Do Changes In AHI Matter?

I called my sleep clinic yesterday to ask the Physician's Assistant a question about "patient triggered breaths". In the course of that conversation, I asked at what point should I be concerned about changes in my AHI. At what point would I want to let them know there had been a change that might mean my therapy needed to be changed. I asked this because the number of hypopneas I have seems to be increasing with every night that goes by.

The PA told me that there was no reason to ever be concerned with a change in my AHI because even if there were a change, nothing would be changed about my therapy. She said that concerning myself with changes in my AHI or any other data related to my sleep apnea or my BiPAP machine constituted micromanaging my apnea and there was no reason for it.

She then qualified that by saying, "If you gain a significant amount of weight or there is an increase in the amount of pain medication you are taking, maybe we would change something."

So, now I am totally confused. Seems to be a recurring condition in my life! The only thing I can think to make sense of what she said is that I am already using a BiPAP ASV and maybe the parameters of the pressure settings are already broad enough to cover everything. But I don't know if that makes sense. Anyone have any thoughts aobut this?

These are the pressure settings from the machine. Let me know if there is some other bit of information I should include.

Pres Max: 25
EPAP Max: 15
EPAP Min: 8
PS Max: 15
PS Min: 0

Deborah

Paper_Nanny wrote:I called my sleep clinic yesterday to ask the Physician's Assistant a question about "patient triggered breaths". In the course of that conversation, I asked at what point should I be concerned about changes in my AHI. At what point would I want to let them know there had been a change that might mean my therapy needed to be changed. I asked this because the number of hypopneas I have seems to be increasing with every night that goes by.

The PA told me that there was no reason to ever be concerned with a change in my AHI because even if there were a change, nothing would be changed about my therapy. She said that concerning myself with changes in my AHI or any other data related to my sleep apnea or my BiPAP machine constituted micromanaging my apnea and there was no reason for it.


She then qualified that by saying, "If you gain a significant amount of weight or there is an increase in the amount of pain medication you are taking, maybe we would change something."

So, now I am totally confused. Seems to be a recurring condition in my life! The only thing I can think to make sense of what she said is that I am already using a BiPAP ASV and maybe the parameters of the pressure settings are already broad enough to cover everything. But I don't know if that makes sense. Anyone have any thoughts aobut this?

These are the pressure settings from the machine. Let me know if there is some other bit of information I should include.

Pres Max: 25
EPAP Max: 15
EPAP Min: 8
PS Max: 15
PS Min: 0

Deborah

My advice: RUN - don't walk - away from this PA. Big red flags, if you care about getting good therapy. If you don't have a good sleep doc (and many of us don't), try to find one. In the meantime, rely on what you learn here to help you in your therapy journey. Many of us have found that our "support" in the real world amounts to nothing, and we get all the help we need right here. (And thank goodness for that.)

Can't really tell anything from the pressure settings info you've provided. We'd need to see actual data reports to be able to comment on what might need to be adjusted to make your therapy more effective. I neglected to look at the bottom of your post to see if you have software for your machine. If you do, perhaps you can post some data for forum members to look at. If not, you can obtain the software easily enough.

And to answer the title question of the thread, yes, changes in AHI can matter. Generally speaking, an AHI of 5 or less is considered adequate treatment. When a pattern begins to emerge (as you say above that your HI index is increasing with each night that goes by), there's reason for some concern (and possibly a needed adjustment in the settings). But we all take some time to adjust to therapy. If you're brand new to it all, I'd just let things ride for awhile as is and give the current settings a little more time. If you've been at it for awhile already, then it's time to look at the data and see what's up.

And FWIW, settings on an ASV are just as important as they are on any other machine. We all want optimal therapy, and we each have very individual needs in that regard.

Oh the old "don't micromanage your health because it doesn't matter" argument.

I have asthma and I'm supposed to check my peak flows DAILY. A drop in peak flow can be an early signal that I'm having problems, and I have a plan in place about what to do with it to MAINTAIN my health.

A diabetic checks blood sugar regularly, not just for the exercise of doing so, but because diabetes can be managed by adjusting therapy accordingly.

But we are not supposed to monitor or care about the amount of times we stop breathing each night??? Whose dumb ass idea is that???

Now, if you're getting stressed about very small changes in AHI night to night, but your overall AHI is good and you feel well, that might be considered "mircromanaging". But if you are trending ever higher and higher in hypopneas, and you are not feeling the benefit of therapy, that MEANS something, and a change in therapy may definitely be in order. The PA who told you differently is either ignorant, stupid, or so full of himself that he thinks he is G-d and you are an idiot. As Bleeping Beauty told you, run, run as fast as you can away from this jerk and don't take medical advice from him ever again!!!!

I agree with Beauty; you need a REAL sleep doctor--not the idiot you just saw.

BleepingBeauty wrote:My advice: RUN - don't walk - away from this PA. Big red flags, if you care about getting good therapy. If you don't have a good sleep doc (and many of us don't), try to find one. In the meantime, rely on what you learn here to help you in your therapy journey. Many of us have found that our "support" in the real world amounts to nothing, and we get all the help we need right here. (And thank goodness for that.)

