Why has my AHI gone up? (w/screenshots)

I had an AHI of less than 1 on most nights until a few weeks ago, and since then it has gone up into the 3 to 7 range on some nights, while it stays under 1 on others. I raised the minimum pressure from 12.5 to 14.0 on 11/12/2016 and lowered it back to 12.5 on 11/16/2016. I don't know what kind of effect that had on the AHI if any. I use a Philips Respironics Dream Station DSX500 with a Philips Respironics Amara full face mask. How much leakage is acceptable? I can feel it blowing into my eyes a bit at first but it seems to "settle" a bit after a few minutes. Is it OK to loosen the mask? I keep it fairly tight. It rubs against my forehead, the bridge of my nose, and my right cheek but I put Band Aids on these areas before I go to bed which helps. Here are some screenshots. Does anything look amiss?

The gaps on some of the screenshots are when I couldn't sleep so I turned the machine off for a bit then turned it back on and went to sleep.

I fell asleep on 11/15/2016 before I had a chance to hook my machine up, which is why there is no screenshot for that day.

11/14/2016:


11/16/2016:


11/17/2016:


11/18/2016:


Here are a couple of older screenshots with very high AHIs. Why did it go up so high on those two nights?

9/21/2016


9/23/2016


Thanks in advance.

It has been out of control over the last two nights. Could it be something to do with the fitting of the mask?

2016/11/20:


2016/11/21:

Has anything else changed? A new bed, a new hose or mask (even one that's supposedly identical)? Have you lost or gained weight? Have your medications changed?

I've lost about 10 pounds (from 270 to 260) but nothing else has changed. I got the mask that I use now maybe 2 months ago, well before the AHI jumped. Medications are the same. I'm visiting family out of state but I have had two nights here with an AHI under 1. I don't know what else could be causing it other than an ill-fitting mask.

I don't see a mask issue (leaks, etc)

what else has changed?

bugo,

It may be time to speak with your sleep doctor. The large number of CAs on some nights, but large number of OAs on other nights, and much lower AHI on other nights is not easily explained in terms of mask fit. And you say you can't think of anything in particular that's changed. So this is actually a time where speaking with a sleep doc and having the doc review the data may be worth it. Yes, the doc could recommend another sleep test. And truth be told, it looks like you could really use another titration test. Of course given the intermittent nature of your problem, there's no guarantee that you'll have a bad night on the night of the sleep test. Still, if this were my data, I'd be showing it to the sleep doc and asking him for advice about what to do about it.

Last night was bad as well. There's nothing unusual in the graphs? I guess I'll have to call the sleep doctor. I hope it's not serious, because I cannot afford another sleep study.

2016/11/22

there's a lot unusual in the graphs, but none of it shows what might be wrong, which is why I asked what else has changed lately...

you could try turning off flex, because that might be making the centrals worse.

I'll try that. Hopefully I'll get a decent night's worth of sleep.

Maybe a higher minimum pressure so the machine doesn't have to try to catch up as much. Have you changed your sleeping position? New pillow?

Your leak rate is excessive by a lot. IF I recall rightly, the max acceptible rate is arouind 24 and you show 60 and above. I think your problem is with the amara mask which is complicated to adjust. The vent is at the top of mask where all those small holes are, Its okay to feel the venting but you shouldn't hear anything or feel any venting elsewhere. I used to have terrible problems with the Amara V. mask but with persistence I got my leak rate down to near zero except for nighttime movements that disturb the mask. Also, be careful not to over-tighten as this causes leakage. Try loosening and see if that helps.

The 24 L/min leak number line in the sand is for ResMed machines.
Bugo is using a Respironics machine and they don't use the 24 L/min excess only leak number because the Respironics machines report both the vent rate and any excess leak....called total leak.

The 60 L/min leak number is for total leak and not just excess leak and is actually a fairly normal total leak number for the mask and the pressures used.
It's hard to come up with an exact number like ResMed does when using Respironics equipment in auto adjusting mode because the vent rate varies so much which makes the line in the sand move so much but probably somewhere up around 80 to 90 L/min would be a more appropriate line in the sand to avoid.

Besides...if there were large leaks present the machine would flag them up on the Events graph...LL...that stands for Large Leak. If there are any large leaks flagged...they are very brief and certainly not enough to explain the AHI change.

The high AHI is NOT related to leak.

Now why the change in AHI? I don't know but something changed.
Meds? Sleeping position? Other health problems? Any number of things but something changed and it's bad enough that the doctor probably needs to be aware of what is going on.

blownaway wrote:Your leak rate is excessive by a lot. IF I recall rightly, the max acceptible rate is arouind 24

no, his leak is fine.

youre' confusing respironics leak figures and guidelines with resmed leak figures and guidelines.

I tried turning flex off but my AHI was still poor. I was advised to change to a fixed pressure of 12.0. I'll try that tonight.

2016/11/23

All those crazy machine names will drive ya nuts, like model and serial numbers 25 digits long and toss in a few letters to boot.