AHI suddenly higher

[Outlier]

I'm 35 days into APAP therapy. I immediately started sleeping well, had no problems with the mask or leaks, and have been compliant every night. After about two weeks in, I started feeling amazing, and my AHI was consistently under 4. Even when I had a higher AHI, it was no higher than 6 or 7. Then about a week and a half ago, for no apparent reason, my AHI jumped considerably and has averaged between 10 and 12 since. Now I'm just feeling okay, and I don't have the abundant energy that I had been experiencing.

So what would explain this sudden jump? I at first attributed it to a worn out mattress, as I was having significant back pain that was keeping me awake and preventing me from staying in one position for too long. I replaced the mattress and box springs four days ago, but have seen no improvement whatsoever in the AHI. I have my one month follow-up with the sleep doc Friday, but I don't anticipate getting too many answers from him, unfortunately. I suspect he might prescribe a change in pressure. I'm currently prescribed a pressure of between 5 and 12, and my average pressure over the duration of the therapy has been 11.6. However, the average pressure over the last week has been 12. Any thoughts?

[JDS74]

Do you use SleepyHead or ResScan to get detailed reports?
Can you see what components of the AHI number being reported are now higher?
I think your machine's LCD display can give better detail than most others so you might get some clue there.

For example, OSA may have gone from 2 or so to 9 to account for the change.
Or CSA may have made a simiar move.

Without this kind of detail, it would just be a guess in the dark.

[Sheriff Buford]

I would most certainly bump my upper pressure up towards a 14. Your machine won't go higher than it needs to treat an apnea incident. In my view, don't worry about the jump on AHI. It's too early to determine what's "normal" for you. Sometimes my AHI is low, and the other morning, I woke up with a .9, which was the highest AHI I have ever received. The next night, the AHI was back to normal. It'll bounce around...

Sheriff

[Tom W]

I'm currently prescribed a pressure of between 5 and 12, and my average pressure over the duration of the therapy has been 11.6.

This is telling me that you're spending close to zero time down near 5 and most of your time up near 12.

I would think your doctor will (should) raise your minimum pressure to something closer to 8 or 9.

Waking up can 'reset' the pressure back towards the lower portion of its range causing an increase in your AHI.

A sleepyhead report would be nice to see.

[SleepyBobR]

I would most certainly bump my upper pressure up towards a 14. Your machine won't go higher than it needs to treat an apnea incident. In my view, don't worry about the jump on AHI. It's too early to determine what's "normal" for you. Sometimes my AHI is low, and the other morning, I woke up with a .9, which was the highest AHI I have ever received. The next night, the AHI was back to normal. It'll bounce around...

Sheriff

.9 is the highest you've ever had? Did you mean 9?

[Sheriff Buford]

I would most certainly bump my upper pressure up towards a 14. Your machine won't go higher than it needs to treat an apnea incident. In my view, don't worry about the jump on AHI. It's too early to determine what's "normal" for you. Sometimes my AHI is low, and the other morning, I woke up with a .9, which was the highest AHI I have ever received. The next night, the AHI was back to normal. It'll bounce around...

Sheriff

.9 is the highest you've ever had? Did you mean 9?

I normally get a .2 or .3... and two or three times a month, I'll get a zero. A .9 was the highest I've ever gotten. Sheriff

[Outlier]

Is this what you mean by a Sleepy Head report?


http://www.filedropper.com/102213report

[JDS74]

Is this what you mean by a Sleepy Head report?


http://www.filedropper.com/102213report

Yes that is such a report.
However, it doesn't show the components of the AHI.
You need to post the part that shows CSA, OSA, Hypopnea, Flow Limitation, etc.
It appears on the left side of the screen and shows a pie chart with the proportions with the details below.

[Outlier]

Here's a super-detailed report from Rescan. It has my name and birthday, but what the hey, the NSA is already well aware of all that:

http://www.filedropper.com/102213rescanreport

I'm not sure how to make a report of the pie chart deal in Sleepy Head.

[Pugsy]

How to post images of reports is explained in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779
There's also some examples of what we like to see in the way of the SleepyHead detailed daily reports.

[Todzo]

I'm 35 days into APAP therapy. I immediately started sleeping well, had no problems with the mask or leaks, and have been compliant every night. After about two weeks in, I started feeling amazing, and my AHI was consistently under 4. Even when I had a higher AHI, it was no higher than 6 or 7. Then about a week and a half ago, for no apparent reason, my AHI jumped considerably and has averaged between 10 and 12 since. Now I'm just feeling okay, and I don't have the abundant energy that I had been experiencing.

