OSA have increased significantly in very short time-Cause?

Justin_Case · Post by **Justin_Case** » Fri Sep 22, 2006 10:56 am

Ever since returning from out of town a few weeks ago, I developed shoulder and neck/arm muscle spasms. I just woke up one morning and pow. I think I may have pinched a nerve. I have been to the chiropractor who has been treating me.

Since this new issue developed, at the exact same time, my AHI has gone up considerably despite the pressure increasing. Several Non Responsive apneas were detected too. For example, I would typically have an AHI of 4 or 5 with a pressure of 10 before the neck/muscle spasms. Now, with a pressure increasing using the autopap, the pressure of 15 is gives me an index of 16!!! The usual pressure of 10 NOW gives me an AHI of ~16, which was my original index when first diagnosed withOUT CPAP.

What the heck is going on?

Wulfman · Post by **Wulfman** » Fri Sep 22, 2006 11:38 am

Which machine?
Are you monitoring with software or screen display?
What's happened on your Snore Index? (snores can increase pressure)

Would you please fill in your Profile so we know a little more?

Best wishes,

Den

DreamStalker · Post by **DreamStalker** » Fri Sep 22, 2006 11:40 am

What are your pressure settings?

What was your titrated pressure?

- r

Justin_Case · Post by **Justin_Case** » Fri Sep 22, 2006 12:52 pm

Done. Yes, using the Encore software. My titrated pressure was 12 but since starting using CPAP again in April, it has rarely gone to 11.

Now, even 12 cm is too low. I kept on upping the min/max range. It is now 11 to 18cm. Previously, it was 4-15, but to get the AHI to below 5, I bummped it up 7-13. Until my shoulder, neck, and arm pain started, the pressures would not go past 11, with 90% below 10.

I thought about my sleeping position making a difference, but my position is the same, and last night, I made sure I didn't sleep on my back. I am a side-sleeper. Last night, it was the worst with pressures reaching 16 and the OSA events still quite high. HI were lower, less than 2.5.

I am only a few pounds overweight.

Wulfman · Post by **Wulfman** » Fri Sep 22, 2006 1:27 pm

And the Snore Index?.......
What are the individual AI and HI numbers?
Does it look like the AI and HI are going up as the pressure increases?
Taking any medications?

Den

DreamStalker · Post by **DreamStalker** » Fri Sep 22, 2006 1:47 pm

My guess is that you should set your APAP to about 2 cm above and below your titrated pressure unless you have good reason to believe that your titrated pressure is incorrect.

- roberto

Justin_Case · Post by **Justin_Case** » Fri Sep 22, 2006 3:34 pm

Wulfman wrote:And the Snore Index?.......
What are the individual AI and HI numbers?
Does it look like the AI and HI are going up as the pressure increases?
Taking any medications?

Den

OA:103 (25 average)
H: 23 (~average)
SI: 1.4
Total time in apnea: 1548 seconds

I couldnt find any indication that my pressures are causing my OA events as you can see from my average.

No meds. When I returned from holidays, I posted in a previous thread that my OA had gone up. I didnt link up the two (back/shoulder issues) and OA. With chiropractor treatments it has gone up even more.

I found an interesting article on OA and chiropractic work: http://www.jvsr.com/abstracts/3199-0016_descriptive.htm

Wulfman · Post by **Wulfman** » Fri Sep 22, 2006 9:27 pm

Justin,

YIKES!!!
You'd better be seeing/talking to your doctor(s).

Good luck and let us know what happens.

Den

Snoredog · Post by **Snoredog** » Sat Sep 23, 2006 12:30 am

your pressure requirements do NOT change that rapidly, indicating something is wrong.

You mention playing with the Min and Max pressures?. That could be your problem.

What was your last PSG titration? 12cm? If so then set the Max. to that 12cm pressure and no more!

Set the Min. pressure up a bit higher than you originally had, set it to 6cm instead of 4cm. So your range becomes 6cm to 12cm. Do NOT increase the Max pressure.

When your AHI jumps that fast those events are more than likely Central events from increasing the pressure, increasing it more will only make them worse. In fact, I would set your Max. pressure 1cm below the last PSG titration or 11cm.

If you went to chiropractor did they send you home with any muscle relaxers?

If so, that could explain some of the jump. 10cm pressure will clear just more than 70% of the SDB events you might have.

Set your machine to 6cm to 11cm and see what it does. Your shoulder and neck pain is probably from sleeping on your side. Examine your pillow, make sure it supports your head level when sleeping on your side.

elliejose · Post by **elliejose** » Sat Sep 23, 2006 3:34 am

Has your significant kitty made a tiny hole/holes in your hose?

