Considerable Increase in AHI

[nycdug]

I have been using the Respironics System One REMaster Auto A-Flex for a few weeks. I have never felt better using the machine and much of the time I think I feel worse. A week ago my AHI was .48 (0 OSA and.33 Hypopnea) now it is 4.78 (.33 OSA and 4.07 Hypopnea). I can see in the reports where the hypopneas increase. This is just before I wake up. Last night I woke up around 3:30 am. I then went back to sleep and slept until 6:30.

[Bill44133]

I have been using the Respironics System One REMaster Auto A-Flex for a few weeks. I have never felt better using the machine and much of the time I think I feel worse. A week ago my AHI was .48 (0 OSA and.33 Hypopnea) now it is 4.78 (.33 OSA and 4.07 Hypopnea). I'm using the Sleepy Head software and took some screen shots, I just don't know how to load them here. I can see in the reports where the hypopneas increase. This is just before I wake up. Last night I woke up around 3:30 am. I then went back to sleep and slept until 6:30. On the graphs it's evident that there was an increase in the hypopnea just before waking.

Review this link on how to post your screen shots: viewtopic/t95851/How-to-Post-Your-Repor ... ation.html

[Pugsy]

It might help to see the pressure graph and flow rate graph and the leak graph along with that event graph.
Exp time and AHI graph are pretty useless.
These are the graphs on the right side that I like to see
Events
Flow rate
Pressure if using auto adjusting
Leak
You can resize the graphs so that the 4 graphs will fit on one large screen shot. Turning off the pie chart will allow some important statistics to come in to viewing range.

If leaks aren't a factor then the little clusters of hyponeas might be either supine sleeping or REM stage sleep or maybe a little of both.

[tmr]

Had you done the septoplasty? It could be a factor.

[nycdug]

Yes, I did have the Sinoplasty. Had the splints removed and breathing just fine. Doctor said to lower pressure to 7-15 to see how the machine would adjust because the previous 10-15 setting was like sucking in a tornado.

[Guest]

A few observations from your posts:
You're trying to compare apples and oranges.
You've been on this therapy for a very, very, very short time. (It can take MONTHS to start feeling better even after all the proper tweaks are made.)
You had surgery. You're apparently comparing before and after.
You're using a range of pressures. And then, you changed the ranges. Pressure ranges in general can disturb sleep to the point of keeping the user from obtaining meaningful sleep quality. You may be getting bumped out of the needed sleep stages (deep and REM) and into lighter ones from the pressure changes. At some point, try straight pressure to see if that helps. "Low numbers" don't necessarily mean better sleep.

Hang in there!

[Pugsy]

Leak rates aren't a factor as they are quite acceptable.

When did you have the surgery?

What was the minimum pressure on the Aug 7 report
(it would help if we had the statistics under the AHI graphs on the left instead of the Events tab showing)?
What was the minimum pressure on the Aug 15 report? Kinda hard to see that one to get an exact number.
It appears that the minimum pressure is less than 6.2 on the Aug 15 report?
Neither one correlates (per the graphs) with 10 to 15 or 7 to 15 that you say were used.. Wonder if you need to turn off pixmap caching...I had to do that with my machine. Go to preferences then the appearance tab and remove the check mark from "use pixmap caching" and see if the pressure graphs line up to 10/15 and 7/15.

With the reduction in the minimum pressure the airway isn't being help open quite as well as it was with the higher minimum so those little cluster of hyponeas sneak past the defenses. Most of the night you do well but for some reason you need a little more pressure during those times. The most usual suspects are either supine sleeping or REM stage sleep.

I suspect that just a little more pressure would hold the airway open better and those hyponea clusters will go away. I doubt you need the original 10 cm minimum though...probably just 1 cm more minimum will do the trick. Your pressures aren't varying widely anyway. When the minimum was at 10 it really didn't even roam around much at all. The little saw tooth looking spikes are the normal test probes.

For now....looks like a simple case of just needing a tiny bit more minimum pressure...you might make sure the machine is set to 7 minimum if turning off pixmap caching doesn't change the graphs because right now it looks like the minimum is around 5 and not 7.

[nycdug]

Thanks Pugsy, I thought the same thing about the starting pressure being slightly low. My old RX was for 10-15cm. The max pressure never went above 12.5. After the surgery the ENT said I would probably drop down to 6 or 8 starting pressure. I guess I didn't mean to set it at 5 but I did. Maybe I was thinking that the machine would ramp from 5 to 7 at the time or maybe I just thought it's an APAP and will do it's thing. I'm not sure and I can barely remember my name these days. Anyway, the max pressure has only been 10.0 since the change. I'll change the starting pressure to 7. Hopefully that will work.

Unfortunately my sleep doctor is a real tool. I honestly believe that he thinks I'm lying about feeling worse since starting CPAP. He told me no one has ever told him that before and instead of suggesting tweaks told me to stop using the machine for two weeks to see how I feel. (Yes he billed for that quality advice.) Fortunately my ENT is fantastic and I made and appointment to see a new sleep specialist, one that was recommended by the sleep tech who performed my sleep studies.

Thanks again for the advice!

[Pugsy]

I wish all it took to feel the miracle was a nice low AHI and 6 hours of sleep. This therapy would be a walk in the park if that was all that we needed to feel the "miracle".
Unfortunately there's just so much more to it and sleep docs aren't real big on doing a lot of detective work. Unless someone actually has experience with OSA personally they often think that if we can get the AHI down that is all that is needed and they can't see outside the box to maybe go looking elsewhere for potential suspects for feeling crappy.

