High AHI numbers and and bipap to lower them?

Back in January I had four things happen that caused me a lot of pain. Torn cartilage in hip, pinched nerve in lower back, pulled hamstring, and rotator cuff injury. My AHI numbers went from an average of 1.6 or so to 10 or more. I blamed the pain. The nerves carrying the pain signals to the brain were burned , the hip was replaced. the hamstring healed and a cortisone shot in the shoulder fixed most the pain - still had enough at night to wake me up often. The AHI stayed high and I thought the night pain was the problem. A therapist suggested I sleep with a pillow and that really helped with pain. The AHI numbers decreased some for a few days but are still at average of 7.

My old sleep doctor retired so I made an appointment with what I thought was an MD but she turned out to be a nurse practitioner.
I had an overnight oximeter study. Levels were good but seesawed a lot.
The NP looked at the info on my SD card and decided that my problem was due to CAs as reported by my Respironics Signal One. She has ordered a new sleep study and thinks a bipap machine will fix the problem. So far I am not impressed with her but am trying hold my judgment and give her a chance.

Below is a copy of my statistics from Sleepyhead. The AHI average for the last year is Apnea = 1.08, Hypopnea = 2.57 and CA = 1.96. Looking at the data when my AHI was 1.58 the hypopnea was still the major contributor.
Does a bipap machine seem like it is what I need?

Get me the detailed nightly report from that most recent report which I assume is last night.
Need the usual stuff on the left side minus the calendar and pie chart and these graphs on the right side
Events
Flow rate
Pressure
Leak

I think I see something that you can try right now but I need to see a nightly detailed report to confirm.

Okay here is last night. Since I updated Sleepyhead a few days ago I get two graphs at once on pressure and leaks. Slightly different. Don't know why.

You get 2 pressure lines because since you are using Flex exhale relief you have 2 pressures....one for inhale and one for exhale.
You get 2 leak lines because one is total leak and one is an approximation of excess only leak....remember total leak is the mask's intentional vent rate plus any excess leak.
The updated version of SleepyHead just shows you what you always had but couldn't see..no big deal.

You need more minimum and more maximum pressure at some times during the night...not all the time but sometimes. That's why you see the clustering of events. Something changed in the airway so that the existing pressure just can't hold the airway open well enough.
Usually when we see this happen we think either the person is on their back more or maybe in REM sleep because both of those can worsen OSA and cause increased pressure needs.

While I can't be 100% sure I suspect that with the time frame of those clusters during your night .....my first suspect is REM stage sleep.
Google "sleep stages" and look at the hypnograms of normal sleep stages and look at the pattern when REM happens. First REM is normally about 90 minutes after sleep onset and is relatively brief but as the night goes on REM comes on more frequently and lasts longer with the greatest amount of REM happening in those wee hours of the morning.

My suggestion to try....change your minimum pressure to 10 and raise your maximum pressure to 20.
See what happens with those clusters. Might need a little more minimum but a 2 cm increase is a big enough increase to start with and if you can't even handle that do it in increments.
With the current minimum pressure the machine takes too long to get to where it needs to be to hold the airway open and prevent the airway collapse. You have to give it a better head start. Quite common really and I have seen this exact same thing myself because my OSA is 5 times worse in REM and when I first started cpap therapy with a Respironics apap machine I saw reports exactly like these you are having.

Now if you have aerophagia issues at the higher pressures...limit the max to 16 instead of 20. Maybe with a more optimal max the pressure won't need to go high enough to trigger aerophagia issues.
The minimum pressure is the most critical pressure setting though.

Are you comfortable making the pressure changes yourself and do you know how?

Thanks ! I will try your suggestions and see what happens. I usually give any changes I make a couple of weeks at least to see what the results are.
Yes I do know how and am comfortable making them.
I have been on cpap for about 13 years and early on made adjustments to the pressure recommended and got my AHI from about 4 to 1.6. Will report results later.

I made changes and after a couple of weeks the results are mixed but there has been some improvement - from an average of over 7 to less than 5.
I set the max pressure at 18 and the min at 11.
The results were:
CPAP Statistics
2608 days of CPAP Data, between Thu Sep 8 2011 and Tue Nov 13 2018
Details Most Recent Last Week Last 30 Days Last 6 Months
CPAP Usage
Average Hours per Night 06:44 07:36 07:30 06:58
Compliance 100% 100% 100% 97%
Therapy Efficacy
AHI 7.26 4.76 6.09 7.24
Obstructive Index 0.44 0.64 0.96 1.23
Hypopnea Index 3.41 2.16 3.20 3.94
Clear Airway Index 3.41 1.97 1.92 2.08
Flow Limitation Index 0.00 0.09 0.17 0.12
RERA Index 3.41 5.53 6.27 6.14

My sleep study is tonight and what I do next depends on the results of that. If auto bipap is prescribed I will try that and see what happens.
Regarding the auto bipap, if I am allowed to influence the choice between the PR Dream Station Auto Bipap and the Auto Bipap Pro which one would be the best?

ClayL wrote: ↑

Wed Nov 14, 2018 11:00 am

Regarding the auto bipap, if I am allowed to influence the choice between the PR Dream Station Auto Bipap and the Auto Bipap Pro which one would be the best?

The BiPap Pro is NOT auto....it is a fixed pressure machine.
2 modes of operation....either cpap fixed mode or fixed bilevel mode.
Pro is the key word in this model name. Anything with "Pro" in it when it comes to Respironics model names means fixed pressure only.
There is no "Auto Pro" anything when it comes to Respironics.

You might want to follow this thread.
viewtopic/t173642/Opinions-Please.html

Thanks for the answer. I just talked to the Nurse Practitioner and things have changed since I got my cpap machines years ago. Now they don't specify the type or brand of the machine to the DME. They just give them a prescription telling them what the therapy is supposed to accomplish and let the DME choose a machine that does that. I will have to go to the DME's office and tell them what I would prefer. Don't know how that will go.

ClayL wrote: ↑

Wed Nov 14, 2018 11:00 am

PR Dream Station Auto Bipap and the Auto Bipap Pro which one would be the best?

Since there's no such thing as an "Auto Bipap Pro" I'd have to say that the Bipap Auto would be the better thing.

It works much better when you don't just throw words together at random, learn what things are called, and use the right terms, or the DME will use your confusion to stick you with something you don't want.

"But, he said "pro"..."

The sleep study was a waste of time. The nurse practitioner didn't do a good job of telling the study personnel of what she was trying to do. As soon as my AHI dropped below 5 at a pressure of 8 they said all was fine and CPAP was all I needed. Since I had been on CPAP since 2006 and for the last few years a pressure of 11.5 had yielded an AHI of less than 2.6, obviously 8 was not the answer. I even told them as the study started that I was using auto PAP set at 8 to 18 and my AHI was averaging above 7 with that setting.
The nurse practitioner had thought that BIPAP was probably what I need and since they had terminated the study before testing that she could not prescribe it. She said that she really did not have a solution for me.
The good news is that with advice from Pugsy I started trying different settings on my machine and have now reached an average AHI less than 3. I do see an occasional outlier of 6 to 8. This is the stats I am seeing now.