Question about AHI & Sleep quality

[Cryssied]

I will confess that part of this post is to celebrate having my new doctor and a hugely positive change in my therapy!

I went to my sleep doctor the day before yesterday, and she said my "grades" were excellent. She was concerned to hear that I was still having frequent wakings, daytime sleepiness, migraines, and no dreams. She checked the machine, and for whatever reason, my old doctor had set my APAP capable machine to a set pressure of 8. I think he only prescribed the APAP Data capable machine because I asked for it, I don't think he knew what he was doing with it.

My new doc changed it to 6-16 cmH2O. Almost immediately I went from waking at least 5x a night to waking 1x a night. I dreamt both nights but not excessively, and I feel amazing! My numbers are still crazy good, but I noticed that my AHI increased along with the pressure increase. I'm NOT complaining at all, but I am super curious as to why that would be.

Does anyone know? Coincidence?

As I said before, I'm just in shock at what a difference a good doctor can make! I should've known there was a problem when I liked my DME better than my doctor!

[Pugsy]

What category of events in the AHI seems to have increased a bit?

[Matt00926]

According to the pressure recordings, there are times that the machine goes above 8cm h2o - which before, at a set pressure, the machine could not. And then on the lower end, since the min pressure is now 6cm h2o, the machine is also not able to prevent some events that were prevented before at 8cm h2o - which may explain the AHI increase (although obviously, your numbers look pretty swell). I would try raising the min pressure to 7 or 7.5, since you're already used to 8. But if the machine wants to go higher, your doc was correct in widening the max pressure.

[Julie]

You're apparently using the EPR (exhalation pressure relief) which always comes with a slight rise in AHI, though if that's not a concern and/or you still feel rested, and you like the feature, then I wouldn't be concerned about it.

[Cryssied]

Thank you all for your replies!!

Pugsy, it is an across the board increase both my OSA and Central doubled.

Julie, that makes a lot of sense. The higher pressures would make the effect of the EPR more significant? I think I'll turn that off simply because at 6cm I doubt the EPR really does much and the pressures don't rise until long after I'm asleep.

Matt, I think that's good advice, but since my numbers are good I'll probably leave it just the way the doc set it. I actually like starting off at 6 until I fall asleep! I didn't think I would like it because I couldn't stand the ramp feature.

You guys rock!

[Pugsy]

According to the pressure recordings, there are times that the machine goes above 8cm h2o - which before, at a set pressure, the machine could not. And then on the lower end, since the min pressure is now 6cm h2o, the machine is also not able to prevent some events that were prevented before at 8cm h2o - which may explain the AHI increase (although obviously, your numbers look pretty swell). I would try raising the min pressure to 7 or 7.5, since you're already used to 8. But if the machine wants to go higher, your doc was correct in widening the max pressure.

The bulk of the AHI is Central/Clear Airway and more pressure isn't going to fix those type of events with this model machine.

The obstructive index was 0.39....doesn't necessarily need reducing further.

I wouldn't change anything if it were me and this was a typical night. If the increase in events is central/Clear airway I wonder if now that better sleep is obtained that maybe the centrals are normal sleep onset centrals because the normal sleep cycles are happening and it's normal to wake after REM (most of the time we don't remember it) and thus when we go back to sleep there's another sleep stage transition and a chance for a normal sleep onset central.

There's always the chance that those CAs are arousal or post arousal breathing...and if that is the case they wouldn't count anyway.

No matter what those CAs/centrals are...either real or Sleep/Wake/Junk...not enough of them to worry about or do anything about since it is being reported that the sleep quality has improved a lot and feeling better.

I wouldn't mess with the settings at all if it were me.

[Cryssied]

Yes, my sleep quality is much better. I woke up early this morning after only 6 hours of sleep where I used to sleep 12 hours desperately trying to function. I was so tired back then! I had actually been diagnosed with mild cognitive impairment because my GP didn't realize it was OSA. (the MCI disappeared about 2 weeks into CPAP)

I feel alert on 6 hours now, it is amazing. A lot I owe to you guys as I've gotten a lot of helpful information from these forums.

[D.H.]

You numbers look reasonably good. Since you feel so much better, that's what's important.

I was advised that the EPR settings are a matter of comfort, rather than "therapy affecting" in any significant way.