AHI Too High

[monarch22]

I started CPAP in January and have faithfully used it expect for a few nights where I couldn't breathe through my nose due to a sinus infection. I adjusted to it pretty well and my AHI was anywhere between 1 and 3 up until about 2 weeks ago when my numbers starting going up, one night even to 20! I take Ambien and am falling asleep easily most nights, but am sleeping less than 6 hours. I'm waking up and can't go back to sleep. I'm having a lot of pain issues and think that may have a lot to do with not sleeping well. I had my pressure set at 7 - 12 up until recently, and have tried increasing the pressure to see if that would help my numbers. My AHI is still high - anywhere from 11 - 13.

I just don't get it. Why such a difference in events? My leaks are pretty much the same as they have always been. Same equipment. Most of the events are hypopneas. Any ideas on how I can try to get my numbers back down? My doctor (PCP) has no clue on how to treat apnea and is of no help...

[rested gal]

I saw your post yesterday, but didn't reply 'cause I didn't have any idea what to suggest. Hoped some others would see something I'm missing.

Reading it again today, I still don't know. Perhaps the pain issues you mentioned are affecting your breathing while you sleep. Wish I had a suggestion, but that's really a mystery that your AHI has been nice and low for so long (since January) until now.

Maybe the occasional congestion has gotten worse?

[Pugsy]

I also saw your post yesterday but could not think of anything to offer. Especially anything to explain the increased AHI. I have had pain issues all along and while they certainly mess with sleep quality there hasn't been any perceived change in AHI.

Are you taking anything besides the Ambien?

If you are waking often is it possible that some of the scored events are false events? Meaning occurring while awake and the machine can't tell? Maybe the pain is sufficient enough to change breathing?

Any pattern or clustering of the events scored that you can spot?

[avi123]

I started CPAP in Dec 2011. Used Ambien for two months and gave it up. But take Xanax 0.5 mg 4 times daily. I sleep for 6 hours with one break in the middle. I take one half hour nap daily. My AHI never got below 7, even after changing the pressure all over the scale. At my present pressure of 10 cm h2o the AHI varies from 7 to 15. I am almost certain that it is related to underlying medical conditions which I might have. So I am not concerned about my AHI, b/c I know it that CPAP is not meant to cure most illnesses. Only sleep related.

[monarch22]

Thanks for the replies. I'm stumped too.

Rested gal, I'm not at all congested now...breathing through my nose just fine, so I know it's not that. I wish it was something that simple.

Pugsy, I am showing a ton of clusters. Does that mean something? My pain level hasn't really changed. Some days are worse than others, but it's been this way for a few years. I don't think I'm awake during the events. I seem to be sleeping pretty hard during the few hours I sleep. As a matter of fact, I have been having some pretty vivid, scary dreams which I wondered if are related to the events. This is something recent too. I am on a few others meds, but nothing new.

avi, are your doctors ok with your AHI being between 7-15? That just seems high to me, but my AHI's were less that 3 as soon as I started therapy, so I guess I want to get the numbers back to that...

I know there are a lot of different opinions on Ambien, but it has really been the only thing that has helped me sleep. Before starting it over a year ago, I barely got an hour or two of sleep and was feeling horrible. I have had concerns about taking if for so long and have tried skipping a night or two, but each time, I would be awake all night. At this point, I'm starting to get nervous about sleeping and I know that's just going to cause more problems. I need to work on finding a new doctor who is familiar with sleep apnea!!

[HoseCrusher]

I will throw this out for consideration...

If I toss and turn in bed, my AHI number goes up. When I don't, it goes down.

When my wife tosses and turns in bed, my AHI number goes up. When she doesn't, it goes down.

While it is too early to conclude anything, the trend is interesting...

[Pugsy]

Can you post one of your reports showing the clusters? Don't know if they mean anything.. just wondering if some pattern is there. Sleep onset... REM...maybe supine related????

[avi123]

I know there are a lot of different opinions on Ambien, but it has really been the only thing that has helped me sleep. Before starting it over a year ago, I barely got an hour or two of sleep and was feeling horrible. I have had concerns about taking if for so long and have tried skipping a night or two, but each time, I would be awake all night. At this point, I'm starting to get nervous about sleeping and I know that's just going to cause more problems. I need to work on finding a new doctor who is familiar with sleep apnea!!

