[Diagnosis] modest811 - Therapy Thread

[modest811]

Been feeling exhausted no matter how much sleep I get so I got a sleep study. Was told I have mild sleep apnea with 5.3 ahi, mostly on my back, got as high 9ahi. 

Set up my machine and had a pretty on and off sleep, put it in into oscar and go this. What is happening? Is this data not right? I do think I slept but I wasn't out all night, was awake quite a bit getting used to the mask. Is the cpap causing central apenas?

Won't let me post the picture so the OSCAR data is here - https://i.imgur.com/bXHBvd1.png

[staceyburke]

You will have some great advice on the centrals, just it will take a little time for one of them to stop by.  But I will comment on a couple of things your min is set at 5 with epr at 3.  The lowest a min can go on the machine is 4 and the epr set at 3 means your min is set at 1.  I would suggest 8.  One reason for Centrals is a large swing in pressures so moving it to 8 should help.  Also epr to 1.  Again, to minimize swings.  Some of your OAs are clustered as well as all of your CAs.  Many times that has to do with sleep position...  You are cutting off the air so it does not matter how high the pressure is you can't get air.  Take a look and read a little bit - first one is the link I have at the bottom about collars. 

Please don't panic, there are a lot of people here that have had the same problems and some great gurus are included that will help you.

[modest811]

Thank you for your help! 

I'll look into the collar. I am a little afraid to go to sleep again with my CPAP considering at my sleep study my AHI was so low, and it looks like with the mask it increased so much... I was hoping it was just a one off and it was some sort of mistake because it felt like I had a crummy sleep that night. Hopefully someone can chime in soon about the Centrals.

[Gideon]

Your central apnea is way too high. We need to reduce your EPR
I suggest you set EPR =1

I have issues in general wit min pressures lower than 6 in adults. Most say its like breathing through a straw.
Set Min Pressure = 6. Don't be surprised at suggesting a higher value. If your min wasn't at 5 I'd suggest the 8 mentioned above.

[Sleeprider]

Therapy onset central apnea or complex apnea happens in a relatively small group of users. The approach outlined by bonjour which limits the change in pressure between inhale and exhale (pressure support or EPR), and a more steady pressure should help reduce the central apnea. The onset of central apnea with CPAP therapy is often associated with a reduction in the blood CO2 levels that results from the improved respiratory ventilation. There are a number of approaches to treating it directly, including using enhanced expiratory rebreathing system (EERS), or adaptive servo ventilation (ASV). In this early stage, we will use less EPR and a more constant pressure, then see how things turn out. There is a good journal article here https://www.hindawi.com/journals/sd/2014/798487/

With the extent of apnea you are showing in your results, I am tempted to turn EPR off altogether and set pressure to a very confined range of 7.0 to 8.0 cm pressure, then manually titrating pressure upward if needed for obstructive apnea or comfort. In your case, the baseline AHI from your diagnostic study is in the mild range, and we won't tolerate therapy actually making your condition worse, so if these simple measures do not work out, the recommendation will be to refer you back to your doctor for a titration study where he can see the central apnea onset in a clinical setting, and consider the use of ASV rather than CPAP therapy.

[modest811]

Yeah I'm just still iffy if that chart I posted is entirely accurate. I remember not sleeping well that night at all and was awake for a good portion of it. I could just be remember it wrong though. 

I used my APAP again last night and took it off unfortunately halfway through the night. Definitely a lot less events and I feel less tired today but not perfect. Lot of leakages though and I don't know if that's contributing to the low Centrals. 

Bleh, sorry guys. I'm feeling a little discouraged by all this. Just want a good night sleep completely.

[Sleeprider]

Therapy onset centrals will be consistently inconsistent. It will take time to sort out what is sleep disturbance and leaks in a new user, and what are real apnea events. There is a period of adapting to therapy and working out the kinks, so all of that has to be given a chance before jumping to conclusions. It can still be helpful to use a narrow range of pressure and low or no EPR to eliminate some of the variables. Leaks make any conclusions more difficult. Read the mask primer (written by bonjour) in my signature links, and let us know what mask you are using.

[modest811]

Hey guys, back again and could use some help. 

Attached is my reading from last night. Seems turning the EPR off helped with the centrals, but I'm still at a 6+ AHI - annoyng. I'm also having a lot of leaks with my mask. I woke up at 5 am this morning with my mask off and just decided to go back to sleep. I have my pressure rating from 6 - 10, should I narrow this down a bit? I also contacted my RT to see if I should get a full mask. I have a tiny nose and I think the nasal cushion, even the small one, causes too many leaks.

I'm using a dreamwear nasal cushion mask btw. I've read the mask primer and I go to sleep fine, but once I'm asleep the mask keeps slipping it seems...

[Sleeprider]

You really need to get the leaks under control or change the mask type. Most "events" are associated with a high leak rate, and this can be a function of the leak, sleep disruption from the leaks, or perhaps a real event. You have less then one fourth of the events we saw in your original charts, so this represents great progress, but the next step is dealing with the leaks with either a different style of mask or other technique that keeps air from escaping from your mouth.

[modest811]

Ended up getting a new mask F20. Getting a lot less leaks and my AHI has gone down quite a bit, but i'm still struggling to keep it on at night and i'm exhausted today, even with an AHI of 2ish. 

Thinking of increasing my pressure from minimum of 7 and max of 12. Thoughts?