Need Advice Please

I have been on BIPAP for a little over 6 months now and everything so far has been going good. Until this week my AHI is usually around 1 or2. Starting Wednesday it has went up. I am sorry I could not get the graphs to upload. Nothing has changed no new meds. Just wanted to see if this happens sometimes or should I be concerned. My average for the 6 months is 1.5 I think. Thank you for the help

Tuesday was
AHIApnea / Hypopnea Index 0.96
HypopneaHypopnea 0.75
ObstructiveObstructive Apnea 0.21
Clear AirwayClear Airway Apnea 0.00
RERAResp. Effort Related Arousal 0.43
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 0.00
PB/CSRPeriodic Breathing 0.00%


Wed AHI
Apnea / Hypopnea Index 3.23
HypopneaHypopnea 2.59
ObstructiveObstructive Apnea 0.54
Clear AirwayClear Airway Apnea 0.11
RERAResp. Effort Related Arousal 0.32
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 0.00
PB/CSRPeriodic Breathing 1.06%

Thur AHI
Apnea / Hypopnea Index 3.15
HypopneaHypopnea 1.99
ObstructiveObstructive Apnea 0.94
Clear AirwayClear Airway Apnea 0.21
RERAResp. Effort Related Arousal 0.52
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 0.00
PB/CSRPeriodic Breathing 0.32%

Fri
AHIApnea / Hypopnea Index 4.03
HypopneaHypopnea 2.18
ObstructiveObstructive Apnea 1.52
Clear AirwayClear Airway Apnea 0.33
RERAResp. Effort Related Arousal 0.54
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 0.00
PB/CSRPeriodic Breathing 0.15%

SatAHI
Apnea / Hypopnea Index 4.35
HypopneaHypopnea 3.85
ObstructiveObstructive Apnea 0.49
Clear AirwayClear Airway Apnea 0.00
RERAResp. Effort Related Arousal 0.99
Flow LimitFlow Limitation 0.00
VSnoreVibratory Snore 0.00
PB/CSRPeriodic Breathing 0.51%

According to the data you posted, it looks like your elevated AHI is mostly hypopneas. That would indicate either the reading is inaccurate or you're needing a little bit more pressure. I wonder what your leak rate is. Are you trying a new mask?

Leak rate is low using nasal pillows but I have noticed lately that i do feel some air quite a bit and have to reposition a lot before I fall a sleep. I was going to put on new nasal pillow tonight since the one I have been using is 6 months old. Maybe that is it since it all of a sudden went up.

other info not sure how to read the leak rate

Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH20)
W-Avg: 5.00 5.00 5.00 5.00 5.00
IPAPInspiratory Pressure (cmH20)
W-Avg: 11.00 11.00 11.00 11.00 11.00
PSPressure Support (cmH20)
W-Avg: 6.00 6.00 6.00 6.00 6.00
Minute Vent.Minute Ventilation (L/min)
W-Avg: 8.08 0.12 7.75 12.12 22.00
Resp. RateRespiratory Rate (breaths/min)
W-Avg: 16.43 11.37 16.20 18.80 21.60
LeaksLeak Rate (L/min)
W-Avg: 0.48 0.00 0.00 2.00 3.00
Total LeaksTotal Leak Rate (L/min)
W-Avg: 20.84 20.00 21.00 22.00 24.00
SnoreSnore (unknown)
W-Avg: 1.44 0.00 0.00 6.00 25.00
Insp TimeInspiratory Time (seconds)
W-Avg: 1.43 0.26 1.40 1.66 2.80
Exp TimeExpiratory Time (seconds)
W-Avg: 2.24 0.52 2.26 2.72 3.26
Tidal VolumeTidal Volume (ml)
W-Avg: 483.42 13.33 480.00 700.00 1180.00

Six months on a set of nasal pillows is a significant amount of time for sure and the leakage does look little high. (At IPAP 11 cm H2O your 48 L/min leak should be closer to 35 L/min) The idea of trying a new set of pillows and adding some lanolin (Lansinoh) if you still have trouble getting a good seal would be a good first start.

If that didn't work, if you feel comfortable adjusting your pressure, you might try raising your EPAP from 5 to 6.

Hope that helps.

SleepWellCPAP wrote:leakage does look little high. (At IPAP 11 cm H2O your 48 L/min leak should be closer to 35 L/min)

Where are you seeing Leak being 48 L/min? I don't see it.
I see leak 0.48 but that is the minimum excess leak number (or SH's close approximation of excess leak)...the worst he ever got was 24.00 max under the Total leak column.
I am betting the leak line is so straight and flat I would be pea green with envy if I could see the actual graph.

cpierc01 wrote:LeaksLeak Rate (L/min)
W-Avg: 0.48 0.00 0.00 2.00 3.00
Total LeaksTotal Leak Rate (L/min)
W-Avg: 20.84 20.00 21.00 22.00 24.00

You're right Pugsy. Puzzling indeed, total leaks don't appear to have changed.

I'd still recommend trying a new set of pillows though and see how that goes before I would recommend a pressure increase.

Thank You for the responses and yes normally the leak line is very low. But I have been having air leak around the seal that I have to keep adjusting. I will change the pillows out tonight and see ow it goes. I am puzzled by this if I needed more pressure strange that it went changed in one day.

Changed out the nasal pillows last night and AHI went back down to 1.0 from 4.3 the night before. Thanks everyone and I will keep a check on it.

i would make sure that your mask has a proper fit as well, lot of times patients do not realize the fit is off.

changing your settings you should consult with your sleep provider before doing so.

Thanks just an update second night AHI was 0.5 so hopefully it was that I need to change out the Nasal Pillows. I am new to this so I am learning.

Glad to hear it cpierc01, good for you!