My AHI is going up. Why?

I have been using the CPAP from the past 4 years. Earlier i used the Respironics System One and from the past year have been using the Dream Station. Continue to use the nasal TruBlue mask. Since the past 3 months or so, i notice that i have not been sleeping well. I get up in the night (where earlier i used to sleep like a log) have sleep for 4-5 hours (earlier 6 hours minimum) and am generally restless. Possible life style changes that could have caused this :

- Increased smoking ( started a year back again )
- Stopping my daily 1 hour walk
- decreased activity levels
- decreased social activity, though increase in travel.

From the data i gather that my AHI has gone up. What could be the reason? Apart from smoking? My mask fits loose and i am not sure whether the CPAP is doing all for me due to this. Yet to learn to decipher the SleepyHead stats.
could some one throw some light?
Thanks in advance.

ps: Not able to attach screen shots of the Sleepyhead report?

You have to put your screen shot on some place like imgur that hosts images and then put the link in your post.

See these 3 pages for how to organize the graphs.. We don't need all the graphs...just the basics
https://sleep.tnet.com/resources/sleepyhead/shorganize

See this thread for examples
viewtopic/t103468/Need-help-with-screen-shots.html

and this for how to use imgur if you wish to give it a try
https://sleep.tnet.com/reference/tips/imgur

So what was your AHI in the past (and event category breakdown) and what has it increased to now (and the event category breakdown)?
It's real important to evaluate the event categories as well as the overall AHI especially when someone is reporting a lot of awakenings during the night because sometimes awake breathing is getting flagged by mistake and giving a person a falsely elevated AHI.
Usually these are centrals/clear airway apnea events but not always.

Have you had a change in medications??? New meds or change dosage in old meds?

Thank you, Pugsy for your prompt answer and help.
Here are the stats:





No change in Meds (No meds at all, except one in the morning for acid control.
Pugsy, i cannot answer the rest of your questions since truth be told, however embarrassing, i do not understand them at all.

I cannot read your summary page because things are too small and I can't click on the image to enlarge it.
To make it so we can read it we need to be able to enlarge it.
So...copy the linked bbc code address (bottom line the box of addresses) after you have click on "large thumbnail" then you will get a more easy to read image that we can click on and make it bigger. See the image below... put your mouse cursor over the image and you will see a little hand instead of a little arrow which means we can click on the link and make it bigger. The last line in the box of addresses is what you need to use.

For your AHI issues...your machine settings are pretty much wide open and you didn't include the pressure graphs (did you go look at the thread with the examples) but I think all you need is a little higher minimum pressure. Your minimum is 4 right now and the overall average appears to be around 11 cm...so it's taking too long to get to where it needs to be to hold your airway open. I think a minimum of 7 or 8 (maybe 9 but I would start with 7 first) would give the machine a better head start and reduce your AHI. For some reason you need more pressure now than you used to need. It happens...we gain weight or simply get older and the airway tissues sage a bit more and need more pressure to hold the airway open.

If you don't know how to change the pressure you can request the manual for your machine via email here.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Easy to do.

I'm just going to throw in a little observation as well (personal experience) and that is that a surprisingly small amount of weight gain or loss (10 lbs) can make a difference to therapy. From what you wrote, I wonder if you've actually checked your weight lately as I imagine it could have gone up a bit, though could be part of a cycle where apnea not well treated causes lower metabolism, tiredness and difficulty keeping weight off.

Julie wrote:.. I wonder if you've actually checked your weight lately as I imagine it could have gone up a bit, though could be part of a cycle where apnea not well treated causes lower metabolism, tiredness and difficulty keeping weight off.

I have gained 20 lbs in the past 8 months. Mostly lack of exercise and binge eating.

Pugsy wrote:I cannot read your summary page because things are too small and I can't click on the image to enlarge it.
To make it so we can read it we need to be able to enlarge it.

Shall do.

I think a minimum of 7 or 8 (maybe 9 but I would start with 7 first) would give the machine a better head start and reduce your AHI. For some reason you need more pressure now than you used to need.

Shall change the initial pressure setting. What you say makes sense. And i thought that the "Auto" in the CPAP would automatically ramp up the pressure 'as desired'. And what reasons would they be? The fact that i need more pressure than i used to? Weight gain as Julie said?

Let's hope this works: Sorry for the back to back posting:

earthian wrote:Shall change the initial pressure setting. What you say makes sense. And i thought that the "Auto" in the CPAP would automatically ramp up the pressure 'as desired'. And what reasons would they be? The fact that i need more pressure than i used to? Weight gain as Julie said?

These auto machines will increase (ramp up) to what is needed up to a point but the increasing takes a bit of time. They can't go from 4 cm to 10 cm in the blink of an eye...it takes several minutes to get up there and while it is getting up there the airway can go ahead and close and then open back up so while it is "going up" the apnea events go ahead and happen. star
When we give the machine a better head start it can get to where it needs to be in a more timely fashion and thus stand a better chance of preventing the airway tissues from closing off.

With your weight gain it is very possible that you need a little more pressure now than you did in the past and the machine can't get there fast enough because of the distance it needs to travel from 4 cm.
4 cm starting minimum will work fine if a person on needs 9 cm to hold the airway open but doesn't work go great if a person needs 12 or more ....just takes too long to get there.

I am not sure just were your optimal minimum starting point is because I would need to see several detailed pressure graphs to get a feel for it but it should be fairly evident to you fairly quickly if you start the minimum higher. Sometimes a relatively small increase in that minimum will make a substantial difference in the results. Often the maximum will reduce and the 90% pressures also reduce when the minimum is more optimally set.
So I usually suggest modest increases for a few nights just to see what happens...besides it's easier to adjust to a small increase in pressure when starting the night than it is a big increase. I suspect 8 or 9 will give you much better results but going from 4 to 9 right in one big jump might not be all that comfortable for you...so instead start small (like 7) and see if you need more and if you do then move up slowly. It will be an easier adjustment for you. Don't want you staying awake half the night because you aren't comfortable with the pressure.
Instead work up slowly and you might get lucky and find that you don't need as much as I originally thought you would.

Yep, I can read it now. Thank you.
My suggestion stays the same. The bulk of your AHI is obstructive in nature and we fix the obstructive stuff with a little more pressure.
Your AHI isn't horribly high but it is high enough to cause symptoms...so let's see if a little more pressure and bringing the AHI down a bit will help you feel better and sleep better.

Pugsy wrote:.so let's see if a little more pressure and bringing the AHI down a bit will help you feel better and sleep better.

Well, i did increase the starting pressure to 5cm H2O and tightened the straps of the mask a bit. Slept for over 7 hours and AHI=2.22
Do i increase the starting pressure even more?

No...keep the pressure at the new minimum for 3 or 4 days. Don't ever go changing things based on one night's results unless the results are horrible.
We don't sleep the same each night so the AHI can and will vary from night to night.

And be sure to look at the event catgories...if your AHI of 2.2 is half or more CA/Centrals...no real need for more pressure as more pressure can't reduce centrals anyway.