Please Help! AHI high after 30 days

I take 10mg Crestor (cholestrol) and Zyrtec D for allergies. I do take 2mg of melatonin sometimes, but not every day. I do wake up after 2-4 hours of sleep and kind of have a hard time getting back to sleep. I changed min pressure to 7.5 last night and changed dreamware nasal mask to dreamware nasal pillows and feel better this morning. I don't know the results yet, but I feel like I slept better. I went to bed around 10:30 and woke around 3am, struggled to get back to sleep but did get back to sleep till around 7am, got up used the bathroom and laid down for another 2 hours until 9am without the mask. I dream a lot, often remembering my dreams every morning. Here is a screenshot of the stats from sleephead. Thanks again for all the comments/suggestions, I greatly appreciate the help in this journey.

overview graphs, sorry not very good at resizing

Please post the daily view from last night.

hdclassic4466 wrote: ↑

Sat Apr 28, 2018 7:51 pm

I appreciate the comments and will raise the minimum to 7 or 8 tonight and see how that does? Anybody see anything else I need to look out for in the data I posted? Thanks again.

Sometimes the higher pressures can cause Central Events. However, it really doens't matter if you lower it from 20 to 15, as you're never going above 15 (as far as I can see) anyhow.

The reason to set a max lower than 20 are the following:
1) If there is discomfort or arousal related to the higher pressure. Discomfort could be leaks, noise, or discomfort from the pressure itself. Arousal is tricky, as you need to determine if the higher pressure did it or if the underlying reason that you need higher pressure did it.
2) If you are having central events, and they are associated with the higher pressures. If you determine that the higher pressure is not causing the centrals (also a tricky determination), then leave it at 20.

What does the detailed report from last night look like?

Particularly want to see how many centrals might have been flagged around known awake times.

You probably should start figuring out how to distinguish between real events and SWJ events.
Start by reviewing the videos here with special attention to the bottom video.
http://freecpapadvice.com/sleepyhead-free-software

Report from last night......

That large leak is when I got up to go to the bathroom, the early stuff on the graph around 3pm, I tried to take a nap. I do feel much better today.

Did you have a sleep study done in a lab where they hooked you up to the mask and machine?
Or did you have just some sort of diagnostic sleep study (home or in lab...which kind???) and sent home with apap to sort out the pressure needs?

When is your follow up appointment scheduled? Do you have one? If not...make one.

I don't know what to think about your central apnea/Clear Airway flagged events at this time for various reasons...one we don't know if they are real or not and we don't know if they are real if you had them on the diagnostic sleep study or not...or if they just popped up because of cpap itself.
There's a lot that we don't know for sure but one thing we do know for sure...the obstructive side of your sleep apnea is not optimally treated just yet.

So let's try to fix what we can fix with this machine and see what's left after the obstructive side of things is better managed.

Try minimum of 8 BUT turn Flex off if you can do it off comfortably...if you can't try just reducing it to 1.

Turning off Flex might...stress might...reduce the centrals but only if Flex is the cause of them and they are real and not SWJ. Chances are slim but not impossible.
Increasing the minimum might help reduce centrals only if the centrals are post arousal centrals because the OAs are causing arousals.

Edit...I see you had a home study....do you know the name of it? Have a copy of those results?
Did you wear anything around your chest or abdomen?

Yes, I had 2 at home sleep studies. The first one, the machine shutoff after 5 hours and they told me that they needed more data so I had to do a 2nd one (free of charge). I have the results for the first test, but not the 2nd test. The test was conducted on a ApneaLink Plus Type 3 device. The first test said I had an AHI of 8.6. 1st test showed ODI (oxygen desaturation index) of 11.2 and lowest recorded desaturation seen was87%. When I took the 2nd test it said AHI of 21 but I don't have the rest of the data. Yes, I did have to wear the band around my chest and an oxygen meter on my finger. I'll try going up to 8 tonight for minimum, I have been having the flex on 3. I'll reduce it some too. Post back tomorrow the results.

follow up appointment is May 11 with the Dr. but I don't have a lot of hope that they are going to solve this for me........judging by my visit after 1 week, but I may get surprised. will wait to see.

