AHI increasing, what to do next ?

John_M · Post by **John_M** » Thu Sep 13, 2007 2:47 pm

When I first got things working about three or four months ago, I was steadily scoring AHI's under 1.0. It has steadily been increasing until last night it got to 8.3 .

Here is the data......

...................................................
The leak rate seems reasonable. So what can this be due to ?

My guess is that this related to the fact that recovering from foot surgery and am spending most of my time on my back in a hospital environment and have slight ongoing pain from my foot.

I supect it is time for me to do auto-titrate again. I have been running on 9cm H20 for a while and am thinking of going back on APAP with a range of say 7-13 for a week and see what happens.

Suggestions and comments welcomed

John M

bdp522 · Post by **bdp522** » Thu Sep 13, 2007 7:03 pm

Your leaks don't look that good to me. It seems you go into a bunch of leaks and have events. You need to get better control of those leaks. I think if you stop most of those leaks your AHI will come right back down.

Brenda

RosemaryB · Post by **RosemaryB** » Thu Sep 13, 2007 7:04 pm

Your leak line looks pretty bumpy. I go for a nearly straight line. If mine is really bumpy like yours, my AHI goes up. Plus, with the leaks, you can't tell if that AHI is accurate.

Wulfman... · Post by **Wulfman...** » Thu Sep 13, 2007 7:13 pm

John,

I was thinking that your leak line didn't look all THAT bad to me.

It's only that when you DO start leaking, you start having "clusters" (or vice versa).
I'm also wondering whether it's a positional thing as you mentioned (being on your back).

Den

JeffH · Post by **JeffH** » Thu Sep 13, 2007 7:38 pm

Leaks don't look that bad to me either.

How much time are you spending sleeping on your back?

tomjax · Post by **tomjax** » Thu Sep 13, 2007 7:59 pm

The leaks loo a lot bett than mine.
Most of the time it is very low with a couple so spikes of very brief duration- pit stop?

I definitely vote to go back on apap to see your pressure.

And why are you not using apap full time?

I bet it is your pressure, not leaks.

Goofproof · Post by **Goofproof** » Thu Sep 13, 2007 9:02 pm

If you don't mouthtape. it's time to start, of get a FF Mask that works for you. Way too much leaking. OA high, H low, your airway isn't holding the pressure it needs. Jim

Being on your back really makes it worse, worse yet if you are on pain med's.

Snoredog · Post by **Snoredog** » Thu Sep 13, 2007 10:17 pm

leaks don't correlate to the run of OA's seen on the report, but the Large Leak seen isn't good either. That occurred near the end of the session in the early morning hours, where you were probably in REM. So mouth breathing could be a problem.

Your condition has probably worsened due to medications you are taking for your foot. Hope they go away after you stop taking them.

But those OA's are not good even without mouth leaks. You are now at CPAP at 9.0 cm, I would increase pressure by 2cm to 11.0 cm and keep an eye on it until you go off the medications.

ozij · Post by **ozij** » Thu Sep 13, 2007 11:19 pm

Your condition has probably worsened due to medications you are taking for your foot. Hope they go away after you stop taking them

Yep, that's what I thought of too. Between medication and partial immobility, you might need the pressure changed - temporarily.

O.

rested gal · Post by **rested gal** » Thu Sep 13, 2007 11:34 pm

Leak rate looks ok to me.

If you're going to use a single pressure, I'd raise the pressure to 10 or 11.

If you're going to use auto-titration mode, I'd set it at 9 - 16. See how that goes. I wouldn't put the minimum pressure at 7 since you say you've been using a single pressure 9 for awhile with a climbing AHI.

As the others (and you, John) mentioned...could be the meds and having to sleep on your back that are raising your AHI. Maybe after your foor surgery heals you'd be able to return to the straight 9 that was giving you good results before. Hope you get better very soon, John!

Patrick A · Post by **Patrick A** » Thu Sep 13, 2007 11:50 pm

I agree with RG

John_M · Post by **John_M** » Fri Sep 14, 2007 12:04 pm

OK, auto-titrate 9-16 it is for a week.

I am off the pain meds but sleep patterns are not good. Sleep for an hour, wake up and play with computer, sleep another hour, short wake up and then long sleep. I think I am mostly doing side sleeping but the foot is still hurting slightly

The doc upped my omneprazole but that doesn't seem to be helping.

I am spending most of my time on my laptop obsessing about the data format of Smart Card and running tests with a blocked hose to see how the data changes. Haven't made any sense of it yet.

But I think I will try using the prescription facility of Encore Pro to swap modes between CPAP for testing and APAP for treatment.

Should be fun.

John M

JeffH · Post by **JeffH** » Fri Sep 14, 2007 12:17 pm

I couldn't tolerate a spread of 9/16. I'd be awake several times a night.

Mask

Additional Comments: Equipment isn't correct, S9 ASV w/H5i

Machine

AHI increasing, what to do next ?

AHI increasing, what to do next ?

leaks

Thanks guys