Lots of data - could use some help

[kutastha]

I posted a while back about some difficulties I was having, and need some further input.

I was diagnosed with OSA in 2004. I currently use a REMStar Pro with C-flex+. My PSG from 3/2010 showed an AHI of 0.6, but an RDI of 9.6. I subsequently had a titration study that resulted in a Rx of 5.0 cm H20 (I cannot current find the report).

A couple months ago I moved from 5200 ft to 1000 ft (the elevation my sleep study was at). At that elevation, I had it set at 5.5 cm as my AHI was not below 5 and the symptoms were obvious. After moving at the end of June, I still had it at 5.5 cm and my AHI gradually rose from ~3 to ~5 with symptoms returning. As I was starting to get symptoms, I started taking a closer look at my data by downloading SleepyHead. In doing this, I noticed I was getting some leaks that would correlate with my AHI increasing through the night, so looked into my Swift FX mask and realized I didn't have the straps optimally set and readjusted them. However, since doing so, my leaks have gone from 5-6 Lpm to 1-3 Lpm yet my AHI has climbed to between 4-5.

Here's more of a breakdown:



Sample:


At 7/21, was having symptoms still, so tried an increase of 0.5 cm to 5.5, everything pretty much stayed the same.


Sample:


Was still getting some high numbers which would correlate with afternoon exhaustion and sluggishness, so checked out mask fit and discovered I was wearing it incorrectly (velcro straps too high up, silicone strap too far back). I then had the results from from 9/1 to 9/4:


Sample:


I noted a decrease in leaks almost immediately, but also AHI jumped to the mid 4s with even more tiredness. Most notable are an increase in CA and HA. I thought perhaps I was getting too much pressure and then went back down to 5.0, my prescribed setting for 9/5 to 9/7.:


Sample:


It should be noted that for some reason I'm getting scored for obstructive events that last less than 10 seconds. On 9/5 it scored 9 events (4 of which were > 10s), 9/6 one 11s event and 9/7 had 7 events (one of which was > 10s). Now there's a big jump in hypopneas and I'm figuring an insignificant jump in obstructive events.



So, the trend I see is that my leaks have improved, but my AHI has worsened. Over this time, I've also noted that on nights where I have alcohol, my AHI can be very low - in the 0.9 to 1.5 range - obvious outliers, but I would think it would have the opposite effect. Looking at this data, it makes me wonder if my pressure is actually too high.

[robysue]

kutastha,

I'm sorry that you are having problems.

However, I don't think the leaks are what's responsible. The leak lines for the days you post are, for the most part, excellent to very good leak lines. Lots of folks would love leak lines like yours. Moreover, on the one day (8/2)where there is a real correlation between a much higher than normal leak rate that lasts for more than twenty minutes, the cluster seems to be related to REM according to your zeo data.

Indeed, although many of the other clusters of OAs and Hs don't line up exactly with your zeo REM cycles, the timing of them makes it seem as thought they may be related to REM that is mis-scored as Light sleep. And the vast majority of your events are Hs and OAs, not CAs. So a bit more pressure may be needed. But if you chose to increase the pressure to 6cm, it's important to give the new setting several days or a week before concluding whether it's better or worse than 5.5cm or 5cm.

[kutastha]

Thanks for your input and perspective. I get a lot of variance despite sticking with a pressure for several weeks. I'm considering the bump up to six, but will ride out the 5.0 for a few more days. Thanks.