CPAP making AHI go up?

I just sent you a PM with some information about your specific machine.

Here's the software for the PR System One, which is EncoreViewer 2.0: https://www.cpap.com/productpage/respir ... chine.html. You'll also need an SD card reader. I've only used ResMed machines myself, but I believe that your data card can be read with a regular SD card reader, like the ones that are often installed in computers these days. But Janknitz, or someone else here who is familiar with your machine, can confirm that.

I use the Activa LT nasal mask, which uses the same frame as your SoftGel. With my mask, it's important not to overtighten the straps. Also, having the correct size is very important. By checking your leak rate with the software and experimenting with chin strap, mouth-taping, etc., you should be able to determine where the leaks are coming from (mouth or mask?), if that is indeed a problem.

It'll take a little time and detective work, but I'm confident that you'll be able to figure out if you're having excessive leaks or need pressure adjustment. Please let us know how you're doing.

The clinician's menus and set up are accessible, I believe you have been sent the "secret handshake", but you do need to be careful about doing it on your own if you don't fully understand what you are doing. Ideally your doctor will work with you on this--clearly your DME provider will not.

It helps me enormously to be in control of my therapy. I can look at my data, and while I know how to change it, I'm fortunate to have clinicians who will work with me on problem-solving and are comfortable with my questions and concerns. This HAS made me wiling to keep going even when it's tough, and I've been 100% compliant. Best of all, I'm getting great therapy. My AHI's are always under 5, and I'm very comfortable and sleeping well after a long, hard struggle to get here.

Those documents were of great help, I have a copy of that software on the way. But just sitting here for a while with the machine on I start to isolate it to the mask - the softgel cushion just seems way too big for the structure of my face and I'm getting hissing everywhere...can't get it to fit well or comfortably at all. I know I don't respond well to the nasal pillows becaus I have a small nose, but is there a nasal mask that takes up less face real estate?

budleigh wrote:What is going on here? I'm all for wearing the mask, but if it isn't improving my AHI, what's the point?

Your original question, "CPAP making AHI go up?", is intriguing. I'm beginning to believe that it DOES. I recently increased my pressure from 8 to 9 cm (CPAP) per the doctor's instructions. The first night I slept like a baby with an AHI of 1.9, no apneas. It's gradually gotten worse to the point that last night I had 5 apneas, which I never have, and my oxygen sats were way down, even during one period where only flow limitations were recorded.

Guest wrote:But just sitting here for a while with the machine on I start to isolate it to the mask - the softgel cushion just seems way too big for the structure of my face and I'm getting hissing everywhere...can't get it to fit well or comfortably at all. I know I don't respond well to the nasal pillows becaus I have a small nose, but is there a nasal mask that takes up less face real estate?

Masks are such an individual thing! I have tried on at least 15 different ones (nasal, nasal pillows, full face and hybrids), in various sizes, and only a few have worked for me. I don't have a lot of "padding" on my face, so my sharper facial contours make getting a good fit a real challenge. I have found that the nasal pillows masks work best for me.

From what you said, it sounds like your Medium SoftGel may be too large for you. I use the Activa LT, which uses the same frame as the SoftGel, and I wear a size Small. If you want to try nasal pillows, they do make some that have Petite pillows available. I don't think that I have particularly big nostrils, but I wear a large-sized nasal pillow in several different models. They are all sized differently, so you'd have to try some on to get the proper fit.

If you have a local DME supplier (or sleep center?) where you can try on various masks in different sizes (including the Small Activa LT and SoftGel), I suggest that you do that. Make sure you are fit while the machine is at full pressure, and move around (preferably while lying down) to test for leaks.

As for which nasal masks to try, I like the Activa LT because it's lightweight and it seals very well for me. I didn't have much luck with the others that I tried. But everyone's different. What works for one person doesn't work for someone else.

Perhaps others here can suggest which nasal mask works best for them. You could look at the nasal mask reviews at cpap.com also: https://www.cpap.com/cpap-masks/nasal-c ... rating:20:. You can sort them there by Rating and Most Popular, although I'm not sure I agree with their rankings personally (from my own experience trying them).

