Increasing AHI and Periodic breathing

I am trying to get an apt. with my sleep apnea doctor to follow up on my concerns. I thought that I would post here in the mean time to see if I can get some advice or opinions. Over the last 3 months my AHI has increased from less than 5 to around 20, and my periodic breathing as gone from non-existant to around 50%. I have been having problems with my heart (afib and CHF) so it seems to be related. Here are my stats from Sleephead:

Details Most Recent Last Week Last 30 Days Last 6 Months Last Year
CPAP Usage
Average Hours per Night 07:32 07:13 06:39 06:36 06:21
Compliance 100% 100% 100% 99% 99%
Therapy Efficacy
AHI 22.41 14.01 10.86 5.74 5.06
Obstructive Index 14.72 8.97 6.36 2.83 1.81
Hypopnea Index 7.03 4.84 4.33 2.78 3.15
Clear Airway Index 0.66 0.20 0.16 0.13 0.10
Flow Limitation Index 0.00 0.02 0.02 0.07 0.12
RERA Index 0.53 0.67 0.80 0.83 0.66
Leak Statistics
Average Leak Rate 18.99 15.77 18.50 14.62 11.95
90% Leak Rate 53.00 44.00 45.00 32.00 27.00
% of time above Leak Rate threshold 28.29% 17.61% 24.25% 17.59% 12.65%
Pressure Statistics
Average Pressure 10.63 10.27 9.93 9.32 8.11
Min Pressure 9.00 9.00 9.00 8.00 4.00
Max Pressure 14.00 14.00 14.00 14.00 14.00
90% Pressure 14.00 13.00 12.00 11.00 10.00
Average EPAP 8.73 8.35 8.07 7.52 6.38
Min EPAP 6.90 6.50 0.00 0.00 0.00
Max EPAP 12.30 12.30 12.50 12.50 12.50

Any comments would be appreciated. Thanks

An AHI of 20 is considered Moderate APnea, meaning that you are basically not having effective treatment if the numbers are correct. Personally I'd try a pressure change... You can do a test on your own if you want if you have a resmed machine. It's pretty easy to get into the clinical menu (just google it) one night of higher pressure as a test isn't going to hurt you and it could answer right away if a higher pressure could help your Ahi.

Also I'm pretty much a neophyte, but your leak rates seem really high.. Could that be the reason? Have the leak rates always been that bad? Just comparing to mine they are way higher.

Looks like a Respironics report...need confirmation as to brand and model.

If Respironics...the leak numbers are normal for a Respironics machine...so leaks not and issue because Respironics report total leak..you won't ever have 0.0 total leak from a Respironics machine because the vent rate is included.

and the % of time over leak rate threshold is not correct because it is based on a ResMed baseline number which doesn't work for a Respironics machine.

I wouldn't go increasing the pressure just yet even though the bulk of the AHI is obstructive in nature per the machine.
The Periodic Breathing is very troublesome especially with the history of CHF. I have seen Respironics reports where a person had high PB and it was flagged as OA but it was really central/CA. ...and more pressure won't fix centrals and might make things worse. If those are centrals and not OAs...more pressure could hurt you.

I would like to see a zoomed in section of PB along with standard graphs.
See this thread for examples.
viewtopic/t103468/Need-help-with-screen-shots.html

How to post images
https://sleep.tnet.com/reference/tips/imgur

How to organize the graphs...we don't want all of them..just the basics and you can get the 4 main basics on one screenshot.
https://sleep.tnet.com/resources/sleepyhead/shorganize

For zoomed in section of PB.
Go to the Events tab and click on one of the event categories that has a lot of PB...then highlight and click on one single event in the green PB area but try to pick one in the middle of 3 or 4 other very close in time.
The graphs on the right will change to the level of zooming in we need...then get a screen shot.
Do this in addition to the basics above.

https://imgur.com/a/NyPwr

Did that work?

Image worked but not what we need. The Overview reports don't show the details needed.

Please review the example thread I linked to above.

Do you take any medications? If so, what?

I will be leaving for the day so won't be able to respond until this evening.

Sorry, I had to re-post. Here is the new URL:

https://imgur.com/a/iErqm

I also posted a daily report, which is after the overview if you scroll down. Is that what you are looking for?