Taking Ambien was found good for certain type of apneas. See this:



Excerpt

Due to the heterogeneity of the central sleep apnea syndromes, different medications have been used under different circumstances. No single medication can be considered a drug of choice.[1] Several different medications aimed at improving central sleep apnea include acetazolamide, theophylline, and sedative-hypnotic agents.

•Acetazolamide (Diamox): Acetazolamide is a carbonic anhydrase inhibitor that causes bicarbaturia and metabolic acidosis, which presumably shifts the apneic threshold of PaCO2 to a lower level. It has been shown to be effective therapy in primary central sleep apnea and CSB in patients with heart failure and in the treatment of high-altitude periodic breathing.

•Theophylline: This agent has been studied in patients with heart failure and was found to be effective in attenuating CSB.[34] It may also be effective for high-altitude periodic breathing.

•Sedative hypnotics: These agents have been used successfully in treating nonhypercapnic central sleep apnea. Temazepam and zolpidem have been shown to be effective under these circumstances and are believed to work by consolidating the sleep pattern, thus minimizing the instability in ventilation induced by sleep-wake transitions. A case series showed zolpidem reduced central apneas, and the overall apnea-hypopnea index, without worsening obstructive events.[35]

Link:

http://emedicine.medscape.com/article/304967-medication

But if you get hooked on it don't be surprised:

http://www.non-benzodiazepines.org.uk/zolpidem.html


_________________

[avi123]

I will throw this out for consideration...

If I toss and turn in bed, my AHI number goes up. When I don't, it goes down.

When my wife tosses and turns in bed, my AHI number goes up. When she doesn't, it goes down.

While it is too early to conclude anything, the trend is interesting...

Reply:

Crusher, I would not be surprised if at the Sleep Clinics they give you hi OHI values which were taken before you fell asleep while you tossed and jumped all over the place. Later, the low sleep AHI they get when you're really into sleep. This way you can convince your insurer that you do need a CPAP and they get more business this way. Any thoughts?

[ozze_dollar]

Wouldnt hurt to have your equipment checked out.

[HoseCrusher]

Avi, I double checked my sleep study with my own pulse oximeter and I did have some desaturations below 90% and some heart rate changes that are compatible with arrousals. Their data on O2 saturation and heart rate almost exactly match the data I recorded on my pulse oximeter. They may have scored it aggressively, but I can see a difference between pre and post CPAP, so I think they made a good call.

I threw this observation out because of your comments that you are ending up with a higher AHI index score. Since your AHI is based only upon flow data, I thought I would throw out some ideas that may influence the data.

An underlying health issue may play a part in your high AHI numbers, but if you toss and turn a little at night, that may inflate your numbers too.

My idea is that the machines base their scoring with the idea that you are sleeping. If you are falling asleep, or waking up a little to roll over, you may have different breathing patterns that may confuse the machine scoring.

I am using several channels to look at this. Each morning I interview my wife to question how active she was the night before. She actually glances at the clock during the night and is able to give me some idea of the time she was up to go to the bathroom, or tossing around a little while falling back to sleep. I don't remember waking up, so I wear a fitbit set to "sensitive" to monitor my movement during the night. In the morning I review my pulse oximeter data, the fitbit data, the details provided by my wife, and the machine airflow data.

As I mentioned earlier, it is too early to draw any solid conclusions, but the trend is interesting.

My AHI is ranging from around 2.5 to around 18. However, the AI ranges from 0 to 0.7. This peaked my interest in trying to figure out what was going on.

Through all of this my average O2 level remains a little over 96% and I have no desaturations below 90%. I also continue to be symptom free.

I hope you are getting restful sleep and simply throw this out as a "pre theory" idea.

[HoseCrusher]

ozze, my machine was checked out last week and it is working fine. My pulse oximeter was compared with the hospital units and found to be in good coorelation just after the first of the year. The fitbit seems to be working properly, but I have no way to check its calibration. My wifes memory is... well it's subject to interpretation.

[avi123]

Thanks Crusher. I could add to your observating the following:

1) When I try the CPAP during daytime for up to an hour NOT SLEEPING and check the AHI it's always above 20. Such hi # never happened while asleep.
2) The more breakes that I take during the night the higher the total AHI.
3) More Central apneas cluster before and after taking breakes from sleep than overall during continous sleep.

[HoseCrusher]

Avi, interesting...

Apneas lasting half the recording time are normal... if you are doing underwater laps in a pool.

Perhaps you should consider taking up surfing.

[cowlypso]

Cheyne Stokes respiration?

I would definitely try to get a doctor's input. Can your PCP refer you to a sleep specialist? Something's just not right here...