PROGRESSIVE RECENT INCREASE IN AHI & PERIODIC BREATHING

[mcs2015]

3 year anniversary of use Philips Respironics DreamStation Auto CPAP.

OSCAR DATA:
https://app.box.com/s/d44b3f38ugoqp0fuu8i6x3pxjs8cu4fm

Over time, AHI increase has progressed (2-3 avg for the last couple years). I was good up until May, 2020, and then AHI started a faster ascent to an avg of 6.9 in the last 2 weeks.
You can also see from the data an increase in periodic breathing. Why the very recent increase remains a mystery. That's what I'm here for, as hopefully someone experienced in reading my data can make some substantive inferences.

Periodic breathing a year ago was 0.5%, pressure 5.8%.

I was @ minimum pressure of 5 for last couple years, then went to 6 on A-flex for this last year and just increased it to 6.5 4 days ago to see if it would improve when it actually worsened. Such a small adjustment, it's hard for me to believe this much difference.

Another observance which I know can be related but not certain is that around same time the jump in AHI, my PVCs started increasing. I am fully aware that ectopic beats can go hand-in-hand. I am also experiencing late day/early evening energy dips where I just fall asleep at the computer.

From what I'm researching, an increase in periodic breathing could be an indication of CSA which has me concerned. I've never been dx'd with CSA before, only mild-moderate OSA.

I had a septoplasty/turbinate reduction to correct a deviated septum 12/16. While my nasal airflow and breathing improved, it was limited to mostly the right nostril and many times, I wake with zero airflow in the left nostril.

As you can see, mask fit has been consistently 99-100%.

I do not drink alcohol, don't smoke, and have not changed any meds (blood pressure, thyroid), supplements or diet. The only thing I did add was prescription growth hormone to help recover from hand surgery which coincidentally is when I started observing a more sudden increase in AHI and ectopic beats.

My weight is pretty much the same as it was last year, maybe a couple lbs heavier.

Appreciate any an all input!

[Julie]

You said your results worsened after using exhale relief, but did you feel better using it, or worse?

I ask because generally when exhale pressure is moderated AHIs can tend to go up a small bit, but not enough to stop the exhale relief if it helps you to breathe and sleep better, and is often accepted as a side effect.

Or, do you actually feel worse?

I would also raise your min. setting by 1-2 cms as it's very low and can make breathing difficult.

[Miss Emerita]

I think it'd be worth talking with your doctor about a couple of things.

First, the potential side effects of growth hormones are not trivial and can include factors connected with sleep:

https://www.mayoclinic.org/drugs-supple ... g-20069416

Especially given the correlation between the increase in your AHI and your taking this drug, you should ask your doctor whether there may be a good reason to discontinue it.

Second, please draw your periodic breathing to the attention of your cardiologist. It may well be insignificant, but some types of PB can be indicative of heart failure. If the proliferation of hypopneas is occurring during the PB episodes, you should mention that as well. In other circumstances, I might suggest that you post a zoomed-in view of a PB episode for review by the experts here, but given your heart issues, I think your best course is to go to your cardiologist with this. You can show him or her the zoomed-in view.

[Cannuck 1]

Interesting you received a some surgery and the right nostril is working the most, it must be forcing air in under more pressure because left nostril is not functioning as it should.
You did not mention what mask you are using? I think you are using a pillow mask!

[mcs2015]

Interesting you received a some surgery and the right nostril is working the most, it must be forcing air in under more pressure because left nostril is not functioning as it should.
You did not mention what mask you are using? I think you are using a pillow mask!

Dreamwear nasal mask.

[mcs2015]

You said your results worsened after using exhale relief, but did you feel better using it, or worse?

I ask because generally when exhale pressure is moderated AHIs can tend to go up a small bit, but not enough to stop the exhale relief if it helps you to breathe and sleep better, and is often accepted as a side effect.

Or, do you actually feel worse?

I would also raise your min. setting by 1-2 cms as it's very low and can make breathing difficult.

Don't feel any difference.

[Julie]

Well, I would raise your min. pressure by a couple of cms for a few nights and see if that helps... and if your AHI also goes up by a couple, I wouldn't worry if you end up feeling better.

[mcs2015]

For the AHI & PB experts - can any one give me insight as to why the sudden increase in AHI and PB after 3 years of no issues?
As you can see, both the spike in AHI and PB are very recent. Below is the highest AHI and PB reading thus far:









I have observed that both my blood pressure and PVCs typically spike when my AHI creeps up to >5 and is many times accompanied by spike in PB.

