Hypopnea Events Too High Recently

Hi All - I am getting confused here. I have been using my CPAP for 5 months, and have been doing great overall. I found my mask was too big after about 6 - 7 weeks, and swapped out for a small one. My mask leakage went way down and is still low for the most part.

I have several autoimmune conditions besides sleep apnea, and I have been taking a mix of medications to control those conditions… Like Minocycline for Rheumatoid Arthritis, Pilocarpine for Sjogren’s, and Lunesta for Insomnia (from several of my conditions). I have also been taking codeine for pain (from the RA, Sjogren’s, etc.), but it seems to be causing me to hold fluid in my thighs. When I started comparing the pain from all of this mix, I decided that I need to pull out of some of them, at least for a while. I have so far quit (five days ago) the Minocycline, Pilocarpine and Lunesta, and am doing really well with sleeping (including my CPAP).

But, and this is the point of my ramble here, now my events are way up. During my sleep study, I was at 90 hypopnea events per hour. But, for the last five months, they have been at 7.30 average per hour. For the last three nights, they were 23.8, then 13.5 (and boy did I sleep great the night before last - it was wonderful), and then last night was 38.7 - the highest I’ve been since the sleep study. Does anyone have any idea what could be causing this? I wondered if it could be the withdrawal from the Lunesta? Just not sure where to look or what to try. I have a ResMed10, and it is auto setting (or at least claims it is), but the auto ramp is at 11 - the same level as the sleep study. Help! I would like to avoid another doctors appointment if I can - As you can imagine, I have a lot of them as it is. Thanks so much!

I would not quit any prescribed medication without consulting my doctor. Did you do this on your own? Aren’t you worried?
Perhaps you should also ask your doctor about another kind of pain med. Good luck!

Hi Hamish - Thank you for your reply. Actually, I’m not worried. The Minocycline I talked my doc into putting me on, as opposed to Methotrexate (a Chemo drug). It can cause several long term effects, so I’ve discussed stopping it before with both my GP and my Rheumatologist, and actually have done so - they were fine with it. The Pilocarpine I stop and start as my system can handle it. If I am NOT taking that one it can cause me to get sores in my nose and thick phlegm, but I have started and stopped it several times. My GP knows it and seems to be okay with it. The Lunesta is the same - I have started and stopped it several times and she knows it and is okay with it. Please understand that the only thing I take that is dangerous to start and stop on my own is my blood pressure medicine, and that condition is caused by 4 of the medicines that I take. I would talk to her before I mess with that one. It’s interesting, it occurs to me that the Lunesta might have been keeping my events down artificially since it suppresses breathing. hmmm

So, I just answered my own question I think. I started thinking of stopping the Lunesta. I had read some place that Lunesta suppressed breathing and that would potentially suppress the events as well. I found a study just now at: https://www.ncbi.nlm.nih.gov/pubmed/21269278?dopt=Abstract that indicates exactly that, IF the person has a low arousal threshold, which I definitely do - An ant blinking can wake me up - ha ha… The referenced study concluded that

" We hypothesized that eszopiclone would increase the arousal threshold and lower the AHI in patients with a low arousal threshold (0 to -15 cm H(2)O). In conclusion, eszopiclone increases the arousal threshold and lowers the AHI in obstructive sleep apnoea patients that do not have marked overnight hypoxaemia. The greatest reductions in the AHI occurred in those with a low arousal threshold. The results of this single night physiological study suggest that certain sedatives may be of therapeutic benefit for a definable subgroup of patients. However, additional treatment strategies are probably required to achieve elimination of apnoea." So, I think problem solved…

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Caeryl, This much variation in events sounds more like a mask leak issue to me. What type of mask are you using , and is it a nasal or full face?

Reading this I agree. Mask leakage can really cause issues. Maybe you should try different masks and see how the numbers go. For more information check here on the website: https://www.sleepapnea.org/sleep-health-faq/

Hi Afrontive - I am so close to walking away from this even though I am listed as severe… Last night was the third night in a row that I started perspiring immediately (I mean within 2 - 3 seconds) until I am drenched. Since I have a full face nasal mask, it just slides around on my face no matter what I do. I put Bare Minerals on before I put the mask on (everything else causes a rash). I just ordered a nasal pillow mask yesterday to see how it does without the stuff around my mouth. Wish me luck! :slight_smile:

Absolutely good luck I am hoping you will soon find an answer to this issue soon. Have you taken a look at the different treatment options? There are so many and new ones being explored as we speak. Here’s a link for the website to get started https://www.sleepapnea.org/treat/sleep-apnea-treatment-options/ Plus there’s more info on the web and don’t forget to work with your health professionals on this as you go.

