why does my AHI increase at 2am?

ems · Post by **ems** » Mon Nov 05, 2012 10:54 pm

Pugsy wrote:

So cuuuuuuuuute! Makes me smile every time I see it!

lorraineg57 · Post by **lorraineg57** » Tue Nov 06, 2012 10:01 pm

ems wrote:
Pugsy wrote:
So cuuuuuuuuute! Makes me smile every time I see it!

Me too, would make a cute screensaver. Anyone have a link?

lorraineg57 · Post by **lorraineg57** » Tue Nov 06, 2012 10:02 pm

Denial Dave wrote:I've finally solved my leak issues with the Mirage quattro mask & my leak levels are well below 24.

Last night they were below 16 for 95% of the time with a max of 21.

But now I'm having trouble figuring out is why my AHI goes up every night around 2AM for about 30-45 minutes...

I go to bed at 10PM every night.... my alarm goes off at 4:30AM on weekdays and I tend to stay in bed until 6:30 on weekends.

Sleepyhead charts clearly indicate that around 2AM; obstructives happen, snores increase, tidal volume increases and my AHI goes up to around 12. The events last for about 30-45 minutes and suddenly everything returns to normal.

before and after 2AM, my AHI seems to stay around 2-3.

I don't know but on the nights that I only wake up once, it's always around 3 o'clock....weird.

is it aliens?

Bon Bon · Post by **Bon Bon** » Wed Nov 07, 2012 7:57 am

ems wrote:Bonnie... I wonder if you have the Bella Loops too tight? Mine are so loose I keep them on with the help of my bed pillow. I am a side sleeper and use a memory foam pillow which is fairly firm. I use a foam neck roll also that I put in the case along with the bed pillow . There is a bit of a slope between the neck roll and the pillow. That's where my head is which means my ear falls between the roll and the pillow. I hope that makes some sense.

Occasionally my nose feels chapped so I use lanolin before I put the Loops on.

I agree, you might have them too tight. Pugsy gave some great advice in this thread about fitting the bellas AFTER you're laying down. viewtopic.php?f=1&t=83401&p=756557&hilit=+bella#p756557

If I sit up while wearing the bellas, they hang down a little ways from my nose and air blows everywhere. But when I lay down, the settle up against my face perfectly. They would be way to tight and uncomfortable if I tried fitting them while sitting. Pugsy's post has some good points about handling the hose with the bellas as well.

Good luck!

Bonnie · Post by **Bonnie** » Fri Nov 09, 2012 5:49 pm

I did try adjusting the Bella while laying down last night. Didn't check my numbers yet. I'll probably do another night and check tomorrow. The quicky cover I made for the cheek piece made it a pain finding the darn straps to adjust. Not much room to get my fingers in there and locate the slippery buggers. WHEN I get to the point I feel comfortable using it I will order "real" ones from Karen. What I did like this morning was that my hair wasn't plastered on my head with pieces sticking up every which way. That was nice.

DavidCarolina · Post by **DavidCarolina** » Sat Nov 10, 2012 2:47 am

Pugsy is awesome, been a big help to me.

2 AM????? You and I sound like the same guy with the same name.

I awake every night at around that time give or take. I suspect an oximetry issue in REM sleep, or a more severe event cluster.

As pugsy said, it could also be supine sleeping--youre rolling onto your back, something you have to prevent.

Another idea is alcohol or food issues: you could have a disturbance from that in your CNS or refluxing of one type or another.

You might consider elevating your bed or using an incline pillow.

Denial Dave · Post by **Denial Dave** » Sat Nov 10, 2012 8:20 am

Yep, every night around 2AM, my AHI climbs and then goes back down.

it is not alcohol related.... when I have beer, my overnight AHI typically is about 7....

For 26 years, my wife and I have gone out on Thursday for pizza & beer.... small pizza, 2-3 beers... it gives us a chance to talk about our week and plan for the weekend.

I'm guessing Pugsy is right and it is related to sleeping on my back or REM. my leaks are really low these days... I'm maxing out at 10-11 each night.... The Quattro is the mask for me!

Dave

Denial Dave · Post by **Denial Dave** » Sun Nov 18, 2012 9:35 am

I have solved my leaks and have kept my overnight AHI below 3 for the past three weeks.

Sleepy head shows that 80% of my nightly issues are obstructions & 20% hypopneas.... 2-3 nights a week, it will show 1-3 clear airway issues.

During my sleep study in August, it showed that I had some centrals, but there was no mention of UARS.I was prescribed with Bi-pap because of issues exhaling at straight CPAP levels above 10 cm/l.

after 60 days of bi-pap therapy, I have begun to see some trends in my data... most nights, my AHI will spike to 5 around 2AM... last night it went to 8.

Approximately 10-15 minutes before my AHI rises in the 2AM range, Sleepyhead and Rescan show a dramatic increase in Flow limitation. everything last for 30-45 minutes and returns to normal.

Aside from the brief spikes in the 2AM period, flow limitation is almost non-existant each night.

Is the increase in flow limitation related to UARS or is it more associated with REM?

or none of the above
Dave

Pugsy · Post by **Pugsy** » Sun Nov 18, 2012 10:24 am

Denial Dave wrote: Is the increase in flow limitation related to UARS or is it more associated with REM?

