AHI>10 - 1.5 yrs later

[zeleni]

Been on CPAP for 1.5 years. My AHI is still averaging over 10 with some nights above 15. I've only experiences a <5 AHI night a handful of times since I've been using the machine - even during testing. And I'm still tired. If I don't use my machine, I feel like I'm hit by a bus, so I know it's doing something. Just not as much as I'd like.

I've gone back and forth with the sleep doc, respiratory therapists, and primary physician with no luck. We've looked at my thyroid function (fine), Vitamin D levels (low but now much higher), other vitamin deficiencies (all fine now), cholesterol (very low, but increased now), narcolepsy (nope), and BiPAP (no better than APAP). My sleep doctor says it's out of his hands now. The sleep latency test showed I'm not tired - I'm fatigued - so it's not his responsibility. He wasn't that concerned with my AHIs.

I recently shifted to straight CPAP and no A-Flex. This improved my clear airway events, but my obstructives increased to make up for it.

I've used nasal masks (hurts the bridge) and nasal pillows (hurts my nostrils), but full face masks seem to work best.

A few images below for context.










Any suggestions? Anyone successfully bring their AHIs down after struggling for awhile?

Thanks!

[jdm2857]

What were your settings on APAP? Do you have data for typical night or two on APAP with
centrals?

[Denial Dave]

+1 to jdm2857 question

your charts show that the pressure is clearly not stopping obstructives, have you ever tried a slight increase pressure?

[Stormynights]

Your lower AHI seems to be with cpap at 12 or 12.5 according to your chart. Maybe bumping up the cpap pressure might help a bit.

[Wulfman...]

Do you sleep on your back?


Den

.

[Pugsy]

Back in January you used cpap mode with pressure of 12 for 3 nights...Jan 31 thru Feb 2 and the AHI average was in the 6 range.
Can you post an image of one of those nights?....what was the event category breakdown? How much of it was centrals?

I don't see a lot of purple Clear Airway (centrals) on the overview graph which shows the last 25 nights...in fact I see zero purple centrals.
All obstructive and hyponeas...the 10 cm pressure is not sufficient...if the Jan 31 to Feb 2 with cpap pressure of 12 gave AHI 6 range...unless it was half central...you need more pressure than 12 cm. Going down to 10 cm sure is the wrong way to go.

So...how many centrals each night when you used 12 cm cpap mode?
Also...how is your overall sleep quality? Wake up often that you remember?

[zeleni]

Thanks everyone

Here's a bad night while I was still on APAP and A-flex. I did have some centrals show up in my sleep studies, but the clear airways disappeared after getting off the A-flex. Not sure if it was waking me up or if the categorization just changed.



I'm going to try bumping it up a bit. Tried it at 14 cm last night and it didn't work out very well. Will keep the setting a few days to see what happens.

I do tend to sleep on my back. The full face mask makes it difficult to sleep on my side, but I do when I can.

Pugsy - here's January 31st. Those were some good nights! Unfortunately, I only used the machine for 2 hours on the night I got an AHI of 4 (although the unrecorded time was probably much higher!)



I did use the same setting for a total of 25 days after this stretch. First from 3/5 to 3/21 and then from 4/21 to 4/30. AHI averages were 10.2 and 12.25 respectively. No clearairways appear when I'm in CPAP mode - even in Cflex. They only appear in APAP with Aflex. They don't show up in any other combo.

I do remember waking up several times at night - especially in the second half of the night. I do think sleep quality has improved a bit. But I'm still exhausted and have brain fog. I'm at an average weight, but trying to lose some to see if it helps. Also trying to practice my didgeridoo more =)

Thanks again

[Pugsy]

Try cpap mode with pressure of 12 or 12.5...give it a few days/nights...the if the obstructive apneas are still too high increase to 13 and give it a few nights...go up slowly and it will be much easier for you to adjust to the pressures.
Watch the clear airways and if they start showing up in large numbers then back off the pressure increases.
The goal would be to get the pressure up to the point that the obstructive apneas and hyponeas are below 5 per hour and not have a large number of centrals (assuming you were indeed asleep).
Another goal would be good sleep quality...minimal awakenings and minimal time spent with the mask and machine on and you are awake along with more hours of sleep. I know it's a tall order.

I don't know why AFlex causes the centrals in your situation...it shouldn't but maybe your body just doesn't like the rhythm and you have poor sleep quality and maybe a lot of arousals and thus maybe a lot of sleep onset centrals with the arousals and going back to sleep.

If you are spending a lot of time awake/semi awake on the machine it may be flagging some awake/semi awake breathing irregularities by mistake.

Your report has a general pattern of increased obstructive apneas with clusters that goes along with REM stage sleep...starts about 90 to 120 minutes after sleep onset and progresses and gets worse as the night goes on with the worst part of it in the wee hours of the AM when REM stages last longer and come on more frequently. It's very common thing to have happen.
It can also happen if your OSA is worse when sleeping on your back. Normally when that happens there aren't as many gaps or little clusters of obstructives as you seem to have.
Doesn't really matter what the cause...more pressure is needed to help hold the airway open better so that the collapse doesn't ever occur in the first place no matter what the cause.