Looking for advice – very high AHI

[sparky2]

I go back on Thursday, so I will post an update on Thursday evening. I will also ask for a copy of my overnight study on while on CPAP when I am there.

Thanks for staying interested.

Sparky2

[Pugsy]

Please do keep me posted. I don't like being stumped. Besides, it's an opportunity to learn and I am always ready to learn.
Your situation has be scratching my head.

[sparky2]

We are both scratching…

I went in to have my treatment reviewed on Thursday. Again they only looked at one number from all of the data that was collected – average AHI. I do not think that she even looked at the proportions of OA/CA/Hyp. In any case she ordered my pressures to be increased by one cmH2O to 11 – 15. Also, after talking for a while she said that I should be taking Lunesta rather than Ambien and I was sampled 5 tablets of 3mg.

So, I had a very rotten night’s sleep. It seems that I woke up at about 3:00 and was mostly awake until 6:00. I am not sure if that really was the case, but I think so. Here is the head-scratching part. I had the best AHI ever! OA= 0.20, CA = 0.40 and Hypopnea = 2.01 for a total of 2.61. I was expecting that it would be really bad as I was so restless, but nope. The pressure only went above 13 for a brief moment, was at 13 for about 10 minutes, and spent most of the night below 12.

The reason for not sleeping well was not having my Ambien. I will go back to them tonight to get that out of the equation and see what happens.

[sparky2]

I have been away for a while, but now am back at it…

I have been receiving a lot of help from some members and would like to acknowledge that it is much appreciated. I was asked some questions in a private messages along with the mention that we will continue communication via PM unless I said it was okay to do otherwise. It is fine with me to discuss this in the open. I feel safe with the anonymity here and hope that others may find this useful. I will not quote your messages directly unless you also agree that you are OK to go public.

In answer to the first question, no, I do not remember waking much on nights with high or low AHI. My OA, CA and Hyp numbers are split fairly evenly. Some nights my Hypopnea is almost equal to the sum of the other two, but mostly all three numbers are about the same.

The following are a zoomed in views of nights with AHIs of 2.6, 15.2, and 16.1. I only zoomed in at some of the “active” areas. After those three graphs there is a zoomed out view of 1.5 hours last night. My AHI was 66.8 over that time. I awoke with my mask off – first time ever that I have pulled it off at night. Following that view is a zoomed in view of a typical portion of last night.


Additional info – meds: Ambien 10mg – one before bed. Wilburton Extended Release one at 300 mg. Cozaar one at 100 mg. Amlodipine Besylate one at 10 mg. Supplements that my wife doles out every day split half in the morning and half when I get home: Methylfolate one at 10mg. One multi vitamin and mineral “for men.” Two fish oil at 500mg each. Two Hawthorne at 1000mg each. One B complex at 50mg. 10 Psyllium seed husk capsules. Other info: 62 years old 5’11” 235 lbs. I thought I was in generally good health, but actually am over weight out of shape and recently diagnosed with high blood pressure. No diabetes, cardiac issues, nothing going on with the heart (except for a right branch bundle block), no chest pains or difficulty breathing, lung issues etc. I see my GP at least once a year.

I think that is everything.

[sparky2]

As I mentioned before, I went to the sleep clinic last Thursday as they still want to see me every two weeks until they get my AHI under control. I promised I would send an update after, so here it is.

For the third visit in a row she upped the pressures. The last two visits by 1 cmH2O each time. I am now at 12 – 15. I have included a couple of graphs from SleepyHead. The top shows my AHI in its various parts and the bottom the changes in the pressures. The first change the clinic made was on Feb 2nd, then on Feb 13th and lastly on Feb 29th. It looks to me as though things are not changing much…

[Pugsy]

Been wondering how things were going.
Hey...last night looks like a reduction in centrals... Not much of a reduction but at least not anywhere near the Sears Tower graph on Feb20 or so.

[sparky2]

Yep, it could be a lot worse.

I suspect that they will try something different next time. I asked about BiPAP and ASV (I think ASV was what it was called?) and was told that it would take a sleep study to change from my CPAP to BiPAP and then another one if that did not work.

[zeleni]

Have you tried turning off A-flex yet? I'm struggling with high AHI's as well (including many clear airways). Turning off the A-flex eliminated the clear airways. Not sure if it was micro-arousals caused by the A-flex or a change in the algorithm. Worth a shot!

[sleepstar]

Hi,
how did your visit to the clinic go? did they think you were having central apneas?

I've never used that software before - but it intrigues me how it is scoring the central apneas? It kinda looks like there are efforts in those breaths (not much, but it's there). Central apnea should be completely flat. Like I said though; I've never used this software so I really don't know.

Have you seen the doctor or tech to see what they think?

[sparky2]

Sorry to have been absent for so long. I have gone on a couple of trips for work and had an in-town conference for several days. I have kept up with almost all of my daily downloads into EB and SH softwares.

I moved up my last appointment at the sleep clinic as my AHI seemed to have settled in at about 20 and I wanted some relief for a business trip. As it turns out, I had to visit another office (same company) as no one was available at my local one on short notice. The clinician (or whatever) looked at my data told me quite emphatically that I needed another mask type and put the pressures back down to what they were before my usual person had started adjusting them up every other week. I had been using nasal pillows and was given a ResMed Mirage FX Nasal mask instead. I have gotten pretty used to their uncanny ability to do almost nothing but make things worse and said I would try it out and be back next week when it didn’t help. (This last part I kept to myself).

I tried the mask the first night (also the first night of my trip) and my AHI was 64. The next was a short night at an AHI of 14. I was feeling extremely drowsy those days and the following night I woke to find that I yanked it off after a couple of hours. The next night I was so tired I feel asleep before putting the mask on. The last night of my trip was also a short one (looks like I took the mask off after 3 and a half hours) with an AHI of 59. My first two nights at home however were a 15 and a 7 – each with over 6 and a half hours sleep. The next night was another where I was so tired that I fell asleep before even putting the mask on.

So, it seemed like the best thing to do was try to give it one more week of data collection and then take the mask back and start looking for a new doctor. Since starting this "last week" my AHIs have been 5.6, 5.1, 2.2, 4.9, 1.3, 1.4, and 1.4. I am not sure what happened. Perhaps I just got used to the new mask finally or perhaps I had it misadjusted or something. I am not sure. This is very encouraging, however. Several nights in a row with low (for me extremely low) AHIs is unheard of for me and there is reason to hope that since this is just the first pressure they have tried with this mask that things may even get better!

Thanks to those who are helping. I will give it a bit more time like this and then see what to do. If things stay working well, I can give them one more shot at the pressure and then take a more independent approach .

[Kenwood]

Sparky....

How are things going...any updates on your progress and AHI levels? I've followed your thread since I was diagnosed back in January as I had an untreated AHI of 131. The high AHI members need to look out for each other. Pugsy also took me under her wings and helped me out too.

Kenwood