Once my pressure suddenly jumped, and this seemed to be the cause. I covered the holes until I could get a new hose and that put me back to normal at that time.

rested gal · Post by **rested gal** » Sat Sep 23, 2006 11:52 am

Wulfman wrote:Justin,

YIKES!!!
You'd better be seeing/talking to your doctor(s).

Good luck and let us know what happens.

Den

snoredog wrote:your pressure requirements do NOT change that rapidly, indicating something is wrong.
------
If you went to chiropractor did they send you home with any muscle relaxers?
------
Your shoulder and neck pain is probably from sleeping on your side. Examine your pillow, make sure it supports your head level when sleeping on your side.

All good advice to check into. That kind of jump in AHI should not be happening out of the blue.

Even if you're still sleeping in your usual side sleeping position, perhaps you're hunching your shoulder or tilting your neck differently because of pain or discomfort?

That kind of jump in treated AHI does sound like it's related to your sudden onset of shoulder and neck/arm muscle spasms, but why and what to do about it.... good question.

Since you mentioned neck spasms, I wonder if the possible pinched nerve is somehow causing you to also have vocal cord spasms or some other kind of spasms inside your throat during sleep? Just a wild guess.

Until a doctor can help you sort it out, I think I'd use the capped range snoredog suggested or just set your machine to straight cpap at 9 or 10.

And yeah, do check for hose leaks as Josie suggested. It would probably be too much to hope that such a coincidence would have happened, and you probably looked at your leak rate right away when the pressure used and AHI skyrocketed, but anyway it wouldn't hurt to check the hose and connections. Stranger things have happened!

Do please keep us posted about how this progresses. Very interesting. Sorry you're having such a mystery of a problem.

Justin_Case · Post by **Justin_Case** » Sat Sep 23, 2006 12:03 pm

What Snoredog suggested, that was the first thing I did. I tried the range previously of 2 cm +- my titration range and my AHI was still [MUCH] higher than usual. My DME assured me that the OA were not CA events. I tried the range of 6-12 and it made no difference. APAP was still hovering around 8 90% of the time, despite extensive AHI events.

My GP doesn't think the spasms, pain, et al are all related, I am thinking the same thing as Rested Gal. I am going back to my sleep doc in a few weeks to set up a new titration study. I know he's going to dismiss the findings, values since he is not a believer of Auto PAP or the stats they produce.

I am also getting up sore in the morning, whether it be my hips, arm, or torso....so something is off with my nerves.

I still don't know what to do.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Titration, DME, AHI, auto

rested gal · Post by **rested gal** » Sat Sep 23, 2006 12:21 pm

Justin_Case wrote:I am going back to my sleep doc in a few weeks to set up a new titration study. I know he's going to dismiss the findings, values since he is not a believer of Auto PAP or the stats they produce.

All the more reason to run the machine for several nights or a week as a straight cpap at what your last sleep study found to be a single prescribed pressure. Even if the sleep doc doesn't "believe" in autopaps or their stats, he can hardly dismiss the reports you take in from using straight cpap mode operation.

Justin_Case wrote:I am also getting up sore in the morning, whether it be my hips, arm, or torso....so something is off with my nerves.

That sounds even more to me as if you are sleeping in a tensed, strained position in some way.

Going back to a point snoredog asked about... have you been taking a muscle relaxer during this? If so, perhaps that's relaxing the throat muscles too much. But, I'd think the higher pressures you used should have been handling keeping it open; yet they apparently didn't.

If you haven't been prescribed a muscle relaxer, though, perhaps that would be something to try, to see if your whole body would relax and get into a less tensed or perhaps less contorted sleep position. I'm still just wild guessing here.

Wulfman · Post by **Wulfman** » Sat Sep 23, 2006 12:27 pm

Justin,

When I was talking about doctors, I also meant your chiropractor. Have you been in contact with him/her about your situation? Maybe something went out of place while they were putting other things back in place.....?

Good luck.

Den

Justin_Case · Post by **Justin_Case** » Sat Sep 23, 2006 12:43 pm

Wulfman, I will check with the chiropractor but he did mention he knows nothing about sleep apnea. Going to the chiropractor made my AHI worse, but now, it looks like my apnea is not treatable with XPAP. Which goes back to the basics: what is causing the obstruction or my sleep apnea. Nobody ever told me. Just CPAP was prescribed. CPAP [was] treating the symptom but not problem. Now, it's not doing either.