Can anyone tell me why my AHI is getting worse?

GreenBean · Post by **GreenBean** » Mon May 14, 2018 9:54 am

My AHI is getting worse every night. It is now 5.75, the highest yet (on cpap). The graphs mean nothing to me.

palerider · Post by **palerider** » Mon May 14, 2018 11:19 am

Please go through the links in my sig and reformat your charts so that there's *ONE* chart per day... then post three or four days worth, one chart per day.

jnk... · Post by **jnk...** » Mon May 14, 2018 11:23 am

I am not very well educated on SH-graph interpretation, but if my AHI were increasing and most of my events were flagged as obstructive, I would tend to try raising my EPAP min. It's not so much a matter of why AHI increases but more a matter of what to do about it, as a general rule.

Ah, never mind; I see PR is on the case.

dreamingofdreaming · Post by **dreamingofdreaming** » Mon May 14, 2018 12:28 pm

I'm not an expert at SH, but it looks like you need to increase your max pressure too. It looks like your pressure wants to go higher than what you have set.

jnk... · Post by **jnk...** » Mon May 14, 2018 12:53 pm

dreamingofdreaming wrote: ↑
Mon May 14, 2018 12:28 pm
I'm not an expert at SH, but it looks like you need to increase your max pressure too. It looks like your pressure wants to go higher than what you have set.

It appears that the IPAP max is already at 20 cm, according to the images.

GreenBean · Post by **GreenBean** » Mon May 14, 2018 2:25 pm

Palerider, I have read your posts on images. It explained very well how to make adjustments. However, I have also read posts from people trying to help who have told posters that their images were too small to read. That's why I didn't try to scrunch all the information into one page. I can't even read my own screen when I scrunch all the information into one page . . . but I will try it now. Perhaps somehow when the attachment is added in this forum there is some way for readers to view the images larger. I can certainly understand how much easier interpretation would be if everything is on one page!

GreenBean · Post by **GreenBean** » Mon May 14, 2018 2:38 pm

Palerider, this is all of the information for Sunday, May 13, on one page. I can't read it, but maybe others have a different way of viewing attachments.

Julie · Post by **Julie** » Mon May 14, 2018 3:06 pm

What happened to the graphs?

HoseCrusher · Post by **HoseCrusher** » Mon May 14, 2018 3:14 pm

Not all the graphs are needed for the first review. This link gives an idea of what to show.

https://sleep.tnet.com/resources/sleepyhead/shorganize

I changed the position of the Flow Limit and Snore graphs because I don't snore so that information is not needed.

Give that set up a try.

wertu · Post by **wertu** » Mon May 14, 2018 3:17 pm

thx for link

Pugsy · Post by **Pugsy** » Mon May 14, 2018 3:29 pm

Try reading this thread
viewtopic/t158560/How-to-post-images-for-review.html
compare your images to the ones I show and see the difference

As to why your AHI is getting worse.....there are times in the night when your minimum EPAP pressure isn't high enough for the machine to get to where it needs to be to keep the airway from collapsing.
Some parts of the night the pressure is fine but at other times it isn't...usually related to maybe sleeping position (on your back more) or maybe related to REM stage sleep where with either it is common for our OSA to worsen or need more pressure than at other times of the night.

Auto adjusting pressures can only do so much so fast and sometimes the airway will collapse more quickly than the machine can anticipate the need because the pressure is starting out too low.

Easy fix....increase the minimum EPAP pressure
How much to increase...I don't know because the way you have shared your report images doesn't really tell us a lot. That's why we ask for the images to be shown in a certain way.....so we can best get an idea what is going on and not have to make so many guesses.
I don't think your EPAP needs to be hugely increased though...probably 1 or 2 cm more will do a good job.
Your maximum IPAP doesn't need changing because it never comes close to the max anyway. It might level out and look like the max has been reached but it hasn't. The machine just couldn't go higher faster for whatever reason.

For a Respironics report....this is all that we need...see the image below.
If for some reason anything else is needed we can ask. Compare your images to this image.

GreenBean · Post by **GreenBean** » Mon May 14, 2018 4:42 pm

Okaaay . . . I think I've got it! Here are some screen shots 2017 - 2018, one in the hospital post op. Interesting that it may be too low pressure on exhale. I have always felt that I breathe more shallowly than many people and often when drifting off to sleep pre-cpap would arouse myself to take deep breathes and then continue to drift off. With cpap I always start off breathing "fully" so I don't have that sensation. I was unable to use straight cpap because I could not exhale against it. I felt as if I were trying to breathe against the exhaust of a jet engine. Do these graphs (2017 - 2018) indicate what may have changed post-op? Maybe now that my stomach is out of my chest I have more space to fill on inspiration and not enough "oomph" to expell it. (When my stomach was in my chest it literally left my lungs unable to fill properly and I could barely walk 10 feet without stopping to rest and breathe.)

Apparently I can only add three attachments at a time so I am starting with the last three days this May 2018, then 2017 pre-op, 2017 in hospital post-op, and a day in Nov 2017.

GreenBean · Post by **GreenBean** » Mon May 14, 2018 4:46 pm

These are from 2017. In hospital post-op and for several days after I was massively swollen so I'm not sure my lungs had yet had a chance to enjoy the extra space.

Pugsy · Post by **Pugsy** » Mon May 14, 2018 5:50 pm

There's no way to know what has changed to cause the increased AHI from last year to now.
Something changed....but as to what it was that changed we don't know.
Your pressure needs have changed slightly for some reason or other.
The usual culprits or sleeping on our backs or REM sleep or maybe spending more time on our backs during REM...we can't tell exactly from the data the machines give us.

I would be more inclined to look at sleep position or REM because there are still times during the night that the current settings work well...so something is changing during the night and not necessarily happening all night long.

Julie · Post by **Julie** » Mon May 14, 2018 5:56 pm

Just gaining a few lbs can do it!

Can anyone tell me why my AHI is getting worse?

Can anyone tell me why my AHI is getting worse?

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