Rising AHI with poor sleep

Hi all,

Brand new to this forum and was hoping to get some advice.

Been using CPAP for over a year now (Resmed AirSense 10 with N30i nasal mask). Was diagnosed with OSA last may with an AHI of 93 when untreated and after my sleep study, I was given a pressure of 8.0. I took to the CPAP really well and have used it every night since. My AHI immediately went down to around 0.2-1.0 for pretty much the last year, with the majority of events being under 1.0. The last few weeks my sleep has not been great and my AHI is getting worse. It would hover in the high 2s but the last few nights it was in the 4s and last night hit a high of 10.4, which freaks me out.

I'd like to preface that I deal with bad anxiety on and off. Stress/late nights usually causes a bad wave and then sometimes I can have short bouts of insomnia along with it. It's always gone away after a week or so but this streak has been bad going on almost two weeks and I find I'm not able to fall asleep until way late in the night. And I wake up a bunch.

I find I'm tossing and turning most of the night with my mask on and then fall asleep somewhere around 3-4AM. The few uninterrupted nights of sleep I've had recently are when I take an Ativan, but I'm trying to not do this regularly and have started a CBT program to get my sleep back on track as I'm getting my stress and anxiety under control.

Sorry, this is a lot of info. Not looking for a diagnosis or anything, but I'm worried about my AHI going up. The last two days I got hit with a bad wave of allergies and was finding it harder to breath through my mask, particularly last night... but upping the moisture and turning on the heated tube really helped the breathing feel more normal. I could feel my hands and face get all tingly after I made these adjustments but I woke up this morning just feeling tense. I have noticed that my AHI reads high before I've fallen asleep or am tossing and turning and then reduces slightly once I've got a few hours sleep.

Been a bad few days. I've been to so many doctors for anxiety and other things over the past year and have always been cleared. But regardless of anxiety, this is the first time I've seen my AHI affected. I tried bringing my data into Oscar and Sleepyhead but looks like I have a "Dumb" machine as none of the AHI data is available. Wondering if anyone has any thoughts. Much appreciated. Thank you!

If you are tossing and turning most of the night, most of the events in the AHI calculation may be CAs. Pressure changes won't fix that. These CAs are most likely when you are partially asleep and partially awake when there is a breathing stoppage but no airway blockage. If you could download the Oscar software and we can see more about your data. What specific "dumb" machine do you have???

Movieman, could you fill out your profile and let us know what your equipment is?

Which airsense 10 machine do you have? Have you tried OSCAR and know there's nothing useful? If you have the basic CPAP we should still be able to see when the OA events are occuring, and if you have the Elite, we'd see CAs as well.

LSAT points out that if these are CAs then it probably would not help to raise the pressure ... so we need at least a little more info.

-Kevin

It'd certainly be good to see your AHI go back down! To follow up on LSAT's question, what kind of mask do you have? If you'd put your machine and mask information in your profile, everyone could see it every time you post.

Also to echo LSAT, you may be experiencing "sleep-wake junk." Our awake breathing is a lot less regular than our sound-asleep breathing, and it includes pauses between breaths that exceed 10 seconds. Those will register as central apneas.

So it's hard to tell without data, but it's possible the root problem you're having is frequent arousals from sound sleep, plus periods of wakefulness. In that case, doing the CBT-i and working on depression and anxiety are good steps toward lowering your AHI.

You say you tried to use Oscar but you have a "dumb" machine. Is there an SD card in it, or a slot for one?

khauser wrote: ↑

Mon Jul 20, 2020 10:25 am

If you have the basic CPAP we should still be able to see when the OA events

Nope....unfortunately if OP has the basic AirSense 10 CPAP machine...while it does give the overall AHI it doesn't break down the apnea portion of the AHI number into central or obstructive categories...It doesn't do the FOT thing to distinguish centrals from obstructives....so you just get an overall apnea index and the hyponea index.

It doesn't do ANY detailed graphs at all for anything. So there is no way to even see when anything gets flagged. It's what I call a half assed brick. Might as well just go by what's shown on the LCD screen if that's the machine he has because there's nothing else for OSCAR to report that what is already seen on the LCD screen. Waste of time trying....we had someone show us what the half assed machine showed with the software. There's nothing to show that isn't available on the LCD screen.

