AHI going up - unexplained

[Jason S.]

My nightly AHI used to be in the 1.0-2.5 range. Lately, its been in the 3.5-5.0 range. I'm not doing anything different and the leak rates have been the same. I'm using APAP with a range of 8-12 cm, but my pressure never goes up as high as 12, usually my average pressure for the night is 8.5-9.0. I was titrated at 8cm. I've had significantly more events and event clusters in the last two weeks. No changes in my life or health to explain it.

Any suggestions? Thanks.

[Julie]

Any possibility you've put on a few pounds without realizing it?

[Wulfman]

Move your minimum pressure up. I would guess that there are events occurring that need higher pressure to prevent. Titrated pressures aren't always accurate and the "average" pressure is usually too low.


Den

[Jason S.]

Any possibility you've put on a few pounds without realizing it?

At most 5 lbs. Do you think that could account for it?

[Jason S.]

Move your minimum pressure up. I would guess that there are events occurring that need higher pressure to prevent. Titrated pressures aren't always accurate and the "average" pressure is usually too low.
Den

I could do that, but it doesn't appear by my data that the pressure is wanting to go higher. Otherwise, wouldn't I be seeing my pressures rise to 10, 11 and 12cm?

[Jason S.]

One thing I thought of was increased supine sleeping. I know my OSA is worse that way. I think I used to be more cognizant of back sleeping, but now I often find myself waking up there. My Mirage Quattro leaks at the mouth while on my back, but not on my side. I suspect this is because when my jaw goes slack, gravity creates a gap in the seal between my upper jaw and the mask.

[Wulfman]

Move your minimum pressure up. I would guess that there are events occurring that need higher pressure to prevent. Titrated pressures aren't always accurate and the "average" pressure is usually too low.
Den

I could do that, but it doesn't appear by my data that the pressure is wanting to go higher. Otherwise, wouldn't I be seeing my pressures rise to 10, 11 and 12cm?

If the events are occurring BEFORE your pressure can go higher, then the events will occur. The increased minimum could possibly preempt those events.

On the other hand, if your events are due to your sleep position (as you noted in the subsequent post), then that would account for the increased number.......BUT, if you need to compensate for the supine sleeping position, you would also need to increase your minimum pressure (and probably by quite a bit).


Den

[Jason S.]

Move your minimum pressure up. I would guess that there are events occurring that need higher pressure to prevent. Titrated pressures aren't always accurate and the "average" pressure is usually too low.
Den

I could do that, but it doesn't appear by my data that the pressure is wanting to go higher. Otherwise, wouldn't I be seeing my pressures rise to 10, 11 and 12cm?

If the events are occurring BEFORE your pressure can go higher, then the events will occur. The increased minimum could possibly preempt those events.

On the other hand, if your events are due to your sleep position (as you noted in the subsequent post), then that would account for the increased number.......BUT, if you need to compensate for the supine sleeping position, you would also need to increase your minimum pressure (and probably by quite a bit).
Den

Yeah, you are probably right. I really don't want to jack up my pressure to accommodate the oft times I might roll onto my back. I guess I'll increase the minimum to (9cm?), try to stay on my side, and see what plays out.

[roster]

One thing I thought of was increased supine sleeping.

I was going to ask about that. Back sleeping will definitely bring the AHI up in some people. You may require more pressure while sleeping on your back. Look at the clusters and see if you can correlate them to the supine position. I know it is maybe impossible to know what positions you were in when sleeping.

[Autopapdude]

My nightly AHI used to be in the 1.0-2.5 range. Lately, its been in the 3.5-5.0 range. I'm not doing anything different and the leak rates have been the same. I'm using APAP with a range of 8-12 cm, but my pressure never goes up as high as 12, usually my average pressure for the night is 8.5-9.0. I was titrated at 8cm. I've had significantly more events and event clusters in the last two weeks. No changes in my life or health to explain it.

I wouldn't worry about it too much. It has gone from excellent to very good. Your AHI is still in the normal pattern, and it could be something really simple, like leaks or sleeping position. IMHO, you're still within normal treatment guidelines, so give it time, and see how it is in the long run.