AHI higher lately

[Sleep2Dream]

For the last week or so, my AHI hasn't gone below 3.6 and has tended to be around 4 or 5. I don't seem to be having any significant leaking, I've washed the washable filter and replaced the other one, and in general not much seems to be different. My nose has been stuffy lately, but that's not really new for me, either. I have grown to hate the APAP--not the apparatus itself, which is fairly comfortable, but the idea that I might be stuck using it forever--so it's a little depressing to not see spectacular results from my compliance. Any suggestions about what I could do to make this work better or to find a more positive approach to the whole thing would be welcome.

Another issue: I wear my hear in a knot on the top of my head to keep the headgear straps from slipping. But I feel like having my hair pulled up like that might be contributing to my headaches. I'm not sure what other options there might be. Before I started tying it up, my hair kept pushing the straps out of position and causing the mask to shift.

Thanks for everyone's understanding and help!

[Pugsy]

So what is that AHI composed of?
What is the hourly index for each category in the AHI?
Central/Clear Apnea Index?
Obstructive Apnea Index?
Hyponea Index?

And are you waking often or sleeping soundly with minimal wake ups?
Do you take any medications of any kind and if so what?

Other than the AHI being elevated and annoying...how are you feeling in general?

[Julie]

Hate to ask, but have you possibly gained even a very little bit of weight lately - it can make a real difference. And unless you pull your ponytail very tight it shouldn't make too much difference.

[Sleep2Dream]

So what is that AHI composed of?
What is the hourly index for each category in the AHI?
Central/Clear Apnea Index?
Obstructive Apnea Index?
Hyponea Index?

I'm not sure where to find that info in Sleepyhead. The results from Wednesday August 2nd) night under "Daily Details" and "Hours" say:
Periodic Breathing 0.00%
Large Leak 0.00%
Clear Airway 0.48
Obstructive 0.96
Hypopnea 2.57
Flow Limitation 0.32
RERA 2.57
Vibratory Snore 0.00
Vibratory Snore (VS2) 3.05
Pressure Pulse 1.45
Breathing Not Detected 0.00%

If there's a better or more accurate way to share this information from Sleepyhead, I haven't figured it out yet.

And are you waking often or sleeping soundly with minimal wake ups?
Do you take any medications of any kind and if so what?

I usually wake up twice a night to pee. I fall back asleep easily. I was taking a Proton Pump Inhibitor for possible GERD, but stopped it about 4 days ago. On Wednesday night, I think I took a Sudafed before I went to bed. Some nights I take a Fioricet for headache, like last night (this morning's AHI was 3.7).

Other than the AHI being elevated and annoying...how are you feeling in general?

I think I feel mostly fine. I'm not tired like I was before I started using the machine.

[Sleep2Dream]

Hate to ask, but have you possibly gained even a very little bit of weight lately - it can make a real difference. And unless you pull your ponytail very tight it shouldn't make too much difference.

I've been bouncing around between 112 lbs. and 114 lbs. pretty consistently for the past year. I'm just under 5' 2", so my doc was very surprised when I turned out to have apnea (the sleep study measured my AHI at 23). Those 2 lbs. can make a small difference in how my pants fit, but they've never seemed to make a difference in my AHI before, or anyway, not that I noticed.

I don't pull my ponytail super tight, but maybe I'll try making it looser and see if that makes a difference.

Thanks.

[Pugsy]

Clear Airway 0.48
Obstructive 0.96
Hypopnea 2.57

These numbers are each category index or hourly average.

The bulk of it is hyponea which usually responds fairly easily to just a little bit more pressure but 3 per hour doesn't necessarily need reducing.

RERA 2.57

Now the RERAs are a bit elevated and those point to maybe less than optimal sleep...some arousals that you may or may not remember.

I haven't see the graphs but I suspect what I would do if this were my report is that I would try to clean it up a little even though it isn't horrible.
A little more minimum pressure if using auto mode or a little more fixed pressure if using cpap mode.
Probably around 1.0. Hyponeas usually don't require much more especially in the numbers you are having.

A better way to share is with screen shots so we can see what you are seeing. We dteon't need or want all those graphs...just the basics and they can all be fitted quite nicely on one screen shot. You are using a Respironics machine...there won't be a flow limitation graph because your FLs are shown in the Events graph.
viewtopic/t103468/Need-help-with-screen-shots.html
ttps://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

[Sleep2Dream]

Clear Airway 0.48
Obstructive 0.96
Hypopnea 2.57

These numbers are each category index or hourly average.

The bulk of it is hyponea which usually responds fairly easily to just a little bit more pressure but 3 per hour doesn't necessarily need reducing.

RERA 2.57

Now the RERAs are a bit elevated and those point to maybe less than optimal sleep...some arousals that you may or may not remember.

