Going on 2 weeks, sleeping better but AHI up?

[BlueFrog]

Well, I am almost finished with the second week of my CPAP adventure. I have the S9 and the Swift FX. I have struggled a little since the start with the usual leaks, nose irritation and just getting used to having something foreign strapped to my face. I have, however, felt awesome during the day, no matter how interrupted my sleep may seem. That being said, the last two nights I have slept wonderfully. I only woke several times, usually for a small leak, which I can now fix just by twitching my nose or moving the pillows with my lips! But, my AHI was hovering around 3.0- 3.5 prior to these two wonderful nights and now it has been 6.5 and 4 the last two nights.

Any explanation on what may have caused this? No alcohol or late night feasts, so the playing field has been the same all nights.

Also, with a auto CPAP what can you do to lower the AHI? It is presently set from 5-20 with the EPR? at 2.

Thanks!

[Pugsy]

my AHI was hovering around 3.0- 3.5 prior to these two wonderful nights and now it has been 6.5 and 4 the last two nights.

Any explanation on what may have caused this? No alcohol or late night feasts, so the playing field has been the same all nights.

If you are sleeping more...that just gives you more of a chance to have apneas pop up. Could also be that with more sleeping your are getting more REM sleep and it's fairly common for people to have more events during REM. So the increase in AHI simply could be that you are sleeping more.

If your AHI is mainly "centrals" we don't do anything except look at them. If you are waking during the night you may be seeing repeated sleep onset transition centrals which are normal and not normally something we worry about unless they are present in extremely large numbers or they disturb your sleep (waking up a gazillion times so never really getting to sleep).

We all have centrals from time to time...we don't treat those with pressure when using apap/cpap machine. Unless their numbers are excessive we just ignore them.
So when evaluating pressure needs and looking at the AHI you have to remove the central index from the AHI.
This is why I ask "what is the event category breakdown of your AHI"....anytime people want to maybe change their pressure to try to reduce the AHI. Sometimes a pressure change won't help if the AHI is predominantly central in nature.

So with your AHI of 6ish..how much of it is central (clear airway events in SleepyHead)?
Remove the central index from the AHI and what is left is the index for obstructive apneas and hyponeas and those we do treat with more pressure.

If what is left is mostly obstructive apneas and/or hyponeas then all I would do to try to reduce them is maybe a little more minimum pressure. Since you are using 5 minimum pressure now..then maybe try 6 cm minimum pressure.
It all depends on what type of events you are seeing.
All this is assuming that leaks are well managed.

[BlackSpinner]

There is software called Sleepyhead which will show where this is occurring. Also if you can figure out your 95% pressure then you can set your lower number (5) closer to where it needs to be 95% of the time. It takes time for the machine to increase the pressure and the longer it takes the more chance of an event there is.

[BlueFrog]

Thanks for your input! I am still learning the numbers thing...I hope to have time to read Pugsy's sticky later (working 50 hours a week right now)

How do I insert my sleephead screen shot here?

[cdru]

I wouldn't worry about those numbers for just a night or two. AHI of under 5 is considered normal for someone who doesn't have OSA. The goal for anyone is 0, but some nights you just aren't going to get there. If you're feeling great, I'd make note of it but I wouldn't worry too much about it. Now if it keeps going up, or you don't feel rested, then something might need tweaked.

[Pugsy]

How do I insert my sleephead screen shot here?

Explained in the sticky..
but since that's a novel to read here's the short version
viewtopic.php?f=1&t=81072&p=737779#p737779
Turn off the AHI graph so that you can get leak in the image. Go to Preferences..graphs tab and you will see it...just remove the check mark. The AHI graph isn't needed since we have a better AHI graph on the left showing the AHI breakdown into each category.

[BlueFrog]

Thanks Pugsy!

Here's my sleepyhead report...

[Pugsy]

Looks like you are having a few clusters of events. Might be REM stage sleep..especially that second one on the report at about 1:40.
Normally REM stage sleep occurs about 90 minutes after sleep onset and then starts coming more often and lasting long so that we get the most REM in the we hours of the morning.
Might also be related to position ...like maybe sleeping on your back.
Both REM stage sleep and supine sleeping are known to cause an increase in OSA events and even need more pressure during those times.
Your settings are pretty much wide open. The minimum setting is the most critical setting and I suspect if you were using a little more minimum pressure that whatever is causing your events, might be better prevented with a little more minimum pressure.
Also with a little more minimum pressure the overall pressures needed might stabilize and you wouldn't be seeing such a big roller coaster of pressures. Something to talk over with your medical care team if you want to get them involved.

Here's an example of what happens when the minimum is set more optimally. For an older machine but the principle is still there.
viewtopic.php?f=1&t=39869&st=0&sk=t&sd=a
Now I am not saying that your minimum needs to be 10 cm..just saying that maybe it needs to be increased a bit. I don't know what it needs to be..we never know till someone gets there. Usually going up slowly is suggested because it makes adjustment to higher pressures easier and we never know we might get lucky and not need as much minimum pressure as first thought.

I think the increase in AHI is from most likely sleeping better in general. Getting more REM and with more sleep we just have the chance of having more events. If we don't sleep so great we don't have as much opportunity to have the OSA events in the first place.