changes: weight down. AHI up. pressure down. what?!?

[lebowski8]

Could I get your feedback please?

So, I started therapy back in 2009, and it has been a miracle. I've used the machine every night since then.
In '09, my weight was around 250 lbs. Peaked at 260 in 2011. Now, I'm down to 220.

In the last 90 days, I have had a noticeable degradation in my sleep.
GERD is well controlled.
Emotional Stress level is normal, maybe even less than usual.
I'm not using alcohol regularly, coffee use is lower now than last year.

2009-2013, my AHI 30 day avg was in the 0.7 to 1.2 range.
2014: my AHI 30 day avg is now over 2.0, 7 day is 2.3

I own my machines. I manage my own therapy. I haven't seen the sleep doctor since 2009.

What to do now? I downloaded Sleepyhead yesterday, I'll figure that out later.

Your suggestions are much appreciated!

[chunkyfrog]

Congrats on the weight loss. (Woo hoo!). It sounds like it's time to see the doc again.
Some folks never see a doctor unless they break a leg. They can help you stay healthy too.

[JDS74]

01/10: AHI 0.9 | BP 122/81 | SpO2: 96.5%
03/09: AHI 45.8 | BP 142/97 | SpO2: 78.9%

Are these numbers from this year?
If, so, something definitely is going on, The SpO2 number is troubling.
Do you have a breakdown of the parts of the AHI number - how many obstructive, how many hypopneas, how many centrals?
I concur with chunkyfrog, it's time for a visit to your doctor.

[Janknitz]

Check your leak rates and data. Ahi may be up for various reasons. Perhaps your face has lost weight and you aren't getting good therapy because of leaks. It's not terribly unusual to need more pressure with weightloss, but increased ahi
Does not necessarily mean you need more pressure. The data will help sort this out.

Also, what did you do to lose the weight? Increasing BP is troubling. Certain diets cause metabolic disturbance. Weight loss should not come at the expense of your health.

[RogerSC]

It also matters whether your increase in AHI is centrals or OSA. Recently, the number of centrals that I've been experiencing has been going up, OSA's are about the same, so my AHI has had several trips up (still less than 3). More centrals. Something to keep an eye on, but still not anything I can do anything about, since an Autoset doesn't provide therapy for centrals. Since my OSA's aren't increasing, that's just the way that it is. I'm trying to identify the cause, but don't know of anything that's changed, either.

Anyways, check it out. Sounds like you're headed that way with Sleepyhead.

[Guest]

No, those numbers are from a) January 2010 and b) March 2009. -- so that's the old improving trend.
My BP is still around 120/80 and I haven't done a SpO2 reading since 2012.

01/10: AHI 0.9 | BP 122/81 | SpO2: 96.5%
03/09: AHI 45.8 | BP 142/97 | SpO2: 78.9%

Are these numbers from this year?
If, so, something definitely is going on, The SpO2 number is troubling.
Do you have a breakdown of the parts of the AHI number - how many obstructive, how many hypopneas, how many centrals?
I concur with chunkyfrog, it's time for a visit to your doctor.

[lebowski8]

Thanks for the feedback.

OK, so I got Sleepyhead working. I couldn't get it to work on my Windows XP 3 machine but it was fine on my wife's iMac.

Anyway, I analysed the trend in the last 12 months-- the worsening trend started around May 1. On a nightly basis, 80% of events happened from 3:30 am to 6 am (I wonder why that is?). Most of the events seem to be centrals.

Mask leak is near zero, no periodic breathing.

I looked back at my best 3 months, which looked like October to December. I had slightly different pressure settings then (the Min and Max were 1 cm higher).

So I changed that to match the October to December settings. I'll give it a month and report back.

[zoocrewphoto]

Thanks for the feedback.

OK, so I got Sleepyhead working. I couldn't get it to work on my Windows XP 3 machine but it was fine on my wife's iMac.

Anyway, I analysed the trend in the last 12 months-- the worsening trend started around May 1. On a nightly basis, 80% of events happened from 3:30 am to 6 am (I wonder why that is?). Most of the events seem to be centrals.

Mask leak is near zero, no periodic breathing.

I looked back at my best 3 months, which looked like October to December. I had slightly different pressure settings then (the Min and Max were 1 cm higher).

So I changed that to match the October to December settings. I'll give it a month and report back.

If they are mostly centrals, it could be that you are tossing and turning more and thus holding your breath a lot. Do you feel like you have been more restless? Are there more noises at the time of morning than before the season changed? Do you feel like you are dreaming more? REM sleep is usually more frequent and longer toward the end of our sleep time.

Do you normally get up at 6am, or do you sleep longer than that and the events calm down again?

[Day_Dreamer]

Are you taking any medications or sleep aids after 3:00 ?

[Julie]

Any chance you have put back on even a little bit of weight - it can change the numbers.

[Todzo]

I remember a situation similar to yours and about the same time of year (related to Vitamin D?). I had lost a similar amount of weight and spring had sprung.

In my case I already pretty well knew that I needed to reduce pressure. There was much less of me out there to push back against the pressure of CPAP (15 cm/H2O at that time).

With few doctors near my new digs and a need for a change I decided to self titrate. Using the SleepHead data as a guide I simply started reducing pressure 1 cm/H2O at at time and looking at the results for a week or ten days to decide what to do next. My problematic breathing instability (the result of my high respiratory gain plus the CPAP pressure) went away at 12 cm/H2O but obstuctions did not occur until 7 cm/H2O so I ended up using 8 cm/H2O.

Most people think of sleep apnea only as obstructive sleep apnea. However there is a much broader spectrum of causes of apnea. As well the point at which arousal occurs with an event may well change. They are beginning to sort it out[2,3].

I and others have found moving vitamin D3 into its active range helpful. 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 believe that a level lower than 50 ng/mL is not good and Dr. Stasha Gominak recommends 60-80 ng/mL for good health. It would probably be wise to check your vitamin D3 levels. See “The Vitamin D Council” for assay details.

And during my journey away from sleep apnea I have found that I did not know how to eat well or move well. My three years with a dietitian helped start me on my continuing life long journey to eat well. I still strive toward the basic goal of 10,000 steps a day (running about 80% at this time) and do intend to use more personal trainer time as I pursue an active lifestyle. Lately I have been thinking that running, which is known to help with brain development, might well be worth the risks to my knees at my advanced age. By eating well and moving well I hope to promote whole body metabolic health and I can say it does appear to help with my tendency to have centrals emerge as I use CPAP.

hth


[1] Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934 Related article (commentary):833

[2] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[3] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

[4]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741