AHI Gone to He-- in a handbasket

[Air Force Retired]

Recently (about two months ago) my AHI readings took off like a rocket and I can't figure out why. Right now my readings are floating between 7.5 and 9.5. I am using the same machine I have always used and the same mask (easy life) up until last week when I had to get a new study done for medicare (dumb, but had to do it). I got a Swift FX from that study and it is the bee's knees, I love it. I get the same high readings with it as I do with my easy life. This was my third study. The first ordered a pressure of 10, the second 11 and this final one 10, which I am set at on my auto machine, with a high range of 20. I also tried going straight CPAP at 10 but no change in AHI readings. The only thing that has changed is I have put on some weight because of taking Zoloft.

Anyone have any ideas or suggestions how I can get this under control? Would appreciate any help. Before this started my readings were mostly 1.5 to 3.5 with a few 4's sprinkled in.

Thanks in advance.

[LSAT]

Are you sure that you are not letting air escape through your mouth? Even if you are inhaling through your nose you may be exhaling through your mouth. Have you tried taping or a chinstrap?

[jules]

I would suspect the zoloft.

[RandyJ]

What do your other data look like? As the other poster asked, how's your leak rate? etc

When did you start the Zoloft? The weight gain is enough to change things, but the new study should have confirmed or changed your previous titration.

Does anything else correspond to the time frame of your AHI changes? Other new meds, OTC meds, vitamins, muscle relaxants? Alcohol consumption? Anything new at home? Can you think of anything at all that changed around that time?

[Pugsy]

Could you please post one of your software reports? The daily detailed report showing a single night of graphs.
Pick a typical night for you. Not the summary or trends.

Let's see if the reports point to anything that needs some work.

Don't know how to post an image of a report. I use screen shots. This is how I do it.
Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[Air Force Retired]

I just downloaded and installed SleepyHead and looked at last nights data. I had a AHI of 10.8. Two items stand out as the problem areas: 1. CA was 8.8 vice a 1.6 for a 2.7 AHI. 2. Hyp was a 3.2 vice a 0.3 for the same AHI of 2.7. Now I have to figure out how to lower these two numbers? Should I raise my pressure slowly and see if these numbers improve? Other than changing my flex setting, this is probably the only change I can make. Opinions appreciated.

[jules]

my CA's have been 0 since I turned off aflex - I am just a month into this machine having used a tank APAP before so CA's weren't available

[Pugsy]

Sorry, not quite clear on what your are saying here.

I had a AHI of 10.8. Two items stand out as the problem areas: 1. CA was 8.8 vice a 1.6 for a 2.7 AHI. 2. Hyp was a 3.2 vice a 0.3 for the same AHI of 2.7.

CA hourly index is 8.8? and the whole AHI was 10.8? Don't know what you mean with "vice a"..sorry.

Do you wake often during the night? Remember lots of tossing and turning?

If the CA hourly index is 8.8....no don't go raising your pressure. It could make it worse.

[Pugsy]

Couple more questions...Looking back on your prior data (using SleepyHead) can you pin point the date when the AHI went to hell and any increase in CA indexes?
Does it possibly coincide with when you started taking Zoloft?
Also do you take any other meds RX or OTC?

When was the most recent sleep study done?

[Guest]

Sorry about the confusion---I went back to my old data sheets and picked one that had good readings all around. The average AHI was 2.7. The CA on that sheet was 1.6 and the night I had a AHI of 10.8 the CA was 8.8. Same comparison for the HYP. These two had the hightest numbers. Yes, I take RX meds including the Zoloft but I was taking the same meds back when my readings were .08 to 4.0, so I don't think meds are the problem. Yes, I turn from side to side through the night. I did note last night that some air is escaping through the mouth, more like puffs rather than contineous. I will be getting my new shipment of supplies in about a week and it will include a chin strap I will try. I am also going to set my machine to the same setting posted in my profile as they gave me good results and see if that works. I have changed masks to the swift FX which I got last week when I had my last sleep study. I have not received a copy of those results yet but should get them in a day or two.

[Pugsy]

Okay. Watch the CA index. See how it goes with the new settings per the recent sleep study.

Clear Airway events can be scored when we hold our breath when turning over in bed. They can also be scored during sleep cycle transitions. So a few of them is normal. 8 an hour is not normal usually. Increasing pressure won't reduce the number of centrals (and for a small percentage of people it can even make them worse). Increasing pressure is used when the obstructive components of the AHI is elevate because we treat those with more pressure.
The Hyponeas and the OA (Obstructive apneas) make up the obstructive component of your AHI. That portion is well controlled with your pressure as it is/was.

When you get the results of your most recent sleep study look for any special mention about centrals.

[chunkyfrog]

My guess: 'vice' is OP's spell checker's interpretation of 'vs'. ('versus'-not in spellcheck's vocabulary)
I hate spell check programs. But then I am a little better than average spelling by myself.
Use at your own risk. . .

[Pugsy]

My guess: 'vice' is OP's spell checker's interpretation of 'vs'. ('versus'-not in spellcheck's vocabulary)
I hate spell check programs. But then I am a little better than average spelling by myself.
Use at your own risk. . .

I did try to insert vs into the sentence, thinking along the same lines as you, but I still was a bit unclear about just what we were talking about so I thought it best to ask. It was just one of those sentences where he knew what he meant and I just wasn't sure. Normally not a big deal but when central indexes appear to me to be 8.8 then I want to confirm what I am thinking I am seeing.

[Air Force Retired]

OK---Just got a copy of my study. Here are the results. If you need more info let me know. Before CPAP: Apneas-23, Hyp-83, Total AH-106, AHI index-52.6, Rea's/snore/arousal-0.99, RDI-53.55.

With CPAP, pressure of 10, A-Flex of 3: Apneas-10, Hyp-27, Total AH-37, AHI-7.4, Rea's/snore/arousal-1.60, RDI-9.00.

Reccommendation: Nasal CPAP with humidifier set at a pressure of 10.

I will set my machine up like the test and run for a few days and see what happens with the AHI numbers.

[Pugsy]

With CPAP, pressure of 10, A-Flex of 3: Apneas-10, Hyp-27, Total AH-37, AHI-7.4, Rea's/snore/arousal-1.60, RDI-9.00.

AHI 7.4 and no centrals..

Without seeing your detailed reports I can't really say much about the Clear airway events you had.
Let's see if straight CPAP does better than APAP and watch to see if the CAs return. Maybe APAP was increasing the pressure and caused them.
I don't like the 7.4 AHI but if this was a split study...who knows what happened. Gotta start somewhere though.
If your CAs are related to pressure causing them then CPAP is probably a better choice.. or APAP with a very, very tight range.

End goal is to have a pressure that will effectively treat the obstructive components of your AHI and not trigger any centrals (should you happen to be one of the small percentage of users that this happens to).