LoQ wrote:Your original question, "CPAP making AHI go up?", is intriguing. I'm beginning to believe that it DOES. I recently increased my pressure from 8 to 9 cm (CPAP) per the doctor's instructions. The first night I slept like a baby with an AHI of 1.9, no apneas. It's gradually gotten worse to the point that last night I had 5 apneas, which I never have, and my oxygen sats were way down, even during one period where only flow limitations were recorded.

LoQ, are you using the S7 machine that's in your profile, or an S9 machine? If it's an S9 machine, are these increased apneas obstructives or centrals?

DreamOn wrote:LoQ, are you using the S7 machine that's in your profile, or an S9 machine? If it's an S9 machine, are these increased apneas obstructives or centrals?

S7 Elite, unfortunately.

My initial diagnostic study showed that I had a large number of hypopneas during REM especially, about half obstructive and half mixed. There were no apneas. As best I can remember, my oxygen sat stayed below 88% for 35 consecutive minutes, going down to a low of 71%, so instead of doing something about it, the tech decided to wake me up, which was her way, I guess, of restoring appropriate oxygen levels. Of course, then I couldn't get back to sleep.

When I went for my titration study, I was in REM for only 8 minutes, but during that 8 minutes I had 2 central hypopneas. No apneas that night either, and no other hypopneas of any kind, nothing during non-REM sleep. My original Rx was for CPAP of 7 cm.

My current doctor doesn't think there is any significance to the fact that I had 2 centrals in 8 minutes. I think he thinks it's just a fluke.

I know I don't respond well to the nasal pillows becaus I have a small nose, but is there a nasal mask that takes up less face real estate?

A small nose should be no deterrent to using nasal pillows. The "pillows" sit AGAINST the nares, not in them. Resmed makes extra small nasal pillows for both the Swift LT for Her and the FX which are included in the package. You can't find a mask that "takes up less real estate" on the face than the FX. The only problem you may have is that if you have a very small head, the FX may be too small for the last adjustment on the silicone head strap. The LT for Her will fit even a small head, but the headgear does touch a lot of the face. Take a look at the photo galleries and videos of these masks on the Resmed site.

I have fairly small facial features, and the small Activa LT was too large and heavy for my face. The lower portion of the "bellows" extended past my lips and I found that quite uncomfortable.

LoQ wrote:

DreamOn wrote:LoQ, are you using the S7 machine that's in your profile, or an S9 machine? If it's an S9 machine, are these increased apneas obstructives or centrals?

S7 Elite, unfortunately.

I asked because you had mentioned "only flow limitations were recorded," so I was wondering how you could see that in ResScan with the S7 machine. I assume that you must have a ResLink then.

I used an S8 Elite II for the first eight months or so. It couldn't differentiate between obstructive and central apneas. I kept having a few lingering apneas, and I couldn't figure out why I couldn't eliminate them with increasing pressure. Then I got the S9 Autoset, which can distinguish between apnea types, and that's when I discovered that my lingering apneas were actually centrals (perfectly "normal" ones, in my case), which pressure can't treat. I just wondered if your increased apneas that came about after your pressure was increased may actually be central apneas. But I suppose there's no way to tell in your case.

If you are consistently having more apneas at pressure of 9 than you were at 8, perhaps you should back the pressure off slowly, maybe down 0.2 at a time if your machine has that capability, to see if that has any effect on AHI over time. Also, make sure that your leak rate is okay. Perhaps you're losing more therapy air from the mask because of the higher pressure (although pressure of 9 isn't exactly "blow out" pressure!).

DreamOn wrote:I asked because you had mentioned "only flow limitations were recorded,"

Sorry, I didn't mean that it was only capable of recording flow limitations. I meant that those were the only events that occurred.

DreamOn wrote:I assume that you must have a ResLink then.

No, I don't have ResLink. I'm just using the cable connection.

DreamOn wrote:If you are consistently having more apneas at pressure of 9 than you were at 8, perhaps you should back the pressure off slowly, maybe down 0.2 at a time if your machine has that capability, to see if that has any effect on AHI over time.

