Increasing AHI 7 months into CPAP

[MNKNIGHT]

I wanted to get some perspectives - I've been on CPAP for about 7 months now. Since then I have dropped down from 195#s to 170 and plan to lose another 5 lbs (i'm 5'10" so 165 is about is good as I can get and will get me into the correct BMI range) . On this journey with CPAP i moved from a RAMP pattern to a fix pressure of 8 through a 2nd titration study in March (I increased it 8.5 a few months ago) and saw my 14 day average AHI drop below 5 about a month ago.

I was pretty happy with the results - however my numbers are now going up - 14 day AHI is now 7.9 and i've not had a night below 5 in at least 30 days. While I am not panicking - my goal obviously is to get into the normal range all the time. I'm not tired during the day unless I have been traveling (which I have been for the last 2 weeks - New Orleans and Montreal respectively). I don't sleep on the plane because i don't want to snore...I remember plane sleeping fondly...used to put me right out at takeoff

Anyhow, tweaks I am thinking of making - let me know your thoughts.

1) Currently I have the humidifier at 2 (never changed it from winter) thinking that may help with any congestion. I have pretty bad allergies and the extra humidity really helps - but this could maybe help.

2) Potentially move the pressure to 9

I see a few posts with people way below 5 (which I am envious) but would settle to just get at 5 or slightly below for now.

Let me know your thought on the tweaks

[Pugsy]

We really can't make much of any sort of educated comment about your data without more information.
Are you using software or just the machine LCD for your

14 day AHI is now 7.9

It's really important to know the event category breakdown of that AHI...
Clear Airway Event index (these reported as centrals on ResMed machines)
Obstructive Airway index
Hyponea Index
all the above make up the AHI...and tweaking suggestions involved knowing which will respond to tweaks and which won't. If your AHI is primarily Clear Airway/Central than increasing the pressure won't help and might hurt....but if it's primarily OA or hyponea then more minimum pressure is usually what is needed.
We really need to see the detailed software reports to have any idea what to offer.

You can find out about the software here
https://sleep.tnet.com/equipment

For examples on what we like to see on the software reports
viewtopic/t103468/Need-help-with-screen-shots.html

[MNKNIGHT]

Sure thing - some representative data for the last 7 days (note I was traveling so the 16 is an outlier)

again the machine is set for a flat 8.5 - sometimes the centrals can be a little all over the board at times - especially when I am stressed (which has been the case for the past couple of weeks with my job) - but have been told getting the overall AHI in line is really the most important

Date<AHI>Centrals/Obstructives/Hypopneas/Total events/Total hours

7/17 <7> 12 - 8 - 24 - 44 - 6.19 hours
7/18 <6.2> 8 - 9 - 16 -33 - 5.21 hours
7/19 <16> 26 -25 -29 -80 - 4.57 hours (traveling outlier)
7/20 <6.5> 3 - 2 - 8 -13 - 5.27 hours
7/21 <6> - 3 - 2 - 13 - 2.1 hours
7/22 <6.2> - 3 - 15 -18 -36 - 5.46 hours
7/23 <7> - 6 - 14 -26 - 46 - 6.34 hours

[Pugsy]

Looks like the AHI is primarily OA and hyponea.
Any clustering of events...periods with nothing going on and then some clusters? Any snores showing up?
Usual fix for when we have more OAs and hyponeas than we want...more pressure...how much more is unknown.
Is your pressure a fixed pressure or are you using a range of pressures? If you are using fixed pressure setting the Flow Limiation flagging is turned off on your machine so the absence of any FLs doesn't really mean much when using cpap mode.

It would be helpful if we could see what you are seeing on those reports.

[MNKNIGHT]

ok here is what I have so far

http://imageshack.com/a/img924/5173/kRfFkn.png

[MNKNIGHT]

More
http://imageshack.com/a/img924/6219/8kPuRa.png
http://imageshack.com/a/img924/2347/U2bJzi.png
http://imageshack.com/a/img921/6047/6dUNQA.png
http://imageshack.com/a/img921/4048/bvR3f9.png
http://imageshack.com/a/img924/7505/XFE1qd.png
http://imageshack.com/a/img921/3577/8r0HcS.png
http://imageshack.com/a/img921/3277/SX8EZF.png

[Pugsy]

More
http://imageshack.com/a/img924/6219/8kPuRa.png
http://imageshack.com/a/img924/2347/U2bJzi.png
http://imageshack.com/a/img921/6047/6dUNQA.png
http://imageshack.com/a/img921/4048/bvR3f9.png
http://imageshack.com/a/img924/7505/XFE1qd.png
http://imageshack.com/a/img921/3577/8r0HcS.png
http://imageshack.com/a/img921/3277/SX8EZF.png

These are all wave form data from Encore and way too much zoomed in to get any idea what we are looking at.

How about 1 detailed night from Encore...typical night and not the outlier.
that looks like this

[MNKNIGHT]

ok - here is the one day report:

http://imageshack.com/a/img924/1709/UaGDEo.png

[Sheffey]

by MNKNIGHT on Sun Jul 24, 2016 7:33 pm

ok - here is the one day report:

http://imageshack.com/a/img924/1709/UaGDEo.png

You have a nice auto pap. Why don't you set it to AUTO mode with min pressure 8.5/max pressure 20 and let the nice algorithm prevent most of those events?

[MNKNIGHT]

My titration study (back in March) showed that when using the AutoPap mode it was blowing out Centrals all over the place
Net/Net we arrived at a set pressure which really helped (for most of April-May I was dipping down in the 3 AHI per night).
I'm considering raising the fixed pressure to 9 and turning the humidity down to 1 for now and see how things go tonight.
Any other comments would be appreciated

[Pugsy]

You are in auto mode but with minimum set to equal maximum so that the machine is functioning like cpap mode...is that correct?

Humidity setting shouldn't affect AHI...so make sure your nose is happy because if the nose isn't happy you won't sleep so great and it won't matter how good that AHI might be.
Turn it down if you wish but it won't help the AHI.

You need more pressure. Did they tell you at what point the pressure starting triggering centrals?
It doesn't help a person much if the trade off for reducing centrals is to allow too many OAs and hyponeas.
Maybe we could find a nice compromise that wouldn't trigger the centrals but could still do a little better job with the OAs/hyponeas.

I think I would try a tiny range in apap mode...see what happens..something really tiny like the 8.5 minimum and maybe 10.0 maximum...see what happens. If it goes up and triggers centrals they will show up as Clear Airway Events on the reports. There is some clustering so you might not need more than 8.5 all night long...just need it for the times you see the clustering and allowing the machine to have a bit of room to roam around might just be enough to break up the clusters without causing more centrals.

[MNKNIGHT]

Yep - Automode with upper and lower set to 8.5 is how it is set for the moment.

The recommendation from the study was between 8 and 9 cm (I started with 8 but seemed to need a little more which was highly effective back in April).

My guess is with the weight loss and further adjusting to CPAP throughout the year - the higher pressure is needed. I'll give the 8.5 to 10 a try and see what happens.