I haven't see the graphs but I suspect what I would do if this were my report is that I would try to clean it up a little even though it isn't horrible.
A little more minimum pressure if using auto mode or a little more fixed pressure if using cpap mode.
Probably around 1.0. Hyponeas usually don't require much more especially in the numbers you are having.

A better way to share is with screen shots so we can see what you are seeing. We dteon't need or want all those graphs...just the basics and they can all be fitted quite nicely on one screen shot. You are using a Respironics machine...there won't be a flow limitation graph because your FLs are shown in the Events graph.
viewtopic/t103468/Need-help-with-screen-shots.html
ttps://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

Thanks, Pugsy. I'm not seeing a way to attach or add a screenshot now, but maybe I'm missing something. In the meantime, since I posted this, my AHI has been going down. It was 1.4 last night! So I'm thinking that maybe the recent higher scores were just due to a stuffed nose?

Also, since my score rarely goes above 5, and AHI<5 is considered "normal," and since I seem to wake up with the same degree of tiredness (not too bad) whether the machine told me I'd averaged 1.4 or, say 4.8, I'm thinking I just shouldn't stress it.

I confess I am still a bit baffled about all of this, and feeling pretty resentful at the idea of being tethered to this machine indefinitely.

[Pugsy]

If you look at the 3 links I posted how to post an image of your report is explain.
We can't attach anything..we have to put the screen shot on some place like imgur and then link to it.
Don't use Photobucket....long story there...they used to be a good place but not anymore for several reasons.

Some people say they can notice a significant difference between an AHI of 3 or 4 and one of less than 2.0.
The 5.0 number is just a line that the medical community came up with for a diagnostic tool or guideline. It's not the holy grail of numbers.
There's so much more to feeling better than just the AHI.
Heck, getting a nice low AHI is fairly easy. Now feeling those good numbers is another thing.

Obstructive apneas and hyponeas....they will respond to more pressure.

Central/Clear Airway apneas...they won't respond to more pressure.

So when you look at the AHI and you are evaluating the effectiveness of the pressure you have to sort of mentally remove any central numbers from the evaluation.

I suspect you need a little more pressure but without seeing the reports it's hard to say for sure.

[Sleep2Dream]

If you look at the 3 links I posted how to post an image of your report is explain.
We can't attach anything..we have to put the screen shot on some place like imgur and then link to it.
Don't use Photobucket....long story there...they used to be a good place but not anymore for several reasons.

Some people say they can notice a significant difference between an AHI of 3 or 4 and one of less than 2.0.
The 5.0 number is just a line that the medical community came up with for a diagnostic tool or guideline. It's not the holy grail of numbers.
There's so much more to feeling better than just the AHI.
Heck, getting a nice low AHI is fairly easy. Now feeling those good numbers is another thing.

Obstructive apneas and hyponeas....they will respond to more pressure.

Central/Clear Airway apneas...they won't respond to more pressure.

So when you look at the AHI and you are evaluating the effectiveness of the pressure you have to sort of mentally remove any central numbers from the evaluation.

I suspect you need a little more pressure but without seeing the reports it's hard to say for sure.

Okay, that's what I thought based on those links: I can't actually attach or paste anything here. I don't use any photo sites where I could save something for other people to see. I guess I'll just muddle along without sharing my screenshot--even without it, your explanations and suggestions have been very helpful!

I'm c onfused about upping the minimum pressure, though. Doesn't the APAP adjust the pressure according to what it senses you need? So my minimum is set at 8, my max at 15. Iirc, I tend to average a maximum pressure of 10 or thereabouts. Shouldn't my machine be sensing that I need more pressure than, say, 8 and going up? Or do I need to set the minimum pressure higher so that the machine never has the opportunity to provide too-low pressure?

[D.H.]

If you're mask is causing you problems, there are a variety of masks and mask types to choose from. The basic categories are nasal masks (covering the nose only), full face masks (covering the mouth and nose), and nasal pillows (feeding directly into the nostrils). Sometimes even a sightly different mask of the same basic design will solve the problem. Other times, you might want to opt for a completely different design.

[Pugsy]

Doesn't the APAP adjust the pressure according to what it senses you need? So my minimum is set at 8, my max at 15. Iirc, I tend to average a maximum pressure of 10 or thereabouts. Shouldn't my machine be sensing that I need more pressure than, say, 8 and going up? Or do I need to set the minimum pressure higher so that the machine never has the opportunity to provide too-low pressure?

It can and will auto adjust based on the algorithm and what it is sensing is going on. It won't respond to centrals period.
Here's the thing about these machines...they do the auto adjusting based on what is going on and what happened in the past and they don't increase anything to anywhere in the blink of an eye. The changes of going up and coming down are very gradual and sometimes whatever is causing the machine to maybe want to go up simply happens again before the machine can get to where it needs to be...then nothing happens for a while and the machine goes back down until the next whatever happens that causes it to want to go up.
The machine can't always respond fast enough to get to where it needs to be in a timely manner.
Hence the need for the minimum pressure to be set a bit higher to give the machine a better head start on getting to where it needs to be when it thinks it needs to go higher.