But if he is indeed spending a lot of time awake tossing and turning wearing the mask with machine on...there is a high probability that the bulk of that AHI is nothing more than the machine flagging irregular awake breathing as some sort of apnea event.
The high AHI is a symptom of the poor sleep and not the cause of the poor sleep kind of thing.

To the OP....the machine doesn't know if you are asleep or not. It only measures air flow and the air flow or breathing while awake can be quite irregular when compared to asleep breathing and the machine will flag awake breathing irregularities as some sort of apnea event. You have to be asleep when the apnea event gets flagged for it to be real. Awake flagged events (I think of them as false positives) simply don't count in terms of apnea therapy and we have to instead work on the cause of the poor sleep in the first place.

Thanks everyone,

I updated my equipment info in my profile. And yes, I have the
ResMed AirSense 10 CPAP and when I tried importing my SD card data into Oscar (and Sleepyhead to see if it made a difference) it showed no detailed data on my AHI. Only my usage shown and the word "BRICK" is listed in the profile... I can see this information in the MyAir app but it's basically the same info I see on my CPAP screen.

I'll have to try and see what my numbers are like when I can finally fall asleep soon after getting into bed, which haven't happened yet. It's just so out of the ordinary for me to have these higher numbers, I have to imagine the sleep issues have something to do with it.

movieman5566 wrote: ↑

Mon Jul 20, 2020 10:47 am

It's just so out of the ordinary for me to have these higher numbers, I have to imagine the sleep issues have something to do with it.

I think you're right about the association, but it isn't clear which way cause and effect run. It may be that restless, broken sleep results in the higher AHI via "sleep-wake junk (SWJ)," or it may be that worsening AHI is causing poorer sleep.

Does the increase in AHI correspond to an increase in your weight, the condition of your airway, or new medications? If not, I'd say the odds slightly favor the SWJ theory. And there, I do think you're on the right path, with the CBT-i and attention to your anxiety. Old-fashioned remedies like being outdoors during part of the day and doing at least 30 minutes of moderate exercise per day can also be of some help.

movieman5566 wrote: ↑

Mon Jul 20, 2020 10:47 am

I updated my equipment info in my profile. And yes, I have the
ResMed AirSense 10 CPAP and when I tried importing my SD card data into Oscar (and Sleepyhead to see if it made a difference) it showed no detailed data on my AHI.

You selected the autoset 10. That would be great if true, but if there's no data that's not the correct choice.

Does it say autoset on the front under 'airsense'?

On think most of the machines are under 'A', not 'R'... not sure why they put only the Autoset under 'R' for resmed...

The strange thing is that I've been on a diet for the last month (I'm pretty overweight and have been working to change that) and have dropped 10+ pounds since. Which is why it's weird that I've been feeling as bad at I have.

That being said though, the stress and resulting anxiety have been unusually high due to certain life events and work. My anxiety causes a bunch of physical symptoms, muscle tension, stomach issues. I've been given some anti inflammatories and more Ativan. The anti inflammatories did nothing, while the Ativan helps with falling asleep but I don't rely on it and take only if needed. Also I had taken some antihistamines for recent allergy flare ups, which was a nice cherry on top of things-- So yes, I have had different new meds in me recently but that wouldn't have been the case when all this started a few weeks ago after all the stress.

And to khauser, You're right I selected the wrong machine. Just updated it. It's the basic AirSense 10 CPAP. The drop down menu was oddly ordered.

Many antihistamines can keep you only half asleep... so I use only 1/2 (or even a tiny quarter) of a 3 mg melatonin pill before bed.

If you just got the machine through a DME using insurance, you might try and get them to exchange it...If you bought it out of pocket you are probably out of luck.

movieman5566 wrote: ↑

Mon Jul 20, 2020 12:12 pm

You're right I selected the wrong machine. Just updated it. It's the basic AirSense 10 CPAP. The drop down menu was oddly ordered.

Yes....we are aware of the odd way things got listed and I have asked to have it fixed but was told that it would be difficult and essentially "live with it"....so we have.

Usually it's the people with the AutoSet choosing one of the others in the A's because they don't know the AutoSet it all by itself down in the R's that is the error made.