I don't know of any way to answer for sure. Could you post an image of a typical report so we can see the pattern?
My first thought would be REM activity though. It's not unusual to have more events during REM and not unusual to have those REM events need more pressure to prevent them from happening. Sleeping position (supine vs side) might also be a mitigating factor. Maybe a little combination of both mitigating factors.

If you had an auto adjusting pressure machine then very likely it would respond with a little more pressure since they are predominately obstructive apneas. Since you have only a fixed pressure machine it can't do anything about any extra stubborn events or associated event precursors.
I don't have time to look back through all your posts to see what pressure you are using or see any of your other reports but off hand...I go back to general ideas when it comes to bilevel pressures...EPAP for Obstructive apneas and IPAP for hyponeas. With ResMed machines the PS is fixed so if you want to maintain same pressure support for comfort then both EPAP and IPAP have to go up at the same time to maintain same PS.

If your AHI is really pretty good overall and the clusters that are occurring are rather small then you may not even need to worry about trying to reduce the clusters. If I could see a typical report I could comment on whether I would try to do anything about them if it were my report. At this point I wouldn't worry so much about what the cause is (REM vs UARS) instead I would be wondering as to whether I wanted to do something about them or not.

Do you feel something is lacking in your therapy? Feel like there is room for improvement in how you feel?
Or do you wake up feeling great and don't think the clusters are hurting you in any way?

Denial Dave · Post by **Denial Dave** » Sun Nov 18, 2012 12:34 pm

I'm on bipap with settings of 21IPAP and 15 EPAP... my therapy seems to be going well..

one thing that concerns me is that I go to bed at 10PM every night and sleep all night, but I can't sleep past 5 AM any more.

At 5AM, I wake up and I am good for the day... no naps... But it's a bit annoying to be up that early..

So, I've been looking at Sleepyhead & ReScan data and saw the trend of spike in flow limits and then then rise in AHI around 2AM. It got me to wondering why.

Photobucket seems to be weird for me today... After logging in, it is not showing my photo albums and won't let me upload anything... As soon as I can get photobucket working, I'll post some charts.

Dave

jwerley · Post by **jwerley** » Sun Nov 18, 2012 2:39 pm

Just a suggestion: I had the same problem with Photobucket because they updated it. They give you the option of going back to the orginal...which I did. The original works much better and easier!

Janice

Todzo · Post by **Todzo** » Sun Nov 18, 2012 3:38 pm

Denial Dave wrote:I'm on bipap with settings of 21IPAP and 15 EPAP... my therapy seems to be going well..

one thing that concerns me is that I go to bed at 10PM every night and sleep all night, but I can't sleep past 5 AM any more.

At 5AM, I wake up and I am good for the day... no naps... But it's a bit annoying to be up that early..

So, I've been looking at Sleepyhead & ReScan data and saw the trend of spike in flow limits and then then rise in AHI around 2AM. It got me to wondering why.

Photobucket seems to be weird for me today... After logging in, it is not showing my photo albums and won't let me upload anything... As soon as I can get photobucket working, I'll post some charts.

Dave

Hi Dave,

Before my last move I had a Zeo. It tracked what I beleive they called "deep sleep" and I would be concerned if the number got too low. Through experimentation (and perhaps a bit of luck) I found that I could increase the ammount of deep sleep by taking long walks.

Sometimes I sleep long periods of time and then have trouble sleeping the next night. If I take a long walk during the day after a long sleep night I have this trouble a lot less.

I still think you would find some kind of disturbance - a neighbor who starts his car at 2 a.m. for example - or hits his lights and then drives away at 2 a.m. to go to work for example - which causes the changes in your sleep data at 2 a.m. I still think video taping your night with audio may reveal clues as to why you see major changes in your data at that time.

In my case, for a short time (fortunately) I had some neighbors who would get into very severe arguments early in the morning. It would not wake me up but the changes in my CPAP data were very notable.

Have a lot of fun!

Todzo

Denial Dave · Post by **Denial Dave** » Sun Nov 18, 2012 4:02 pm

it seems that photobucket had a glitch today where it was not working with internet explorer... it appears to be fixed.

RE: external source.... I live on a dead end street with 6 other houses on it... so neighbors are probably not the cause of it & our thermostat turns the heat up at 4AM... newspaper arrives at 5AM...Video or audio recording may be find the issue.

it's really curious as to why the event happens every night sometime between 1:30 and 2:30AM.

pay no attention to the time line on sleepyhead... I have not reset the time on my S9 yet

here is my data from photobucket from last night.

http://s1294.beta.photobucket.com/user/ ... 3252390443

patrissimo · Post by **patrissimo** » Thu Jan 24, 2013 2:32 pm

Those OAs at 2am seem more correlated with the leak increase than with the spike in snoring & FL, which happened together around 1:30am.

REM instability seems quite plausible, but what do you do with that even if you know it is true? Perhaps an Auto-BiPap which could increase your pressure in response? You could also try increasing your pressure, if you feel you have any room to do so w/o causing greater leaks or discomfort.

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