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Merry Christmas and Happy Holidays! 

I was tested about 6 months ago and have moderate obstructive sleep apnea. According to the test, my "overall respiratory disturbance index (RDI) was 20.4 per hour, all on my back.  The overall AHI was 11.3 per hour; 7 apneas, 48 hypopneas, 44 RERAs were present.  Average duration of the respiratory event was 24 seconds.  I had frequent mild snoring and a mild leg movement disorder without a significant arousal index."

For the past 5 months, I've been using the FX nose pillows for her with a chin strap to keep my mouth closed, as I'm a mouth breather.  Much as I didn't like the chin strap, the combo was successful.  Since I use the Respironics REMstar C flex+ PRO machine, I can read my 7 day AHI average, as well as 30 day average.  During this time, my 7 day average AHIs were 5 or below.

I remember getting a cold, including congestion in my nose, for about a week. This was the first time my AHI average increased to 6-7. This didn't bother me, since it made sense having trouble breathing while on nose pillows.  But, after the cold, when I was fine, my AHI continued to stay up around 6, going down several days to 5 or below and up again.

Saw my sleep doc, Dr. Sabharwal in Vienna, Va, who wanted me to try the full face mask, since I am a mouth breather.  For most of the past week, I've used the ResMed Mirage Quattro full face mask, which I'm not crazy about, yet I know I need to give it time.  (I don't like how cumbersome it is, it leaves a sore red mark on the bridge of my nose, and I find I sleep only on my back with it (which is when all my AHIs seem to occur).  During this time, my (average 7 day) AHIs have continued to climb to 7.2.  Yesterday, my air pressure was changed from 8cm to 9cm.  My (average 7 day) AHI jumped to 8.2.  I have no idea what can be happening.  

Can anyone help me?  I have been under the impression that our AHIs should be at 5 or below with treatment.

Barb

 

 

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Yes, Barb, you're correct, 5 is the number of AHIs considered "normal".  There is some debate about using AHI as the sole measurement of effective therapy( though I want mine under five, too).  How are you feeling?  if you've not had a return of symptoms I would not worry too much. Although, like you, I would be concerned you sound like you have a supportive sleep doctor who will see you through this. Perhaps it is just going to take a while for all the changes to kick in.  Hang in there.  About the quattro- be sure to protect the bridge of your nose with a bandaid, or piece of moleskin on the mask, not your nose.  That irritation can get very nasty.

And again, try not to get too concerned unless this turns out to be a long term trend- six weeks or so. Even then you and your doc and the forum can help. Perhaps as you suggested the increase is due to your back sleeping.  Side sleeping with a FFM can take some experimentation.

Don't this let you spoil your  holiday!  Thansk for the good wishes.  They're appreciated.

I had a similar experience after a few months on CPAP therapy. My numbers were different than yours but I too noticed a pattern of a creeping AHI. When I first started the therapy I felt so good that I started exercising and eating right and long story short I lost about 50lbs in three months. I began to notice not just my AHI increasing, but a particular component of it. The central or clear airway apneas seemed to be increasing almost nightly. I suspected that because I was losing weight, my pressure might be too high and my doctor agreed so we lowered my pressure and magically they went away. Bottom-line, it's likely a pressure issue (too high, too low) but if you don't have the software to look at the data from the machine you won't know what the components of your AHI are (Hypopnea, Ob Apnea, Central Apnea).  Increasing or high centrals relative to obstructive is probably indicative of too high a pressure (my case). High obstructive apneas probably indicate too low a pressure. You need to check the data and see how it's changed over time to know for sure though. There's free software out there you can find to read the data from the card on your machine. Try uploading the data from your card to onkor.net just get a better view of things. It's much easier to see patterns. Another one is sleepyhead, just google it.

Barb, I don't have the exact answer for you but my story is similar. my AHI was 30 at the sleep study and it has come down to an average of 3.1, it is now changing daily. I was getting concerned as some nights it is between 10-15 and some around 1. I asked and was advised that as we are all different and do things different each days so your AHI can increase but as Mary said how are you feeling, better than before. Initially I thought CPAP would have me at 0 and I wouldn't have to worry again. I believe it depends on lots of factors, possibly what we eat, temperature and humidity, stress and other factors that make up our life. I have my next appt in mid Jan so will be interesting to see my full results. I have a resmed autoset with pressure of 4-12 and look at my AHI levels on the screen each day.

Hi Mary,

Thank you for your help.  Even tho it's harder for me, I'll try sleeping on my back. In answer to your question, I'm feeling more tired and down.  What does FFM mean?

Barb
Mary Z said:

Yes, Barb, you're correct, 5 is the number of AHIs considered "normal".  There is some debate about using AHI as the sole measurement of effective therapy( though I want mine under five, too).  How are you feeling?  if you've not had a return of symptoms I would not worry too much. Although, like you, I would be concerned you sound like you have a supportive sleep doctor who will see you through this. Perhaps it is just going to take a while for all the changes to kick in.  Hang in there.  About the quattro- be sure to protect the bridge of your nose with a bandaid, or piece of moleskin on the mask, not your nose.  That irritation can get very nasty.

And again, try not to get too concerned unless this turns out to be a long term trend- six weeks or so. Even then you and your doc and the forum can help. Perhaps as you suggested the increase is due to your back sleeping.  Side sleeping with a FFM can take some experimentation.