I live in a fairly rural area and the selection of medical care providers here is quite limited. So, yes, thank goodness for forums such as this! With all the various health problems I have, I have learned that I need to be very well informed if I want good care. I have learned to be assertive with my physicians. And I have learned that sometimes I need to go in and say, "This is what I want you to do and this is why I want you to do it" and then not back down unless there is a good reason to change my mind.

BleepingBeauty wrote:Can't really tell anything from the pressure settings info you've provided. We'd need to see actual data reports to be able to comment on what might need to be adjusted to make your therapy more effective.

Thanks... I am going to look over the data again more carefully and if I do indeed see a trend of increasing AHI's I'll post the reports.

Deborah

I would be concerned if my AHI was consistently over 5. If it's less than that it's considered normal. If you're not feeling well after initially good results I would expect the PA to pay more attention. If you're unhappy with the practice by all means try to find another doctor. If you were just calling to see if there was a problem with the number of patient triggered breaths that might not be something to worry about or to bring to this forum. I think some us do try to "micromanage" our therapy which is why forums like this are valuable. We can save the PA for the really important issues. I would consider not responding to therapy an important issue. Your DME tech or RT may be able to answer some of your questions also.

So paper nanny, how's it going? Are your AHIs in a consistent range under 5?

gasp wrote:So paper nanny, how's it going? Are your AHIs in a consistent range under 5?

Well, my average is 5.2. BUT on 16 of the past 32 days, my AHI has been 5 or over, which seems kinda not so good to me. So... What data would I post to get some ideas about what might be going on? Which of the graps and for what time period?

Deborah

Paper_Nanny wrote:

gasp wrote:So paper nanny, how's it going? Are your AHIs in a consistent range under 5?

Well, my average is 5.2. BUT on 16 of the past 32 days, my AHI has been 5 or over, which seems kinda not so good to me. So... What data would I post to get some ideas about what might be going on? Which of the graps and for what time period?

Deborah

Post screenshots of one or two "typical" recent nights for you. You want the Daily Details reports, not a summary.

Paper_Nanny wrote:

gasp wrote:So paper nanny, how's it going? Are your AHIs in a consistent range under 5?

Well, my average is 5.2. BUT on 16 of the past 32 days, my AHI has been 5 or over, which seems kinda not so good to me. So... What data would I post to get some ideas about what might be going on? Which of the graps and for what time period?

Deborah

I think this really depends on how you feel. As long as your oxygen is not dipping too low during the night and you feel fine during the day, I wouldn't worry about numbers around 5. Not everyone gets down to a 1 and we all have fluctuations at times, at least I do. If you're not feeling well or if it does continue to creep up, you might consider tightening the range of pressure. For me if the pressure gets either too high or too low my AHI will increase. I used a lot of trial and error to finally arrive at a very tight pressure that keeps my AHI under 1 on most nights. . . but like I said, I have fluctuations at times and it usually turns out to be mask leaks. But I will know when that happens, I'll feel like crap the next day.

Paper_Nanny wrote:

gasp wrote:So paper nanny, how's it going? Are your AHIs in a consistent range under 5?

Well, my average is 5.2. BUT on 16 of the past 32 days, my AHI has been 5 or over, which seems kinda not so good to me. So... What data would I post to get some ideas about what might be going on? Which of the graps and for what time period?

Deborah

How much variability is there from the "good" nights to the "bad" nights? You say that 16 out of 32 days have an AHI > 5. So just how bad does he AHI get on those nights? What's the AHI look like on the other 16 days where the AHI < 5?

In other words, is your AHI bouncing between 4 and 6 most of the time? Or do you have a bunch a really good days (say AHI < 2.5) and really bad days (say AHI > 7.5) and a few days in the middle?

The summary GRAPHS from the first page of the Encore Report might be useful for us to see in order to see how widely variable your AHIs are and whether there seems to be an on-going trend upwards. But we also need to see some typical nights Detailed Data as well.

Okay... What does anyone think of this?

I'd start with raising your minimum pressure to 9.0. It looks like you have some leaks going on as well, need to get control of those.

The leak line isn't straight, but it's also not horrible. If you haven't tried a mask liner or the pantyhose trick or something along those lines, though, I would give that a shot.

I'd be wary of raising EPAP. Your problem (like mine) is residual hypopneas. They could be obstructive in nature, in which case raising EPAP would help, but if not, it could make your problem worse. If you look at the Respironics titration protocol, the two settings involved in dealing with hypopneas are actually IPAP and BPM.

It's also really important with the Mirage Quattro to have a clean face and clean mask cushion. I've noticed that even the wrong soap can leave a residue that makes the mask leak. I have to wash my face with fragrance free neutrogena soap, that's the only thing that works for me. I also use it to wash the mask cushion and/or use dr. bronners liquid castile soap (also fragrance free). After I wash and dry the cushion I run my finger along it to see that it's good and sticky, if not, I re-wash it. Be sure to rinse thouroughly! Sometimes if my skin is really dry I add a lotion that works really well with this mask:

http://www.amazon.com/Aveeno-Active-Nat ... B004E2MSJG

Only use a little bit, though, too much and you'll get leaks. Rub it in well on clean skin and it will help your mask stick to your face.