AHI Up, AHI Down, how to level it?

[Tielman]

I'm looking for some assistance, because I'm a little confused.

My daily AHI numbers have been fluctuating a bit wildly for a while now, they are ranging from a 0.8 to a 5.2. Leak rates don't seem to be an issue as my large leak rate is 0, and most of the time I have a fairly flat line with the leak rate. The other day I took a nap for about 3 hours and had a 0.3 AHI, but that night I had a 3.1. Prior to this, my AHI numbers were in the 1.7 to 2.2 range for at least two weeks (which is what I've been expecting). I've had many nights above 3, and a couple in the upper 4 to lower 5. For me, I physically can notice anything above a 3 as having not a good nights sleep (headaches, sinus pain, increased anxiety, increased tiredness).

Straight CPAP with pressure of 11. In the middle of this, I did switch to a Swift FX mask, and have had lower AHIs than previous, but also the fluctuations up and down persisted.

On a personal note, I have been very stressed for a few weeks now both at home and at work. Could that be the sole cause, or is there anything else I'm missing??

Thanks in advance for any hints/tips!!

[Julie]

Hi - If the stress translates to your tossing and turning in bed, maybe dislodging the mask, grinding your teeth, holding your breath, etc. while asleep, then maybe it's' responsible - hard to be sure I suppose and if your leak rate is low, I'm not sure how you'd track the problem. Again, it's easy to say try a FF mask if you inadvertently mouth breathe while sleeping, though I would wonder about that good leak rate again. Can you try taping for a few nights to see if that helps?

[Tielman]

Hi - If the stress translates to your tossing and turning in bed, maybe dislodging the mask, grinding your teeth, holding your breath, etc. while asleep, then maybe it's' responsible - hard to be sure I suppose and if your leak rate is low, I'm not sure how you'd track the problem. Again, it's easy to say try a FF mask if you inadvertently mouth breathe while sleeping, though I would wonder about that good leak rate again. Can you try taping for a few nights to see if that helps?

I'm pretty sure I don't mouth breathe because of 3 reasons: 1 the leak rate is too low, and 2 because I woke myself up once with an open mouth (too noisy!!), and 3 I'm a drooler so no dry mouth, just the opposite!

I have noticed some issues with pressing against my front upper teeth with my lower teeth, but only once I've woken up in the morning. I do know that I roll-over (side sleeper) a lot more on the higher AHI days. I've re-adjusted my mask (Swift FX) so that it's more comfortable, but I had the 0.3 with that adjustment so I know it's not leaking.

Thanks for the input!

PS: This is like me at work, I never get the "easy" problems

[Muse-Inc]

Could be stress induced. Allergies? Congestion? The latter 2 with their inflammation/swelling narrow airways. I have lots of congestion issues so my APAP pressure varies to accommodate. For me, stress causes increased AHI.

[Julie]

And the last thing could be something so many of us have (again, another chicken-egg thing) which is GERD, acid reflux overnight. Try not drinking anything with caffeine for hours before bed, and nothing acidic or spicy. Big pain, but it could make a difference- after which (if it does) you could ask your MD for ongoing meds to counter it, or even just try a Tums before bed. I find it makes a big difference (and have not had caffeine anything in years).

[Wulfman]

What humidity level are you using?
Have you tried turning it Off (using "passover" mode)?


Den

[Tielman]

And the last thing could be something so many of us have (again, another chicken-egg thing) which is GERD, acid reflux overnight. Try not drinking anything with caffeine for hours before bed, and nothing acidic or spicy. Big pain, but it could make a difference- after which (if it does) you could ask your MD for ongoing meds to counter it, or even just try a Tums before bed. I find it makes a big difference (and have not had caffeine anything in years).

You may have hit the nail on the head.

I was being fairly conscious about drinking apple-juice, or water in the evenings and not eating for at least an hour (or two) prior to going to bed, but lately I've been drinking Tea (my favorite beverage), and havn't been as good about not eating prior to going to bed. I don't experience GERD, or acid reflux, but I do have a lot of gas generally I very rarely experience "heartburn" or other similar symptoms either, but as I have grown older I do have more burping with, uh, taste added .

I'll have to remember to do this for a few nights to see if it makes a big difference.

[Tielman]

What humidity level are you using? Have you tried turning it Off (using "passover" mode)?
Den

I've been pretty stable for a while at #2 (Respironics), though I have turned it to 1 and passive to cure "rain-out" during the colder nights.

I'll try it at #1 for a couple of nights and then passive for a couple of nights to see if it makes a difference.

Thanks!