Here is a list of medications:
Heart:
APO-METOPROLOL (25mg x 2) = 50mg
ASA EC, 80mg (once)
Furosemide - 10 mg (once)
Ramipril - 5mg (once)

Lymphoma:
90 IMBRUVICA, 140mg x3 = 420

Supplements:
Vitamin D - 1,000 IU
Magnesium 100 mg x 2

Some additional screen shots:

https://imgur.com/a/xCqvm

Couln't turn off the calendar - is the linux version of SH different?

Your leaking like crazy, which will spike your AHI. The machine can't keep the pressure in the nominal range while air is escaping so fast. Fix the leaks first.

periodic breathing (real PB) is made of central apneas - not obstructive events.

Looks to me more like extensive leakage and maybe positional obstructions. Get those leaks under control.
Try a soft cervical collar or change your sleep position. And think about hose-management! as in: hose buddy.

Guest wrote:periodic breathing (real PB) is made of central apneas - not obstructive events.

Looks to me more like extensive leakage and maybe positional obstructions. Get those leaks under control.
Try a soft cervical collar or change your sleep position. And think about hose-management! as in: hose buddy.

I'm new here ...... what is Periodic Breathing? Is a higher number better than a lower number? Or the opposite? Thanks!
Kim

The leaks increased when I increased the pressure (now at 9-14). I can't seem to get rid of them. I am an extremely restless sleeper, so sleep position doesn't help me since I keep moving in my sleep. I sleep on both sides. I have a sleep buddy - doesn't seem to help much. I ordered a new mask, even though my mask is pretty new. I'll see if there's any difference. The periodic breathing is relatively new, and has me worried. I am going to see the apnea doctor soon to see what he has to say. Its complicated because I have to speak to 3 doctors. I am taking medication for my lymphoma which seems to cause the heart problems, which in turn seems to cause the sleep and breathing problems. I am taking the cancer meds because the chemo wasn't working. In the mean time, the sleep problems are uncomfortable and may be making things worse.

He isn't "leaking like crazy".
1...His machine reports total leaks which includes vent rates and as more pressure is used the vent rate goes up and so does the leak line.
2...the Statictic for time over red line showing 28% is incorrect because it is base on a ResMed leak threshold which isn't a good threshold number for a Respironics machine. Need to go to Preferences/CPAP tab and either turn off that statistic or change the 24 L/min Resmed leak threshold (SH defaults to this setting) or change it to something more suitable for a Respironics machine. Problem being the threshold varies with pressure

Yes there are some times in large leak as see in gray on the leak Events graph but it's not 29% of the time.
Looks like a couple of 30 minutes segments and maybe 1 that was 45 minutes and then 3 or 4 segments probably around 5 or 10 minutes.

His data is still fairly accurate for sure during the other parts of the night...and it's very ugly.

I still would like to see a small segment of PB zoomed in like I described above but make sure it isn't during a time of large leak.

Have you been diagnosed with Congestive Heart Failure?

So that it shows up at this level of zooming. It's real important that I get to see that PB zoomed in with OA flagging.

Pugsy wrote:He isn't "leaking like crazy".
1...His machine reports total leaks which includes vent rates and as more pressure is used the vent rate goes up and so does the leak line.
2...the Statictic for time over red line showing 28% is incorrect because it is base on a ResMed leak threshold which isn't a good threshold number for a Respironics machine. Need to go to Preferences/CPAP tab and either turn off that statistic or change the 24 L/min Resmed leak threshold (SH defaults to this setting) or change it to something more suitable for a Respironics machine. Problem being the threshold varies with pressure

please forgive me - I mean absolutely no offense.

that is simply not true!
the higher leak rate comes from the device and includes the vent rate.

In the settings of SH under CPAP you can set the vent rate for your mask - 4 and 20cmH2O.
this vent rate is substracted from the leak-rate (from the philips device) and makes the 2nd, lower leak-rate. The threshold and time over "red line" is based ON THIS VERY LEAK RATE! (not the first one from the device) "Adjusting" the threashold to numbers beyond everything is like "oh please don't tell me"

As JediMark decided to put in the values for the p10, there is not so much to do if you use pillows.

SH uses a linear funtion to calculate the vent rate. look up the leak chart from you mask-manual - take a ruler and draw a line between 4 and 20. You will see that SH (slightly) undershoots between those 2 and overshoots above that. - and this is the ONLY pressure dependant part of the leakage!
As pointed out already on this board: it is simple math - adjust those values to your pressure-range and your mask.

after that the 2nd, lower leak-rate ist pretty accurate! (and yes, 24 liters per minute is high enough - everything above that is not only annoying but all goes sideways from there, YMMV)