Don't this let you spoil your  holiday!  Thansk for the good wishes.  They're appreciated.

Thanks, Terry.

You said you have a resmed autoset with pressure of 4-12. Does that mean that your pressure can vary between 4-12 each night? The resmed machine that I  have is set to be on one number, ie right now is 9.

I haven't felt as well these past weeks and kind of down, which is showing me that there is something going on. I'll give it several more weeks and make an app't with my sleep doc.

Barb



Terry Vella said:

Barb, I don't have the exact answer for you but my story is similar. my AHI was 30 at the sleep study and it has come down to an average of 3.1, it is now changing daily. I was getting concerned as some nights it is between 10-15 and some around 1. I asked and was advised that as we are all different and do things different each days so your AHI can increase but as Mary said how are you feeling, better than before. Initially I thought CPAP would have me at 0 and I wouldn't have to worry again. I believe it depends on lots of factors, possibly what we eat, temperature and humidity, stress and other factors that make up our life. I have my next appt in mid Jan so will be interesting to see my full results. I have a resmed autoset with pressure of 4-12 and look at my AHI levels on the screen each day.

Thanks so much, Rich.

I'd love to get software to read more data daily to help me see what's happening. I was thrilled to have my sleep doc recommend getting the resmed pro to let me see what my AHIs are on a 7 day and 30 average. When I've seen her in the past, I've brought my chip in from the back of my machine and she's told me from seeing the data on her computer that things looked good, while I was around 5. Then  changed my pressure upward to 9 in hopes that that would help bring my AHIs down a bit.  I'll check out the sites you gave me to learn more on a daily basis and help gain more info.

Sleep well!

Barb

Rich Murphy said:

I had a similar experience after a few months on CPAP therapy. My numbers were different than yours but I too noticed a pattern of a creeping AHI. When I first started the therapy I felt so good that I started exercising and eating right and long story short I lost about 50lbs in three months. I began to notice not just my AHI increasing, but a particular component of it. The central or clear airway apneas seemed to be increasing almost nightly. I suspected that because I was losing weight, my pressure might be too high and my doctor agreed so we lowered my pressure and magically they went away. Bottom-line, it's likely a pressure issue (too high, too low) but if you don't have the software to look at the data from the machine you won't know what the components of your AHI are (Hypopnea, Ob Apnea, Central Apnea).  Increasing or high centrals relative to obstructive is probably indicative of too high a pressure (my case). High obstructive apneas probably indicate too low a pressure. You need to check the data and see how it's changed over time to know for sure though. There's free software out there you can find to read the data from the card on your machine. Try uploading the data from your card to onkor.net just get a better view of things. It's much easier to see patterns. Another one is sleepyhead, just google it.

Barb, Yes mine adjusts itself to the pressure I need during the night when it detects an apnea, so it starts at a consistent 4 then can go up to 12 if I need it. I did test a fixed pressure Resmed on 10 but sometimes felt my head was almost being blown off. The machine I have costs more about $500 but it is ajustable or I can use it as a fixed pressure machine. For Mary's comment FFM is Full Face Mask.
I think it is best if you are unhappy with your treatment that you make an appointmet to see your sleep specialist. Apart from the factors that I mentioned in the previous post do you get much mask leak that you know of as this can cause your AHI to raise. I use the Mirage Quattro and do get occassional soreness on the bridge of my nose. One suggestion for you, to be able to sleep on your side with the FFM, I have my pillow horizontal rather than vertical (up and down rather than across) I find there is less real estate to knock the mask on but can still use my pillow.
I used to use two pillows but have got used to one and are sleeping a lot more on my back than I used too. Keep us updated on your progress.

Barb, sleeping on your back is generally considered the worst position if you have positional sleep apnea.  I realize you are between a rock and a hard place with the mask.  Back sleeping may be fine for you.  See how your numbers go.  Good luck.  The thing about sleeping on your back is not cut and dried.  You have to just do the best you can with all the factors and sometimes it's a trade-off.

As an aside, not to detract from your thread, Barb, but it's exciting to me to see more people becoming interested in there "numbers".  Of course, the numbers are only part of the picture (those we get ourselves from lcd sreens or software), how you feel is equally important.  But as Barb's post shows an awareness of both and making the effort to make therapy optimal for each of us can make or break our success with therapy.

So thanks for an interesting and helpful thread, Barb. I admire your persistence and "work" (because it is work) in getting your therapy tailored for you.

Barb, it's only been since the 24th since you posted, but are you feeling any better?  Sometimes it takes a while so I'm not implying you should be better by now.  It's a life long (and life saving) process.

Hi Mary,

Thank you for your information and comments. No, not any better. Now my AHI's are averaging 13 for a 7 day period.  I'm giving the Quattro full face mask a little more time on 9 pressure.  The mask may leak a little when I'm asleep and not realize it, but it seems okay to me.  With the full face mask and being a mouth breather, I really don't like that I'm waking up with such a dry mouth. 

Mary, what machine are you using & is it a cpap?

Barb


Mary Z said:

Barb, it's only been since the 24th since you posted, but are you feeling any better?  Sometimes it takes a while so I'm not implying you should be better by now.  It's a life long (and life saving) process.

I think it's great so many people are checking their numbers using software (I don't) or the data from  the lcd screen daily or weekly.  Right now it seems more than I am having trouble with high AHI ( 10 .>?). I wonder if it's some  kind of trend related to holidays or weather?

Is that crazy?

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