[Wulfman]

There IS something called "silent GERD".
There have been a number of discussions about it on the forum.


Den

[btesterman]

I was diagnosed with GERD - don't recall that I ever had heartburn or even burping much. I did have lots of coughing and my esophagus felt "irritated" - like I could feel the air moving up and down as I breathed. Everyone is different so you just have to start taking note of things - maybe even journaling - but for me, the QUANTITY I eat has more impact on the reflux than WHAT I eat. Eating 6 small meals isn't really possible when I'm working but just trying not to pig-out helps. I keep a chart of my "numbers" and have a space for notes. You might try noting what or how much you've eaten (and any other factors, like stress, restlessness etc.) and see if there is any correlation with your AHI over a period of time. I'm not an expert - still trying to figure out what makes mine vary. If you figure it out, let ME know!!!

[bill4bikn]

I recently purchased a travel sound therapy system at Brookstone and it has definitely helped me sleep and relax better . It works on both DC and AC power . Great for travelling . Can use with ear phones . It is also a clock for home and away as well as an alarm clock . The unit has 8 sound sessions divided into 2 categories of Sleep and Relax . Using the timer you can shut it off in 30, 60 or 90 minutes. They have a return policy if it doesn't work for you . I have found it very helpful notably with the white noise component which drowns out any extraneous sounds especially from the CPAP machine. Try it you may like it .

[Tielman]

There IS something called "silent GERD".
There have been a number of discussions about it on the forum.
Den

I've read many of the comments about GERD, but kinda dismissed them.

I've always had problems with my teeth and gums (which I thought was related to my sinus issues), and for a long time now I have to cough up "something" because it would be making my voice hoarse. Both of these are related to Silent GERD. I'll definitely look into GERD more, and try and keep the time between eating and going to be at least 2 hours.

Thanks for the suggestion!!

[Tielman]

I was diagnosed with GERD - don't recall that I ever had heartburn or even burping much. I did have lots of coughing and my esophagus felt "irritated" - like I could feel the air moving up and down as I breathed. Everyone is different so you just have to start taking note of things - maybe even journaling - but for me, the QUANTITY I eat has more impact on the reflux than WHAT I eat. Eating 6 small meals isn't really possible when I'm working but just trying not to pig-out helps. I keep a chart of my "numbers" and have a space for notes. You might try noting what or how much you've eaten (and any other factors, like stress, restlessness etc.) and see if there is any correlation with your AHI over a period of time. I'm not an expert - still trying to figure out what makes mine vary. If you figure it out, let ME know!!!

I doubt we'll ever figure it all out, but we can keep trying!!

I agree with you about tracking the food, I've got an app on my iPhone for that, but I'm not using it enough. I'll definitely get back to that and see. I also agree with you about the quantity issue, which I have to admit is an issue for me. One thing you can do that I've been doing regarding the small meals is this: Eat your regular breakfast, but take a bananna, or apple (or other fruit) to work and eat that as a snack between breakfast and lunch, and between lunch and dinner, it's healthy and spreads the "meal" around to different parts of the day.

I'm thinking that I should just make a smoothie in the early evening and nothing afterwards, prior to going to bed. At least it'll be healthy, and I can see if it helps my AHI, and my weight.

Thanks for the suggestions and tips!!

[btesterman]

I just saw my doctor's respiratory therapist today and I asked him why I have occasional high AIs - doesn't coincide with a higher leak rate, could it be from a different sleeping position, GERD....... His answer was that it usually means you've had more REM sleep than normal. That is something we have no control over. Basically he said don't worry about the "occasional" anything, just look at the where you usually are at. Just thought I'd add this bit of info to the possibilities. It makes sense and relieves me of thinking I was at fault, ha, ha!

[Tielman]

I just saw my doctor's respiratory therapist today and I asked him why I have occasional high AIs - doesn't coincide with a higher leak rate, could it be from a different sleeping position, GERD....... His answer was that it usually means you've had more REM sleep than normal. That is something we have no control over. Basically he said don't worry about the "occasional" anything, just look at the where you usually are at. Just thought I'd add this bit of info to the possibilities. It makes sense and relieves me of thinking I was at fault, ha, ha!

I absolutely agree with that, and I have thrown out "outliers" before. What I was seeing was two (2) plus weeks of Up, and Down day after day, and a general slide upwards.

It seems to have settled down (less volatility) and it's slowly going back down to where it was before. I'm beginning to believe it's been stress related, as my day-to-day work stress, as well as home stress has gone down. I have been trying to eat less at night to reduce any possible silent GERD issues, so that could be helping.

Thanks for the input!