Thanks, that's a good suggestion.

DreamOn wrote:Perhaps you're losing more therapy air from the mask because of the higher pressure

Seems unlikely. My leak rate last night showed that it was well below the 0.4 red line until I took the mask off this morning.

It would be helpful if you register and log in to post your equipment in text format. Fortunately CPAP does not cause your AHI to go up! There are many variables that you need to understand and get under control.

Hey all, quick update.

I have a copy of the reading software on it's way. In the meantime, I was able to adjust my machines pressure to what the Stanford sleep people prescribed: 11. This was the only change they saw as necessary after my cpap polysomnograph with them (no open mouth, leaks, etc.)

I also got a new mask to try, one of the RemStar nasal pillows with small pillows. It is fantastically more comfortable to me than the softgel, more motion is allowed and much less Vader going on. I was extremely excited to try the new combination. Woke up this morning, not feeling good, 7 day average AHI went up to 9.1, 2% periodic breathing...

Once again I'm at a total loss.

You should have a much better idea of what is going on once you are able to view your data using the software. You may be having mouth or mask leaks that are large enough that they're affecting your therapy and/or causing your other results numbers (such as AHI) to be inaccurately reported. Keep in mind that you may be sleeping right through them, as they often occur during deep sleep, when all our muscles (including jaw and tongue) relax.

I also prefer the nasal pillows masks. But I DO have to wear a chin strap with the nasal and nasal pillows masks. Otherwise, much of the therapy air goes to waste as it leaks out my mouth instead of keeping my airway open. A chin strap alone is often not enough to prevent mouth-breathing/leaking, so some people tape their mouths or use a full face/hybrid mask instead. I don't know if mouth-leaking is part of your problem or not, but it's good to consider your options if the software reveals that's an issue.

Please let us know what you discover.

Hey all, just got my software and plugged in the data to see what was up. Here's the rundown.

Last night, which I will deem 'the beginning', because I was using my preferred mask and using the pressure setting prescribed by my doctors, it showed:

CPAP pressure: 11
3.8% night in PB <-- ?

CA: 5.2
OA: 2.0
H: 1.5
FL: 0.0
VS: 1.1
RE: 1.8
TOTAL AHI: 8.7

The leak info is also interesting and I need help interpreting.

Min in large leak: 0, 0% of night
Average leak: 30.9

Open mouth? Mask mis-fit? :\



Some other interesting details of the report over a longer term and during the period I was on autopap show that all pressures I used, 6-10, EXCEPT for 8, had AHI's of 8+.

pressure 6:
% time at pressure: 57.3, 223.4 minutes
FL: 0.3
VS: 3.5
OA: 1.3
CA: 3.8
H: 3.0
RE: 0.8
AHI: 8.1

pressure 7:
% time at pressure: 26.9, 104.9 minutes
FL: 0
VS: 0
OA: 2.9
CA: 2.9
H: 2.9
RE: 2.3
AHI: 8.7

pressure 8:
% time at pressure: 15.5, 60.3 minutes
FL: 0
VS: 0
OA: 0
CA: 1.0
H: 0
RE: 3.0
AHI: 1.0

times at 9 and 10 were negligible. Yet, Stanford somehow prescribed a pressure of 11.

I'm also not sure what RE is. But, there it all is. Does anything stand out to anyone? Tonight I'll almost definitely set it to 8 and probably do a taping because of that leak of 30, which is quite clearly not 0. Open mouth or mask mis-fit. The leak seems totally constant throughout the night with one or two spikes to 5 or 10 more points.

Thanks in advance for all insight.

Budleigh wrote:Hey all, just got my software and plugged in the data to see what was up. Here's the rundown.
Does anything stand out to anyone?

Posting the graph from your daily info is the best way to get help. Numbers are just that and are an average for the nite. At some points you were higher and lower. But at what points? Also you will be able to see the events and pressure change with leak rates.

If you mentioned which machine make/model you are using - I lost track.