So what would explain this sudden jump?

Well the first thought that comes to mind is that your therapy was working. So you have less things pulling your Central Nervous System(CNS) down so your breathing system control loop gain is a bit higher.

The first thing that seems to happen to me when I over breath is that my nose stuffs up. In your case I suspect that snoring or flow limitation from this causes your APAP to up the pressure, which tends to make you breath even more – making more snoring and flow limitation – which makes you uncomfortable – so you move around more and make leaks on top of all the rest.

Another thing that comes to mind is that where I live at least there will not be enough UVB available from the sun for me to make any skin made D from about August through April. Historically I have problems related to breathing control this time of year and the added pressure (breathing system gain) from CPAP frustrates my CPAP therapy this time of year.

This year I am trying something new. I am supplementing D3 hormone (A.K.A. Vitamin D3) and doing very light tanning booth sessions at my gym (no pinking allowed!!!). After six weeks I do seem to be having less problems with nighttime unstable breathing (CPAP flow data) and during the daytime I note that it is much less often I find myself over breathing and much easier to bring it under control.

Those who are working with the D3 hormone (A.K.A. Vitamin D3) (e.g. Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., Vitamin D Council) seem to be finding that the very low side of the “normal” range of 30-100 ng/L produces a range of symptoms including OSA, pain, and infection. All recommend a level above 50.

You might get your D3 levels checked

I at first attributed it to a worn out mattress, as I was having significant back pain that was keeping me awake and preventing me from staying in one position for too long. I replaced the mattress and box springs four days ago, but have seen no improvement whatsoever in the AHI. I have my one month follow-up with the sleep doc Friday, but I don't anticipate getting too many answers from him, unfortunately. I suspect he might prescribe a change in pressure. I'm currently prescribed a pressure of between 5 and 12, and my average pressure over the duration of the therapy has been 11.6. However, the average pressure over the last week has been 12. Any thoughts?

1. Raise the head of your bed a few inches. This will lessen the possibility of an obstructive event.
2. Spend some quality time with the machine during the day learning to breath quietly and gently with the machine (as you should while you are alseep). Your CNS is likely changing and “recalibration” of your systems is in order. Spend time without distraction (on the bed but awake) and with distraction (light TV, book, music).
3. If you are doing no aerobics start them if possible. If you are doing aerobics regularly consider adding some Maximum Heart Rate interval training. This will help manage stress in your life, is good for the CNS, and helps keep the breathing reflexes healthy.
4. Do what you can to lessen stress.
5. Be careful to not eat too many carbs, and stay pretty much away from added sugar. This time of year it is easy to over consume.

[Outlier]

How to post images of reports is explained in this thread.
viewtopic.php?f=1&t=81072&p=737779#p737779
There's also some examples of what we like to see in the way of the SleepyHead detailed daily reports.

Ah, I see, screen shots. Thanks, Pugsy.

And Todzo, thank you. That eating right and exercising bit is the hardest part of all for me. I'm making small changes in that direction, but probably not enough yet to make any real difference.

[Outlier]

Last one, I promise - still getting the hang of all this. This is the pie chart dealio from Sleepy Head for last night:


http://www.filedropper.com/101213

[JDS74]

Outlier

Now we're cooking.
It looks like you have had a sudden increase in obstructive apnes compared to not too long ago.

Take a look at the same piechart from when your AHI was much lower.
If the OSA number is much lower, then that confirms what is happening.

The solution is two-fold,
1) talk to your doc about raising your pressure range ,
2) work on controlling the sporadic leaks in your mask. A higher pressure that treats your obstructives better will make any mask mis-adjustment leaks worse.

Separately, look really hard at any changes in your diet. For me, any intake of caffeine, causes me apneas numbers to double. To get an idea of how sensitive I am, just three Hershey Kisses in the morning will totally mess me up that night more than 12 hiurs later.

So, you won't necessarily be looking for some great change, perhaps a change to more spicy food, chocolate, some anti-anxiety med such as one of the benzodiazapenes, etc.

Good luck.

[Captain_Midnight]

Outlier, before changing pressure, consider changing machine filters and snugging mask a bit to prevent smaller leaks.

Good luck sorting this out.

.