I will be consulting with my pulmonologist and cardiologist in the next couple days.

Until then, all input welcome.

[Pugsy]

zoom in on a segment of the PB flagged flow rate....3 minute segment please.

Does it look more like this?


or like this

[mcs2015]

zoom in on a segment of the PB flagged flow rate....3 minute segment please.

Does it look more like this?


or like this

It looks like neither. What does this mean?

[Pugsy]

Probably doesn't mean much. If you haven't been sleeping well it could just be some irregular awake/arousal related breathing getting flagged. More of a symptom of poor sleep kind of thing than anything.

Periodic breathing is just a general waxing and waning of the air flow or our breathing. There are several forms of periodic breathing but the main one we are concerned about is the Cheyne Stokes Respiration pattern of breathing and it's very pronounced and usually has a lot of central apnea flags along with it.

You zoomed in a little too close...you posted a 1 minute segment...it's best evaluated at around a 3 minute segment.

In the examples I posted above...we worry about the top one and the bottom one of mine...we shrug our shoulders and move on.
But I always tell people that if their PB worries them....talk to their doctor about it. Something seems to have changed in your situation and I would be looking more at what changed in total than just worrying about the PB. I think the PB is a symptom of something changing and not the cause of the change.

[mcs2015]

Probably doesn't mean much. If you haven't been sleeping well it could just be some irregular awake/arousal related breathing getting flagged. More of a symptom of poor sleep kind of thing than anything.

Periodic breathing is just a general waxing and waning of the air flow or our breathing. There are several forms of periodic breathing but the main one we are concerned about is the Cheyne Stokes Respiration pattern of breathing and it's very pronounced and usually has a lot of central apnea flags along with it.

You zoomed in a little too close...you posted a 1 minute segment...it's best evaluated at around a 3 minute segment.

In the examples I posted above...we worry about the top one and the bottom one of mine...we shrug our shoulders and move on.
But I always tell people that if their PB worries them....talk to their doctor about it. Something seems to have changed in your situation and I would be looking more at what changed in total than just worrying about the PB. I think the PB is a symptom of something changing and not the cause of the change.

Just had consult with my pulmonologist. Since I am on autopap setting, he doesn't put much creedence in the AHI/PB readings and suggested that auto is not the way to go if it turns out I have CSA. I am due for another follow-up titration study. Last one was a year ago and I could not tolerate CPAP with an 8 pressure setting and went back to auto.

[Dog Slobber]

Just had consult with my pulmonologist. Since I am on autopap setting, he doesn't put much creedence in the AHI/PB readings and suggested that auto is not the way to go if it turns out I have CSA. I am due for another follow-up titration study. Last one was a year ago and I could not tolerate CPAP with an 8 pressure setting and went back to auto.

I think the clinical term for what you're experiencing is pulmonologist-full-of-shit-arrhea.

[zonker]

Just had consult with my pulmonologist. Since I am on autopap setting, he doesn't put much creedence in the AHI/PB readings and suggested that auto is not the way to go if it turns out I have CSA. I am due for another follow-up titration study. Last one was a year ago and I could not tolerate CPAP with an 8 pressure setting and went back to auto.

I think the clinical term for what you're experiencing is pulmonologist-full-of-shit-arrhea.

<sigh> and me (temporarily) without me gif<insert man hiding gif here>

[mcs2015]

Update:

Just had a follow up titration sleep study since APAP pressure setting from 6.50-20.0 was recently showing higher AHIs than earlier this year and prior (see above).

Study showed: "The patient showed a significant reduction in the number of sleep disordered breathing events during the night, falling from 12.5 /hr during the control night to 0/hr with the tittration of nasal CPAP to 8cm H20. Oxygenation and sleep improved on optimal CPAP, which also eliminated the snoring. The patient tolerated CPAP and was willing to use it. A long term trial on nasal CPAP at 8 cm H2O with heated humidification is recommended."

My first night on CPAP @ 8.0 I tolerated well, but my AHI did not drop. Increased pressure last night to 9.0 and AHI dropped to 1.99 which is less than half of my average for the last few months.  First time in months I was at this AHI.

Questions: Do comfort settings influence the AHI? C-Flex+3 is what I have it set to now.

What is the significance of PB? Is there a normative range like with AHI?

I tolerated the 9.0 pressure well, but the frequency of dry mouth wakes me up. I have the humidification set to 5 with a full tank of water. What else can I do???