Central Apneas and APAP response

[DreamerDude]

This shows the additional couple of hour when I went back to sleep this morning after upping the pressure. Thanks

[Sleeprider]

Well, your EPR is off in these graphs and the results are all over the place. There appears to be a ramp on, but can't see the settings. On 2/17, you seem to have a very rapid pressure increase from about 7.7 to 10.7 and experience a cluster of OA before you can sleep, then the machine is restarted and again rapidly increases to 10.7 and holds at that pressure until 02:45. There are three brief startups and clusters of CA that we have to discard as sleep-wake-junk (SWJ). You resume therapy at 10:15 and after 10:25 the machine rockets up to 12 cm and stays there. I assume the maximum pressure was changed.

You really need to kick on the EPR to control the flow limits that are driving pressure to the maximum setting. It might be helpful to take a closer view of the flow rate to see what is going on with the respiration. The CA events have to be discarded at this point and something is causing extremely high flow limits and a tendency for clustered obstructive apnea and hypopnea. I suspect your sleep position is causing you to bend your neck in a way that is obstructing your airway. Can you describe your sleep position?

[DreamerDude]

Here are last night's results. I dropped the pressures some and enabled ramp which has a starting pressure of 6. I currently using a wedge pillow and sleep on my side. I have EPR set to 1 and haven't had good results when I've tried to increase it, but that might be because of other settings, I don't know. I feel better today amd my O2 results are much improved.

[Sleeprider]

You need more EPR to cut these flow limits and I think cutting pressure is working against the obstructive breathing the flow limitation represents. Is there any chance your chin is tucking causing airway occlusion as a result of using the wedge? I'd like to see a closeup of the respiratory flow rate chart, 3-minute segment where the wave-form is visible. I strongly suspect very flattened tops where inspiration peaks should be. In addition, I think the CA events your were concerned about were actually obstructed breathing where your airway was open, you were trying to breathe but you were not moving enough air. We see this sometimes. You are definitely heading the wrong way with reduced pressure.

[DreamerDude]

Here are a three of shots of where I was having trouble and then right afterwards. I hope you can see what you want. Yes, I might be tucking my chin with that wedge pillow. I don't use it all the time but it seems to help me if I am having some breathing issues. I had a bout of AFib recently and it seems to have messed my sleeping up. I do try to sleep on my side. Thanks for looking at this! I appreciate it.

[Sleeprider]

Ready for school?...
Severe obstruction, Class 2 flow limitation showing soft tissue cutoff of flow, with Class 3 fluttering soft tissue.



Apnea with recovery breathing, dropping into serious flow limitation and hypopnea. Continued flow obstructive inspiratory flow limitation.



This one is the most interesting and is definitely obstructive, but flagged CA.  Let's talk about why.  Here we see obstructive inspiratory flow limitation leading into recovery breathing and likely arousal (not necessarily awakening). The CA is an obstructive sleep apnea where you are trying to breathe but can't move much air, so your airway is indeed open, but it's clearly obstructive. Coming out of the apnea is increasing respiratory effort in spite of terrible flow limitation, leading to recovery breathing and just as you balance your oxygen and CO2 and relax, you get an OA where you're still trying to breathe through your positional apnea.  Finally after a couple recovery breaths, your chin is still tucked and you can't breathe freely!  If ever there was an argument for a soft cervical collar this is it.  Your solution is EPR 3 with as much minimum pressure as you can comfortably tolerate.




Just FYI here is some flow limitation info:  The Flow Limitation Wiki http://www.apneaboard.com/wiki/index.php...limitation 
Classification of flow limitation: 

[DreamerDude]

Well that looks like absolute crap!. So it sounds like I should up my pressure and ditch the wedge pillow and see how that goes. A cervical collar would also be worth a try. You had mention enabling or increasing pressure relief which I currently have at 1. I have tried upping that to 2 but as I recall had strange breathing problems the next day where I felt like I couldn't take deep breaths. That went away for the most part when I dropped the EPR to 1. Maybe I didn't have the pressure high enough when I tried an EPR of 2?

[DreamerDude]

Oh, I missed what you said about pressure/EPR sorry. Thanks

[Sleeprider]

Your selection and implementation of the charts was perfect. I just wanted to see if we were dealing with possible central apnea, and I think we can completely put that idea aside and focus on your obstructive apnea and flow limits.

[DreamerDude]

Thanks very much Sleeprider. My head is spinning from this stuff. Probably because I'm sleep deprived! I'll make some changes tonight.