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lkniffin
Unread post  Post subject: Please Help. AHI fluctuates WAY too much  |  Posted: Sat Feb 08, 2020 2:09 pm

Joined: Wed Feb 05, 2020 12:01 pm
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PAP Mask: Amara View
PAP Machine: Dreamstation BiPap
Humidifier: Adaptive Humidification
Pressure Setting: 22 inhalation / 15 expiration

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Hello:

I need help. I have been using a Dreamstation BiPap machine for a little over 60 days. The AHI goes up and down all of the time. Some nights it is as low as 2.5 and it has been as high as 22. It is very frustrating.

I have attached two screenshots from Oscar, one is showing a night that the AHI is low and one is showing a night that the AHI is high.

I would appreciate any advice or suggestions...

Thanks


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screenshot-20200208-142751.png [ 130.41 KiB | Viewed 2058 times ]


Attachments:
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screenshot-20200208-143257.png [ 122.57 KiB | Viewed 2058 times ]
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Pugsy
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sat Feb 08, 2020 7:24 pm
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The nights with the high AHI....are you actually asleep for the most part or do you spend a lot of time awake tossing and turning??

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lkniffin
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 10:49 am

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I'm asleep.


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Pugsy
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 3:33 pm
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Are you maybe on your back a lot when the AHI is higher and on your side mostly when the AHI is lower?

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lkniffin
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 3:52 pm

Joined: Wed Feb 05, 2020 12:01 pm
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PAP Mask: Amara View
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Pressure Setting: 22 inhalation / 15 expiration

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No, I sleep on my side all the time.


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Pugsy
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 4:01 pm
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There's something changing between the higher and lower AHI nights.
Sleeping on one's back can worsen OSA and cause a need for higher pressures.
Getting more REM sleep can do it as well but REM normally comes in cycles that are fairly easy to spot and your bad nights don't seem to point to REM clusters.

Some medications can make OSA worse.

If you said you weren't asleep then I might think a lot of false positive flagging.
http://freecpapadvice.com/sleepyhead-free-software
On your bad nights about half the AHI is obstructive in nature (which usually means more pressure is needed) but about half is central in nature (Clear airway apneas are essentially central apneas and the airway is open) so more pressure won't normally help central apneas.

Now maybe the centrals are arousal centrals related to an obstructive event causing an arousal and if that is the case then the centrals are false positives.

Any other health issues going on?
Medications?

Have you talked to your doctor about this?

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lkniffin
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 4:27 pm

Joined: Wed Feb 05, 2020 12:01 pm
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Pressure Setting: 22 inhalation / 15 expiration

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I have high blood pressure. I take medicine for high blood pressure and anxiety.

I have talked to the dr and he said as long as the average AHI is 10 or less, he is good with that. Up to this point, the average has been 8.5 to 9.5. However, I imagine it will be over 10 in a few weeks,if it continues like this.


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Pugsy
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Sun Feb 09, 2020 8:33 pm
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The only thing that bothers me is your pressure support setting of 7 cm.

It's uncommonly high but maybe your doctor had a special reason for coming up with that number.

You are using a fixed pressure bilevel machine...15 exhale PS (pressure support which is the difference between inhale and exhale) and 22 cm inhale.

Sometimes that much PS causes some unstable breathing. Usually in the form of central apneas but maybe some are flagged as obstructive by mistake as well.

Did you go to the link I posted above and watch the videos that explain how to zoom in on flagged events and figure out awake vs asleep flagged events?

That's the first thing to do....see if you were really for sure sound asleep when the ugly got flagged.

Second thing I would do is reduce PS to 4 or 5 and see what happens.

Something is changing though...something that is causing that big difference in AHI.
We've ruled out the most common suspects though.

Do you have a copy of your sleep study(s)? If you don't....request them.

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lkniffin
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Mon Feb 10, 2020 5:56 am

Joined: Wed Feb 05, 2020 12:01 pm
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Pressure Setting: 22 inhalation / 15 expiration

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What is the pressure support setting?
The only thing the dr explained was the 22 inhale and 15 exhale.

Thanks for your help


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Pugsy
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Mon Feb 10, 2020 8:29 am
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Pressure support or PS
The difference between inhale and exhale.
When your exhale EPAP is at 15 and your inhale IPAP is at 22...that makes PS of 7 cm.
7 PS is rather on the high end for most people.
Normal is 4 or 5 PS unless someone is having a large number centrals consistently... then we do something different but that would involve a totally different machine than what you are using.

Go here and get the provider manual sent to you via email as it explains how to get into the clinical settings area....along with other useful information about your machine.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

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lkniffin
Unread post  Post subject: Re: Please Help. AHI fluctuates WAY too much  |  Posted: Mon Feb 10, 2020 10:31 am

Joined: Wed Feb 05, 2020 12:01 pm
Posts: 8
PAP Mask: Amara View
PAP Machine: Dreamstation BiPap
Humidifier: Adaptive Humidification
Pressure Setting: 22 inhalation / 15 expiration

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Thank you so much for all of your help!


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