Sudden Extreme High AHI

[shaggyzack]

I have been using my CPAP for 6 1/2 years. Thanks to the helpful people on this board, I got started out right and have been very lucky to have had few issues. I used to read my numbers daily, then weekly, and now I just download them monthly, because my AHI is rarely over 5. I send my doctor my data every 6 months, and she says I doing great. So I downloaded my data at the end of January, and just was shocked to see my AHI the last week and a half of January suddenly going into the teens, 20s, and 30s. I was getting ready to leave town for a month, so scurried around and got a new hose, headgear, nasal pillows, assuming that must be the problem. I've felt fine waking up in the mornings, not with the feeling that my head was going to explode, like it does if I accidentally fall asleep in the chair or couch. I haven't been waking up multiple times a night like I did before starting therapy, haven't felt tired etc.
I downloaded Oscar on my laptop and read my numbers thus far for February, and I still have these extreme high AHIs, all but a few days. I did a mask test, and I get the red faced guy. Felt around everywhere from pillows to machine connection, and there is no leaking. Covered up the expiration holes, and I get the happy green face, but that is not an option. I am at a loss. Any and all help/suggestions is so appreciated .

I'm attaching a screenshot of a pretty normal night for me, and two of what is happening now.

[Pugsy]

Still using the Swift FX mask that is showing in your profile?
When you got the new mask and new hose did you also get a new frame for the Swift FX and have you made certain that the nasal pillows are attached to the hose perfect in that little circle thing where the pillow attaches to the short hose?

Can you find time to do an awake test for about an hour so you can review the leak graph for a known awake time when you aren't experiencing any mask movement leaks or potential mouth opening leaks?
Watch TV or read while wearing the mask with the machine on like you were asleep but instead awake so you know for sure no leaks.

The fact that you got Mr Frowny with the mask fit test makes me wonder if the nasal pillow maybe isn't attached to the hose perfectly.
Maybe when you covered the vents you put pressure on that pillow to hose connection and temporarily "fixed" the area that was leaking.

Check all your connections very closely...the large leaks are intermittent so they come and go but they are coming more than they are going and they are so bad that the therapy pressure is not able to hold the airway open and that's why the AHI is so high.

Sort out the leak issue and I suspect your AHI will return to the numbers you used to see.

Final thought....how many hours on the S9? It wouldn't be totally impossible for one of the sensors to start acting up...these things to get tired and wear out..

[shaggyzack]

Thank you so very much Pugsy. Yes, I'm still using the Swift FX and did get a new frame. I will do what you suggested and post back later.

[shaggyzack]

Awake test done.
Checked the connection of the pillows and it is set in the grove evenly all the way around.
Felt around all connections and listened for air leaks at hose connections. Didn't notice anything.
Machine hours: 16,171
Machine data says AHI was 17.1 Oscar says 16.39. Not that that is really significant, just curious why it is different

A few things I noticed, that I'm not sure is normal, since I'm usually asleep. 1-Seems that I am having to use more effort to inhale than I used to, that there is some resistance. Quite a but more than I do in normally breathing. 2-A little moisture coming from the expiration holes. 3- More air coming from the expiration holes when I inhale, than when I exhale.

Thank you for your time and help. You are a blessing.

[Pugsy]

Well.....the machine is never thinking that it's sealed. Awake test if there are no leaks should be showing the leak line at or very near the 0.0 line. Obviously it never gets close to being zeroed out. While I have seen a baseline be slightly above 0.0 I haven't ever seen it look anything like your leak line looks. You've either got a hole somewhere or the sensors are acting up and it wouldn't surprise me give the number of hours on the machine. Plus you are reporting that the inhale doesn't feel normal.

The amount of air exiting the vent holes during exhale and inhale ...it's normal for that to vary.

Another place to check for leaks...the humidifier water chamber and the gaskets inside. Take the water chamber out and inspect it for cracks, etc and look inside and feel around for those gaskets. They could be dried out and allowing leaks to happen.

Verify that you do indeed have nasal pillows selected in the mask type menu. Though to be honest even if the wrong mask was selected it should NOT make this much of a difference so I doubt that is the problem but it is something to verify.

Do you happen to have a back up machine available? If so, can you remove the long hose and stick it on that machine and see what the leak line shows with it.
Know anyone with a machine you could borrow?

[shaggyzack]

Water tank looks fine, gaskets around tank look fine and in place. It appears to seal properly, but that is by sight only. I cleaned the gaskets and cleaned the connection between the humidifier and machine. I did notice when breathing, there is some movement in water tank when I inhale. I assume that is normal.
I'm going to use without the humidifier tonight and see what happens. I've never done that, so not sure how long I will last but it might tell me if it is a problem on the humidifier side of things. I brought a heated hose with me, that I don't like, but I will change it out and use it, when I go back using the humidifier just to see.
I won't get home until the first week in March. My neighbor has an extra machine that I can borrow then, but that's some time away.
Geeze I was hoping this machine would last until I go on Medicare in August. My crappy insurance has a $7000 deductible.

I will post tomorrow what happens tonight without the humidifier.

Thank you for your help.

[shaggyzack]

I played around with the combinations of new hose/mask and old hose/mask, humidifier or not, last night and finally got a green smiley face on the mask fit test with my old mask/nasal pillows--Phillips Resp Nuance, and new hose with humidifier. This is what I have now.

[Pugsy]

So how come the limit of max at 11?

Has something changed in terms of sleep like sleeping position? Been on your back more now?

[shaggyzack]

Clueless, it has always been at 11 for 6 1/2 yrs. I generally stay on my side.

[Pugsy]

Well something changed. If we are to believe the machine you need some pressure adjustments upwards.

Of course if it is a machine malfunction...then we might not necessarily believe the machine.

[shaggyzack]

I think I will adjust to 12 tonight and see what happens. It won’t hurt to try. I also ordered new pillows for the Nuance last night, that will be here tomorrow. I will let you know how that works out.
Thank you so much.

[Miss Emerita]

I notice that the values for tidal volume and minute ventilation look implausible. Does that contribute to figuring out what is wrong?

[Pugsy]

I notice that the values for tidal volume and minute ventilation look implausible. Does that contribute to figuring out what is wrong?

I don't know but something weird is going on and I want to see what a totally different machine reports.
If it is a sensor malfunction then it makes us wonder about any of the results that are shown.
Unfortunately have to wait until he gets home and can borrow a different machine. Things don't normally change so abruptly and all this just doesn't compute and it wouldn't be totally impossible for the machine itself to be ailing. When sensors go bad all sorts of weird things can happen or appear to happen.

With his reporting that the pressure feels different...maybe he isn't getting what the machine is showing he is getting.

I really wouldn't be changing much right now if it were me. Maybe increase the maximum a little but at this point I don't really trust anything that I see the machine reporting and until I can trust it....I sort of lean towards going by how I feel and how I sleep more than what the reports are showing.

[shaggyzack]

I changed max pressure to 12. Ordered new nasal pillows, but they sent the wrong thing, and will be two more days before, hopefully, the right ones will be here. Mask test was happy before I went to bed. Oscar however, is not so happy this morning....and I feel like the graphs look

[Miss Emerita]

Could you zoom in to about a 4 minute stretch somewhere where you think you were asleep, aren't having an event, and weren't having a large leak? I'm curious what your flow rate looks like. If it is normal, then that would add to the evidence that there is something wrong with your machine.