AHI is suddenly spiking to 7-8 from 4.5 Any Ideas Why? OSCAR data included

Hi everyone,

I'm pretty new to using my CPAP and it was starting to work well but the last three days my AHI has spiked even though nothing has really changed. Any suggestions how I can improve things?
Not sure how to get images up on here please let me know how. Here are the image links:

https://postimg.cc/qhJB935q - August 4
https://postimg.cc/R3zZL81c - August 5
https://postimg.cc/8j95jsjX - August 6

Please help! The dreaded head aches and lack of energy have returned

My initial reaction is that the overwhelming majority of your events are central or clear airway episodes.
First need to find the causation of these, are they non-respiratory (aka spontaneous) or neurological in nature.

Recall that your regular cpap/Apap machine will not treat centrals or clearairway events.

dataq1 wrote: ↑

Mon Aug 07, 2023 3:33 pm

First need to find the causation of these, are they non-respiratory (aka spontaneous) or neurological in nature.

Any idea how I could go about doing this?

How has the sleep quality been? Waking often or sleeping soundly through the night???

blaird89 wrote: ↑

Mon Aug 07, 2023 3:35 pm

dataq1 wrote: ↑

Mon Aug 07, 2023 3:33 pm

First need to find the causation of these, are they non-respiratory (aka spontaneous) or neurological in nature.

Any idea how I could go about doing this?

The best way to check out neurologic predicated clear airway apneas is with an EEG that is included with a sleep study.
For a quick overview of the brain's role in controlling and regulating sleep:
https://www.youtube.com/watch?v=9j6BpanhpKY&t=46s


Much more commonly spontaneous arousals are caused by interruptions in quiet comfortable sleeping conditions, comfortable is intended to include peaceful, pain-free, anxiety-free, stress-free.
All the usual practices for good sleeping hygiene are focused on that goal.

In addition to answering Pugsy's question, could you let us know what the breakdown of your AHI was in your sleep study (obstructive apneas, central apneas, hypopneas)?

Pugsy wrote: ↑

Mon Aug 07, 2023 4:42 pm

How has the sleep quality been? Waking often or sleeping soundly through the night???

Not good, I mean I sleep until 6 or 7 but wake up feeling tired with head aches.

Miss Emerita wrote: ↑

Tue Aug 08, 2023 11:22 am

In addition to answering Pugsy's question, could you let us know what the breakdown of your AHI was in your sleep study (obstructive apneas, central apneas, hypopneas)?

Here's a link to the sleep study report, I think I did another one where the AHI went up to 14.

https://postimg.cc/DJVQLyhq

Your sleep study doesn't actually give the breakdown of your events, but the summary says you had obstructive apnea.

One reason Pugsy's question is important is that you may be having a lot of little arousals that are then followed by CAs. Basically the arousal breathing is deeper than your regular asleep breathing, and it washes out a bit of CO2 from your blood, which in turn can slightly lengthen the pause between your exhalation and your next inhalation. That gets scored as a CA if the pause is 10 seconds or more.

You can check on this yourself. Zoom in on the first CA in a group (or a solo CA) and see what the flow rate looks like. Arousal breathing will look deeper and may also look kind of ratty, with little jagged bits here and there.

If that's what is happening, the real problem is more the arousals than the CAs. So you do need to concentrate on good sleep hygiene, as dataq1 has suggested.

I see that you started a different thread about what machine to use. It would be helpful if you'd stay in one thread for your various questions and issues. Thanks!

Miss Emerita wrote: ↑

Wed Aug 09, 2023 11:30 am

I see that you started a different thread about what machine to use. It would be helpful if you'd stay in one thread for your various questions and issues. Thanks!

Sorry, just trying to get eyes on these issues, I'm getting high AHI readings and feel like death now even with a CPAP. With CPAP it's ranging from 5-10 AHI. I was originally using a full mask, found it uncomfortable and decide to try a nasal pillow. Nasal pillow was working terribly so I went back to the full mask. Now for some reason the mask is doing very little I get an AHI now of over 5 every nigh and wake up feeling terrible.

Here is a typical night now with the full face mask:
https://postimg.cc/YvLmcQ8V

I'm guessing this is a ground hog day sort of thing where since it's mostly clear air way issues I'm SOL until I get it looked at to determine if it's central apnea?

I'm not sure why you say you feel the mask is doing very little. Its job is to deliver the machine's pressurized air to your airway to help keep it open. It will have trouble doing its job if you have very high leaks, but according to the chart you posted, your leaks are minimal (which is good news!).

I would like for you to zoom in on your flow rate to look at some of those CAs. You'll be on the lookout for some deeper, messy-looking breathing right before the CA. Please look especially at the first CA in a series of CAs. (The later CAs in the series may reflect unstable breathing as you get over the CA that started things off.) Can you take a look and tell us what you see? Perhaps you could also post a snippet or two of about ten minutes in length.

Also, could you squeeze in your flow limitation graph? To fit it into your screenshot, grab the horizontal gray bars that separate the graphs and push them up a little to make room.

blaird89 wrote: ↑

Mon Aug 07, 2023 2:42 pm

Hi everyone,

I'm pretty new to using my CPAP and it was starting to work well but the last three days my AHI has spiked even though nothing has really changed. Any suggestions how I can improve things?

How long did it work well?

Pugsy wrote: ↑

Mon Aug 07, 2023 4:42 pm

How has the sleep quality been? Waking often or sleeping soundly through the night???

You never responded.

I was originally using a full mask, found it uncomfortable and decide to try a nasal pillow. Nasal pillow was working terribly so I went back to the full mask.

Do you include this as part of "nothing has really changed"? Which mask were you using when CPAP started to work well?
Discomfort and mask changes can wreak havoc on your sleep and on your sleep results. A mask change is a major change.
What was wrong with the nasal mask? Please be specific.
Can you upload an example of a night in which therapy worked well?

ozij wrote: ↑

Wed Aug 30, 2023 8:01 pm

Pugsy wrote: ↑

Mon Aug 07, 2023 4:42 pm

How has the sleep quality been? Waking often or sleeping soundly through the night???

You never responded.

here-

blaird89 wrote: ↑

Tue Aug 08, 2023 1:48 pm

Pugsy wrote: ↑

Mon Aug 07, 2023 4:42 pm

How has the sleep quality been? Waking often or sleeping soundly through the night???

Not good, I mean I sleep until 6 or 7 but wake up feeling tired with head aches.

My bad, missed it somehow.