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Well, to say I am discouraged is putting it mildly. I had a sleep study in 2009 where my AHI was 29. I have been using a CPAP faithfully since then.

I had a sleep study 2 weeks ago and after losing 50 pounds my AHI is 35. WTF? Of all the things I expected in this second study it was not having my sleep apnea be worse.

Any thoughts would be greatly appreciated.

bee

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I'm really sorry you got disappointing news.  You earned a better fate by losing 50 pounds.  That's quite an achievement!

As has been described, there are a number of factors which may have led to the unexpected report.  Among the suspected factors could have been physical or technical issues with one or both studies, or age progression of your apnea.  It is possible that without that significant weight loss your apnea would have been much worse.

I think your best course is the one you have already engaged, which is to try to maintain sanity while waiting to see your physician as soon as reasonable.  Carry on, & again congratulations on your great work!

Rock

You may have some night to night variability in the equation, or time spent more in a vulnerable sleeping posuition (back) that drove up the overall number. A PSG only samples one night and this may not fully reflect your norm at home. I suggest you ask your doc to dissect the AHI number a bit with you. Todd

 

I am going to make a nice long list of questions to take with me to visit with the sleep doc on the 23rd, you all have been so great in helping me refine the questions. I guess that as it is in life, it is the overview that is important and not the data gathered from one night during a lifetime.

"Autos are the worst thing out there"...  Yea, right.  One of the problems that I brought to light with my doctor - and his eyes opened when I mentioned this. 

ANY "PAP" machine will create a market for itself.  Once you go on PAP, you can never go off, or at least virtually never.  Why?  Because, once you are on PAP, your muscles LOSE TONE.  Being on ANY PAP machine for long enough and try going off for just one night and see what happens - you will have the worst night ever.  That's why you can even lose weight but not be able to give up the machine!

Anyhow, think about what I just said...  xPAP is like a crutch that you use, only once you use it too long, your leg muscles get atrophied and so you can't go off if it without proper exercise, but you can't get the exercise for those muscles inside your throat & mouth easily (if at all)...

jeremy gober said:

One thing you would want to look at first is the previous report. Was your study conducted in supine, right/left side or prone. In my experience alot of labs are conducting studies and "titrating" pts on their sides, then when the pt is at home undergoing treatment they sleep in supine and now they dont have enough pressure. If that isnt it you would want to turn to haw long your apneas were. Your ahi might have increased due to the length of the apneas decreasing. Dont look at it as a negative.  Also, auto-sets are the worst thing out there. Patinets should always have a titration done by a competent lab to correctly determine proper titration pressure. ASV should only be used in cases that are CSA and Cheyne-Stokes when deemed necessary.

What is generally not understood by most OSA patients is that the AHI is not chiseled in stone. Its not going to be the same from one night to the next. It can be quiet variable because of the dynamics of the upper airway, subject to change with position, fluid retention, inflammation, allergies, sleep efficiency, drug influences (hypnotics and other respiratory depressants) on brainstem autonomic neurons.

A study a few years ago showed ~ 12 men with AHI's from 1-4  out of a large group of men with AHIs of 1-70 +/-. The 12 men were not treated, those with AHIs of 5 or greater were treated with CPAP. Six months later all the men's studies were repeated, but this time the 12 with AHIs of 4 or less were now all abnormal with AHIs ranging from 7-20. Bottom line: Your AHI may vary from night to night, week to week, month to month. But what do you care? You use your CPAP faithfully, right?

Another missed concept: Losing weight "may" reduce your AHI, but it is not likely to get rid of all apneas, ie., cure OSA. The reason is that OSA is a neurological disease (of unknown cause) involving part of the autonomic nervous system within the lower brainstem that controls the smooth muscles of the pharynx or upper airway while asleep. Bottom line: Losing weight "may" improve your AHI but it will never go to zero and stay there. You still have to rely on your CPAP.

Bob,  if it were true that CPAP made your muscles lose tone you would begin to need CPAP during the day.  You need CPAP at night because in our sleep the muscles lose tone.  We ordinarily are  not  able to stop CPAP because it doesn't give the muscles "tone", but splints open the airway.  If you take away the CPAP for a night of course the sleep apnea returns.

The tongue and throat muscles continue to function just fine during the day.

Excellent response Mack, which I've saved on my computer if you don't mind, so I can use it at a future date to help the UK patients.  Interesting study!

Thanks Mack. This makes so much sense to me now. You are right, what do I care I use my CPAP every night anyway. But it really helps to understand how sleep Apnea works. I really have always appreciated this forum and the advice from long time users and sleep professionals. thanks so much.

Just a thought on this, but weight loss especially if it is done quickly can result in some muscle loss too. The muscle loss in uniform.  Since sleep apnea as far as I know could be affected by muscle tone in your throat, it only makes sense to me that this could be the cause. Give it time. Hopefully this will improve as you modify your diet and some muscle mass is restored. You are better off to be 50 pounds thinner anyway.

l actually lost the weight over 11 months, and worked out 4-5 times a week through it all, I think being 61 doesn't help much. :>D Maybe I can find a DVD for a throat muscle workout! "Tone your Throat by Jilian Michaels" lol  You would think as much "exercise" as I give my throat by talking so much it would be in great tone!!

Is it possible you have more Central Sleep Apnea than obstructive? Not an expert but I think central is more neurological and less about weight. Just thinking out loud.

In what way are "auto-sets" bad?  This is the first that I've heard such said.

jeremy gober said:

 Also, auto-sets are the worst thing out there. Patinets should always have a titration done by a competent lab to correctly determine proper titration pressure. ASV should only be used in cases that are CSA and Cheyne-Stokes when deemed necessary.

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