Thanks Afrontive… Well, I’ve tried, but my doc just kind of says “…if the sleep clinic chose this mask / ramp speed, etc., then it has to be correct…”, so I’m just kind of flailing :wink:. I will look at your recommendation. Thanks

I was diagnosed with sleep apnea and began CPAP in December 2018. I did a home study and then an overnight in a sleep center.

I use a Philips Dreamstation with a heated humidifier and tubing, silicone head mask with nasal cushion, and a chin strap. Air setting 6; humidity 3. I use the Philips DreamMapper app to track the AHI’s.

Sleep quality improved dramatically using the CPAP. No snoring or gasping; literally awake feeling rested and refreshed for the first time in my life. AHI’s stay below 5 generally.

In March 2019, I had partial knee replacement surgery and in May 2019, I had shoulder rotator cuff repair surgery. The anesthesia during the surgery and the pain medications after seemed to affect my AHI’s. I think a major factor also is that I have had to sleep on my back since both surgeries, which gives me higher readings than when I sleep on my side. Note: I was told that unless my AHI’s were sustained at 15 or higher during the recovery, I should not worry.

I do believe that medications affect my AHI’s.

I started tracking a correlation. I also noted that what foods I ate from dinner to bedtime also affected my AHI’s. And now I am experimenting with taking some an hour or more before bedtime. Still tracking both meds and foods, as well as the timing.

I take Celebrex and Tylenol now. Have stopped stronger meds.
Sugar in any form or food (even fruit) is the food that seems to most negatively affect my sleep quality.

Update: I checked w my CPAP supplier and Medicare compliance rep and learned that my device can be set for a range of pressures. So I am meeting w my doctor next week to discuss changing my static pressure to a range.
If anyone uses a range, please share your experiences with that.

Hi Louise - Hope you are getting your pressures set comfortably. My experience: I went to my titration portion of the test, and basically the tech ignored the mask I told her I wanted and when I told her my pressure was too high. So it took me a while to get the mask and headgear right, but once I did I asked my doc to please lower it to ten. She did and I was able to demonstrate that I was doing better, but I still think I need to go down one more. To me, the range is right if I don’t notice the strength of the air flow when it is up to full strength, especially if I am not asleep yet. Hope that makes sense… Best of luck getting it straight…

Thanks for asking and sharing, Caeryl.
I am sleeping noticeably better since I switched to APAP, with the range of pressures. About half of the nights so far, the AHI’s are 5 or below. Highest was a 7. I know that 5 is normal, and I feel significantly better—refreshed and rested—waking up after a 5 night than anything higher. But when the AHI is between 0 and 3, I feel very, very good when I wake up—energized.
Also, my average pressure for 90% of the night is 10, so my previous steady 6 was insufficient.
The Pulmonologist said it would take the full 6 weeks to see if these settings and APAP are what I need and to expect fluctuations. So far, I’m quite pleased. The comfort settings he added are very good also: Flex for exhale; preheat for the humidifier, and adaptive humidification.
One difference, though, is that when I get up once during the night as I usually do, I find it harder to get back to sleep. I tried using the ramp again, but that didn’t seem to help.
Anyone else experienced this? Any ideas?

For me, once I got everything set right, I love the CPAP… Mainly because I feel so much better the next day, so I am keeping my fingers crossed that yours gets perfect for you. As for going back to sleep, I usually use that time to say my prayers, and for some reason that relaxes me so much that I fall asleep before I can finish a lot of times. ha ha Not that my method will help you, but it sure works for me :slight_smile:

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Thanks! So glad you’re doing so well.
Friday night I slept until morning.
Last night, I got up and went back and tried your method. I remember starting the second prayer, and then,:zzz::zzz::zzz:, and then, the morning bird call alarm.
Best mindful meditation ever.

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Ha ha! Glad I am not the only one it relaxes…

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Have increased adaptive humidity to 5 (left heat at 3—don’t want condensation), and have experienced a noticeable improvement: Wake up fewer times, usually later; less dryness; lower ahi’s (4’s), and feel much better upon awakening. See the pulmonologist sleep MD today for APAP trial follow up. Will update after that.