Respironics machines are historically a bit slower in response...both in the going up and the going down than ResMed machines but it's not like Respironics machines take hours to get there...it's really just a matter of a minute or two difference between the brands.

Think of the minimum pressure as a baseline pressure to hold the airway open for the bulk of the night ...it needs to be high enough to give the machine a good enough head start to get to wherever it needs to be to better prevent the airway from collapsing.
These machines work so much better when preventing the collapse from ever happening in the first place than to try to fix them after the fact and they won't do anything at all during an apnea event. They wait until the apnea event is over and then rethink what the pressure might have needed to be.

When I was using apap with an 8 to 20 range my AHI was running 7 to 8...mostly OAs but in very dense clusters. I would have some parts of the night with nothing happen and some parts of the night with 15 events in a 30 minute period...overall AHI wasn't horrible but those 30 minutes of ugly clusters were horrible.
Once I increased the minimum from 8 to 10..the dense clusters went away...AHI dropped to the 1 to 2 range and I slept and felt better.
I simply had to help the machine get to where it needed to go just a little faster so it could better prevent the airway collapse.

Everyone is different in what pressure they need to keep their airway open. The algorithm that dictates the pressure changes is complicated based on a combination of various things and if you aren't having some of the other stuff that drive pressures upward then your machine won't know to start off quickly enough to get to where it needs to be to prevent the collapse. Not everyone has all the warning signs of the impending collapse that the machine looks for. It's all complicated and the easiest thing is to simply give the machine a bit of a head start and be done with it. It just sometimes needs a little help.

[Sleep2Dream]

Doesn't the APAP adjust the pressure according to what it senses you need? So my minimum is set at 8, my max at 15. Iirc, I tend to average a maximum pressure of 10 or thereabouts. Shouldn't my machine be sensing that I need more pressure than, say, 8 and going up? Or do I need to set the minimum pressure higher so that the machine never has the opportunity to provide too-low pressure?

It can and will auto adjust based on the algorithm and what it is sensing is going on. It won't respond to centrals period.
Here's the thing about these machines...they do the auto adjusting based on what is going on and what happened in the past and they don't increase anything to anywhere in the blink of an eye. The changes of going up and coming down are very gradual and sometimes whatever is causing the machine to maybe want to go up simply happens again before the machine can get to where it needs to be...then nothing happens for a while and the machine goes back down until the next whatever happens that causes it to want to go up.
The machine can't always respond fast enough to get to where it needs to be in a timely manner.
Hence the need for the minimum pressure to be set a bit higher to give the machine a better head start on getting to where it needs to be when it thinks it needs to go higher.

Respironics machines are historically a bit slower in response...both in the going up and the going down than ResMed machines but it's not like Respironics machines take hours to get there...it's really just a matter of a minute or two difference between the brands.

Think of the minimum pressure as a baseline pressure to hold the airway open for the bulk of the night ...it needs to be high enough to give the machine a good enough head start to get to wherever it needs to be to better prevent the airway from collapsing.
These machines work so much better when preventing the collapse from ever happening in the first place than to try to fix them after the fact and they won't do anything at all during an apnea event. They wait until the apnea event is over and then rethink what the pressure might have needed to be.

When I was using apap with an 8 to 20 range my AHI was running 7 to 8...mostly OAs but in very dense clusters. I would have some parts of the night with nothing happen and some parts of the night with 15 events in a 30 minute period...overall AHI wasn't horrible but those 30 minutes of ugly clusters were horrible.
Once I increased the minimum from 8 to 10..the dense clusters went away...AHI dropped to the 1 to 2 range and I slept and felt better.
I simply had to help the machine get to where it needed to go just a little faster so it could better prevent the airway collapse.

Everyone is different in what pressure they need to keep their airway open. The algorithm that dictates the pressure changes is complicated based on a combination of various things and if you aren't having some of the other stuff that drive pressures upward then your machine won't know to start off quickly enough to get to where it needs to be to prevent the collapse. Not everyone has all the warning signs of the impending collapse that the machine looks for. It's all complicated and the easiest thing is to simply give the machine a bit of a head start and be done with it. It just sometimes needs a little help.

Pugsy, thank you so much for taking the time and energy to really explain all this: It's very helpful. Early on, I tried setting the minimum pressure to 10, but then I had to use the ramp feature when I went to sleep and whenever I woke up at night, because I felt breathing naturally against a pressure of 10 was difficult. Now that I'm totally comfortable with 8, I'll try 9 for a bit, and see how that goes, and then maybe go up to 10 again. Thanks again--I really appreciate your help!

[RichCee]

That was a clear and useful description Pugsy, thanks so much