Upper respiratory illness + BiPAP = Worst AHI since starting

[robysue]

Folks,

I'm fighting the worst head cold/flu virus I've since starting CPAP back in September 2010. Serious congestion. Lungs hurt. Lots and lots of coughing, coughing, coughing with a seriously scratchy throat. And that annoying "flue headache."

The AHI started to skyrocket (for me): The last four nights the AHI > 2.75, with last night's AHI = 5.56, my worst night ever on PAP. (Oddly enough, my Zeo score still managed to hit 61, which is pretty good for me.) The first night with a high AHI was about 24-36 hours before the upper respiratory symptoms started. And last night, I was coughing repeatedly and doing a lot of tossing and turning. It's worth noting that my long term AHI numbers have been converging around 1.5 for some time. Throughout the winter months, the AHI staying below 2.5 and staying below 2 most of the time. Since Dec. 1, I have had 13 nights with an AHI > 2.75, and the last four nights are four of those 13 "bad" AHI nights. My leak lines are still "ok"---last night's leaks maxed out at 23 L/min (the expected leak rate is between 20 and 30 L/min at 4-8 cm of pressure, and I typically run a bit below the expected leak rate. So serious mouth breathing is not an issue in spite of how I'm feeling.

I'm pretty miserable today between the cold/flu symptoms and the headache and the aerohpagia. (No surprise my pressure was sitting at its maximum of 8/6 for most of the night.

My questions:

Is this increase in AHI with a nasty cold/flue pretty common place?

Can serious body-shaking coughing lead to events being scored that might not be "real" events?

Should I expect the AHI to continue to be this high until the cold/flu goes away?

[LSAT]

You seem to be more interested in your CPAP 'scores' than you are about getting rid of the 'crud'. Of course your AHI will increase when you can't breathe. Go to the doctor...get some meds....use a FF mask.

[avi123]

I agree with LSAT. There is no meaning to those values when you're breathing like that. I would try to skip XPAPing for a day or two. If I could not fall asleep then I would take sleeping Rx such as 10 mg of Zolpidem. You probably got this stuff at school.

[Madalot]

I feel for you, robysue. And I'm right there with you with the crud...

I guess I'm lucky that we don't track AHI with me so I don't have the ability to see how bad it is when I'm sick.

I think it is very common for this to happen. Try to use your machine and don't dwell on the numbers right now. Once you're over this "crud" -- it should improve.

Feel better!

[Kody]

Can serious body-shaking coughing lead to events being scored that might not be "real" events?

Yes, I have also found this to be the case. I noticed while I'm awake, if I swallow with my mask on a certain way, I will hear a "chunk chunk" sound (air flow getting interrupted inside the mask), and it gets scored as a Hypopnea on my data.
Hope you feel better soon and your numbers go back to normal as well, it's no fun being sick.

[RandyJ]

robysue,

In response to your 1st question, I can say that the answer for me was "yes." I had my 1st cold in 4 years or so last November; it was also my 1st cold since starting cpap in March 2011.

My usual AHI is between 0.1 and 0.5. For the 1st few days of the cold when breathing was an issue, AHI ranged between 2 and 6. I had been using a fixed cpap pressure so I set the machine to apap with room in the upper part of the range to allow it to deal with the events and AHI decreased a bit, but things didn't go back to normal until I was over the cold. I was also taking Sudafed and Mucinex so I figured they could be affecting AHI as well.

I had to use my full face mask for a week or so since my cold was mostly in the head; I didn't experience much coughing.

I hope you feel better soon ...

[robysue]

You seem to be more interested in your CPAP 'scores' than you are about getting rid of the 'crud'. Of course your AHI will increase when you can't breathe. Go to the doctor...get some meds....use a FF mask.

Crud is crud and (at this point) I don't really need a doctor with weekend hours to tell me:

It's likely a virus.
Get plenty of liquids.
Avoid dairy.
Use saline nasal spray and neti pots and a decongestant.
Try to get plenty of sleep.
You'll be better in a week or so.

And things really didn't go seriously downhill (symptom-wise) until last night (after 9:00 pm) and this morning. Prior to last night, there was some minor-to-moderate daytime and nighttime congestion and some minor achyness and fatigue. But last night the coughing started sometime after supper and got much worse after 9:00 pm. And I've already got a doc appointment with the PCP that was already scheduled for Monday for other things.

As far as the AHI stuff: It's not that I'm worrying about how to get the AHI down----it will come back down when this dang cold/flu is over and done with in another 3--5 days. I'm just a bit surprised that the jump last night was from the 2.75-3.5 range (where it had been since 24 hours before the cold/flu symptoms started) all the way up to 5.56. So I'm posting more out of curiosity than anything else:

A) Since the first sharp jump in AHI (from 1.0-1.5ish to 2.75ish) occurred a day or two before the symptoms showed up, I'm wondering if my AHI just might be useful as an "early warning system" for particularly bad colds/flu in the future?

B) Since I know I was coughing all night long with the nasal pillows on, I'm wondering if any of the bad coughing spells could have been recorded as OAs or Hs? And if that's the main culprit behind this second sharp jump in AHI?

I agree with LSAT. There is no meaning to those values when you're breathing like that. I would try to skip XPAPing for a day or two.

As for going maskless for a day or two: My discomfort while sleeping was coughing, coughing, coughing, which in turn triggered some moderate knee pain from the almost, but not quite healed torn MCL. The bipap actually seems to help mitigate the worst of the congestion. Pre-CPAP I would have been tossing and turning all night long with both the coughing, coughing, coughing, AND the need to repeatedly turn from one side to the other to "unstuff" the super-clogged "bottom" nostril. With the BiPAP, that bottom nostril never seems to get quite so uncomfortable as it used to get pre-CPAP. So overall, sleeping with the BiPAP was not the issue. Dealing with the post-BiPAP aerophagia all day long is an issue, but it's been far, far worse in the past. And so more than anything, the aerophagia was an unwelcome reminder that I really don't want to go back to straight Bi-level at 8/6.

[BlackSpinner]

Yes staying on cpap helps A LOT! The humid forceful air really helps.

Regarding the higher AHI - that makes sense - all your breathing passage are inflamed and therefore smaller and easier to close. That probably started before you noticed the other symptoms.

Do keep an eye of the coughed up crud, says the person who has had pneumonia twice. If you have an oxymeter now is the time to use it.

[ems]

It's likely a virus.
Get plenty of liquids.
Avoid dairy.
Use saline nasal spray and neti pots and a decongestant.
Try to get plenty of sleep.
You'll be better in a week or so.

Exactly! My bill is in the mail.

I had this a few weeks back and paid for that advice... silly me.

Your bug is gonna run its course, like it or not. So, see the above.

Feel better!

[chickwriter]

Definitely the cough/cold thing affects AHI - I've been recovering from bronchitis/sinus infection + the usual annual OMG!Pollen for the past few weeks & my AHI went up to 1.5-2.0 - when it's been below 1.

Worst is the middle-of-the-night coughing, which has lasted for > 4 weeks - it's better, but still present. (And this is normal, says my doc).

I highly recommend extra nasal rinses - I'm doing 2x a day now, instead of my usual 1x day. Seems to help a bit. Also, ginger & lemon hot tea.

Hope you start feeling better soon!