The ApneaLink home study does flag central apneas as that is why the chest/abdomen belt...to measure effort.
We assume if not many centrals on the home study then that means that the centrals seen now are either just SWJ and not real or real and perhaps because of cpap therapy itself.

There is a small percentage of people that do develop real centrals just from cpap therapy and it's not necessarily caused by high pressures...it can be any pressure even 5 cm. When this happens the doctors often develop a wait and see attitude about the centrals because sometimes the centrals fade away on their own as the body gets used to things. This is of course assuming they are real and not SWJ. If they aren't real they don't count.
For an even smaller percent of an already small percent of people using exhale relief which essentially creates a bilevel pressure situation can also trigger centrals. Hence the idea to reduce or turn off Flex exhale relief just in case you are a very small percent of that very small percent of people. Hurts nothing to try.

It's also possible that the centrals flagged are post arousal centrals meaning they are SWJ centrals caused by an arousal or partial awakening due to the sub optimally treated obstructive apneas. Meaning the obstructive apneas came first and caused the arousal or awakening which in turn causes the SWJ breathing that gets flagged as centrals.

If the centrals are real...we can't do anything about them with this machine other than try stuff to maybe reduce them and cross our fingers. Sometimes we get lucky and sometimes we don't.
Since often the first line of defense even if they are real is the "wait and see if they go away on their own" what usually gets done is people still try to optimize the Obstructive side of their therapy and see if the OAs/Hyponeas get better prevented maybe the centrals will either reduce on their own one way or the other.

All I can suggest to do is treat what is shown to need to be treated with this machine and can be treated with this machine and that is the obstructive side of things. That is where the more minimum pressure comes in.
I once was helping a woman who was having a truckload of centrals and about as many OAs up until pressures around 12 cm. I thought for sure that she was going to end up needing to be on a different machine but she had a sleep study done in a lab where they said 14 cm pressure was what she needed for the OSA and she didn't have any centrals. Thought what the heck...give it a try and you know what...when she tried 14 cm not only did the OAs pretty much go away...so did the centrals. Pretty much all of her centrals were post arousal from the OAs. They weren't real. So it can happen that way.

So fix what you can fix with this machine and optimize it the best as you can and then see what's left that still needs fixing.
That's about the best we can do.

Thank you Pugsy for taking your time to try to help me, I really do appreciate it. will report back tomorrow.

Just for what it I worth......
I am a cpap user of 2 years standing. AHI now consistently <1
I had an in hospital sleep study, which showed AHI in the high 30's - all obstructive apneas.
This was followed a couple of weeks later by the study to determine appropriate treatment. During this study I had multiple CA's, the longest of which was 180 seconds duration during which time my oxygen set fell to 67% - and yes I do have the study results and graphs to prove it.
The difference - during the interval between the 2 studies I had commenced taking 2 x 12 hour release 50mg Tramadol for chronic pain management. Now I take 1 x 50mg normal release Tramadol as soon as I get up and hey presto few if any CA's now.

Queenslander wrote: ↑

Sun Apr 29, 2018 10:16 pm

Just for what it I worth......
I am a cpap user of 2 years standing. AHI now consistently <1
I had an in hospital sleep study, which showed AHI in the high 30's - all obstructive apneas.
This was followed a couple of weeks later by the study to determine appropriate treatment. During this study I had multiple CA's, the longest of which was 180 seconds duration during which time my oxygen set fell to 67% - and yes I do have the study results and graphs to prove it.
The difference - during the interval between the 2 studies I had commenced taking 2 x 12 hour release 50mg Tramadol for chronic pain management. Now I take 1 x 50mg normal release Tramadol as soon as I get up and hey presto few if any CA's now.

Yes, it's true some meds can impact respiration and be a major factor in centrals.
Which is why I asked OP about meds that he might be taking and he's not taking any medications that we can blame the centrals on the meds.

Increased minimum to 8, decreased flex to 1. Best AHI score in 30 days. I'm tired today, but don't feel foggy.