AHI/AI skyrocketing after gastric bypass surgery

[copygirl]

Hi all,
I haven't been to this board in a while, but know there's a lot of knowledge here, so I'm hoping you can help me.

I've had OSA for several years and since my second sleep study, in 2010, have used a Resmed Bipap--regular, not auto. I've never been able to get good numbers on this machine, even after my third sleep study in 2012. My AHI was usually about 9, AI 1 or so.

Three weeks ago I had gastric bypass surgery. Since surgery my machine tells me I'm averaging an AHI of 29 per night! I thought it was the percocet I was taking, but the past two nights I didn't take it and still had an AHI around 30 (AI about 11). What on earth could be causing this?

For reference I have lost 17 pounds since surgery and 45 overall since my last sleep study, where I got my current settings of 15/11.

Is it possible that my weight loss is making it unnecessary to have such high settings? If so, would that cause something to happen with my breathing that would give me AHIs of 30 a night?

When I wake up I feel ... OK. Not great, but OK.

Also, I have been having a slight leak in my mask lately, but nothing over .5.

Any thoughts? I plan to call Lincare tomorrow to see a respiratory therapist. I wish they would just give me an auto machine.

[Pugsy]

2010...would that be the VPAP that was based on the S8 machines with the Smart card in the back for data collection? It's a blue/white card about the size of a credit card?

[copygirl]

It's flat plastic like a credit card, but it's about an inch wide and two inches long. It has a gold square on the back; I assume that's where the data is transferred.

[Janknitz]

This is where it would make SO much sense to have a fully data capable auto machine. You should check with your insurer to see if it's at all possible to get a newer, auto biPAP, but it's likely that you will have to wait until you've had this one for 5 years. So instead, the insurer will probably end up paying for a new sleep study or two.

Doctors often assume that obesity causes sleep apnea and losing weight will cure it, but that's not necessarily the case. The only way to tell--without a fully data capable auto--what your current pressure needs are is to do a sleep study.

[copygirl]

Yes, I completely agree--I would LOVE to have an auto machine. In the past, when I've been between sleep studies, the resp. therapist loaned me an auto machine to use for a week or so. It was a kind of ghetto "home titration." I'm hoping she'll do this again.

I don't want to have another sleep study so soon; it should really wait until I'm months further down the line. But I *have* hit my out of pocket max, so ...

[copygirl]

Also, something else that may be helpful to know--a couple of nights I've ripped off my mask in my sleep. I've *never* done that before. From the very first night they put the Cpap mask on me, I took to it like a fish takes to water (is that the right analogy?)

[Pugsy]

You might ask if they will let you trial one of the new S9 VPAP Auto machines.
The new machines offer more comprehensive data that may be of benefit to you along with the auto adjusting pressure mode availability. New data includes central apnea event collection as well as actual flow rate graphs along with a couple of other graph features.
Things have improved considerably in data and therapy since your VPAP S was the latest and greatest.
Your machine is based on the older technology..the S9 is the latest technology.
Plus the S9 uses a little SD card (like a photo digital card) for data gathering and software to monitor the data gathered is easily found and used.
Your Smart card machine requires a special card reader that is expensive and hard to find.

[copygirl]

Looks like I'm going to do a two-week trial on an auto bipap. Hoping that gives me some answers (and some quality sleep).

[Julie]

I think you should give it all more time - you haven't actually recovered from the bypass yet and your body is going through many changes. Of course you're concerned about AHI's but if you don't actually feel too bad, maybe stop looking at numbers just for the immediate future and see how things go otherwise. It's also quite possible that you might not even need Cpap at all in time (it happens frequently after bypass surg.) and what's happening now is readjustment I think, rather than something to imagine you're stuck with.

[copygirl]

I'm going to update this in case anyone in the future goes through something similar--looks like my AHI was super high because my pressure was too high for me after losing weight.

Resp. therapist put me on an auto bipap, and for my first night last night, my 90 percent pressure was 12.5. That's quite a drop from my prescribed bipap pressure of 15. My AHI was about 12 I think, not great but much better than the 29 I've been getting the past few weeks.

So I guess a weight loss of 50 pounds can make a big difference. I hope that, Lord willing, as I lose more weight, my pressure will drop even further. Meanwhile I am SO GRATEFUL for this auto bipap.

[snoringshrink]

I'm down 80 pounds and am four months out from a RxY gastric bypass. I have not noticed any change in my pressures since before surgery and I'm less than 25 pounds away from my goal weight. My point to this is that you shouldn't be discouraged if you still require CPAP/APAP/VPAP treatment even at goal weight. Congratulations on such a great life change!!