If the slight increase in the minimum pressure doesn't help resolve your issues with how you feel and your AHI comes back down nice and low then maybe we need to look at other potential suspects as contributors to feeling crappy. There's a huge list...believe me....I have my own culprits and don't feel nearly as good as my numbers say I should.

[nycdug]

Last night I increased the pressure. Still woke up a couple of times throughout the night (which is a problem, I know). I have a question about my flow rate graph below. I fell back asleep around 4ish and woke up after 6am. Look at the flow rate graph. ???

[Pugsy]

That spot is just a bad/incomplete/corrupt file for that sleep session. I have seen that happen with other PR S1 reports. Nothing you did in terms of your breathing. It looks like the SD card wasn't in the slot or if it was in the slot it was incorrectly seated. Either that or just a bad set of session files that got corrupted.

I don't know if you used Encore if it would be able to "see" that particular set of session files or not. It might be just a SleepyHead issue or it might also be a problem for Encore. It's a data file vs software issue and you may or may not be able to do anything about it. In Encore that area would be in the wave form data.

Was the SD card inadvertently not sitting correctly in the SD slot? The SD card must be in the slot for you to get the actual flow rate.
Did you maybe pull the SD card prior to going back to sleep at 4 AM?

More important question...what's causing the wake ups? Any idea?

[nycdug]

When I reinserted the data card, the data from the last session (4:30-6:30am) was gone. As far as the wake ups, I have had problems with insomnia for years. My mom does too so I think I just inherited it. Sometimes I'll be up for a few hours and go back to bed, others times I'll go back to sleep in a few minutes and sometimes I'm just up from 3am on. Sometimes I don't wake up at all. Even during my titration study I only slept for two hours. Once the tech woke me up and told me to sleep on my back, I was awake the rest of the time until I finally pulled the mask off. I'll take an Ambien because that's all the doctor will give me. He seems to think my only issue is sleep apnea which is why I fired him on Friday.

[Pugsy]

While insomnia can be caused by sleep apnea it isn't the only culprit. If the insomnia is not caused by sleep apnea then we can't expect using the machine to fix it can we? Too bad docs can't seem to see that fact.
Robysue is the person to maybe offer ideas on reducing insomnia issues. She has first hand experience.

[nycdug]

My ex-sleep doctor wouldn't listen to any of that insomnia talk. He seems to think CPAP is the answer to all my problems. Like I said before, when I told him I felt worse he got snarky and told me to stop using it for two weeks and then see how I felt. After five days of not using it I felt exactly the same, definately not worse and that was after having septoplasty surgery.

I was referred to my new sleep doctor by the sleep tech at my titration study. Incidentally, she also fired my ex-doctor from overseeing her father's care. (What does that say about the doctor when his own staff won't use him???) Apparently the new doctor has a more holistic approach. She thinks outside the box and doesn't just give you the machine and say call the DME if you have any problems.

I've already made lifestyle changes by cutting out alcohol completely, limiting my coffee to 1-2 cups and no caffeine after 12pm. I exercise more and eat pretty clean. I've dropped 16 pounds in the past month. Every night I strap that mask on hoping tomorrow will be different and I'm trying to be compliance so my insurance will pay for the machine, however, I won't keep using it if I don't feel better. I've even discussed UPPP surgery with my ENT.

I'm very grateful for the information I'm getting on this forum. So far it's better than the medical advice I'm getting from my own doctor and Blue Cross doesnt' get a bill for it!

[Pugsy]

however, I won't keep using it if I don't feel better.

I hate you hear people say this because sometimes people feel crappy for reasons that aren't related to sleep apnea and they expected the machine to fix a problem that it simply can't fix. Your insomnia alone without any apnea diagnosis is enough to cause a person to feel horrible. If the insomnia isn't related to the apnea then it's an unrealistic expectation to expect the machine to fix the insomnia.

I don't remember if you have discussed any other possible culprits to feeling crappy....

When I see people with quite decent reports and they still feel crappy then I tell people that it may just take some time and while giving it time maybe investigate other possible culprits.

Some of which are
Insomnia (which we already know you have a problem with)
Hours of sleep (which we already know is deficient due to the insomnia)
Fragmented sleep (which we already know is a factor with the insomnia)
And then we look at meds...is it possible that meds are affecting sleep quality...so we dig deep into potential side effects
and we look at general sleep hygiene
and we look at general health...hormone levels, pain, etc.
and we try to determine what the primary symptom(s) are that we want to fix...is it fatigue or excessive daytime sleepiness..people often use them like they are interchangeable but they are really 2 different things
and that's just a starting point.

Depending on how severe OSA is/was sometimes we have to look at this therapy as preventative in nature instead of expecting it to do the miracle and let us feel like we did 30 years ago. I am still looking for that burst of energy people talk about.
But I am 62 years old and I have other problems that affect how I feel and sleep that are unrelated to sleep apnea.
I do know that the stress on my heart and body is no longer damaging my body. No longer starving the organs for oxygen. No longer dumping stress hormones into my bloodstream which wrecks havoc on the heart and kidneys.
It's more than just "feeling better" whatever better is. It's about preventing further damage to the body. Preventing that stroke or heart attack that might come later.