle
turbinate concha bullosa. The nasal airways are patent. ...

CONCLUSION:
Mild mucosal disease within the paranasal sinuses.
Nasal septal deviation to the right.


Doctor (nose or similar specialist) told that it is not enough to have public sector surgery for balancing the bone.
Private ones might do it, My current health insurance does not though cover any CPAP related issues. So have not done it so far.
If I try to breath only on my right turbinate it is very challenging sometimes almost impossible.
Left works ok.
I'm sure surgery would help but not sure would it be enough.

I would be grateful for any comment/advice.

Cheers

[Pugsy]

Is there any indication that CPAP is not for me and APAP would suit better?

Yep...those clusters of apneas and hyponeas mean that a fixed pressure isn't doing a good job.
Either positional or perhaps related to sleep stage but you need more pressure at those times.
If you were using apap in auto adjusting mode then the machine would/could increase the pressure and hopefully the higher pressure will prevent the airway from collapsing and giving you all those events in the clusters.

To break up those clusters you need even more fixed pressure or a machine that can auto adjust as needed.