107 Days In -- Looking for Feedback

[AndyB]

My question, simply put, is: how can I reduce the number of CA events I am experiencing currently?

Some background:

I was diagnosed in May 2015 with severe sleep apnea, after many years of loud and frequent snoring -- a sleep lab split-night study showed untreated AHI of 41, and a treated CPAP titration of 11 cmH2O. I received a ResMed Airsense 10 Autoset in mid-June and have been on APAP therapy for more than 5 hours, and usually between 6-7 hours, every single night since then.

I'm 70 yrs old, 5'8", weigh 165 and in pretty good shape. I don't have any other medical issues, and I'm physically active.

Like most newbies, I struggled for a few weeks finding a comfortable and effective mask. I eventually settled on a PR Amara View full face mask, but as a committed tinkerer I occasionally experiment with a F&P Simplus ffm and a ResMed AirFit F10 ffm in an effort to find the elusive perfect mask.

After switching to a full face mask in mid-July, my AHI is usually between 3.0-5.0, with occasional dips into the 2.0-3.0 range or increases into the 5.0-7.0 range. My lowest ffm AHI is 1.38 and my highest ffm AHI is 8.95. Leaks are extremely rare.

The concern:

Almost all of my AHI is comprised of CA events. Most nights I have 0-1 OSA events, 3-6 hyponeas, and 20-25 CA events. It is not uncommon for me to have 25-30 CA events in a night. I've spent hours studying SleepyHead data attempting to correlate my CA events with pressures, flow limitations, times-of-night and other data, all to no avail -- while it appears the CA events are more likely to occur at transition times (falling asleep or waking up), a very great many CA events simply appear to occur randomly during the night, well away from a transition time, pressure spike up or down, or any other potential cause I can identify.

I've tried different pressures with a ffm, without discernibly different results. I tried 8-13 (without EPR) for 2 weeks, then 9-13.4 (with EPR of 2) for 4 weeks, and now 9.4-13.4 (with EPR of 2) for the last 4 weeks. My current average pressure is usually 10.5-11.5, and my 95% pressure is usually 12.25-13.0.

Although my AHI results indicate that I am usually "technically treated" for sleep apnea by being under 5.0, and I feel pretty good, I always wake several times each night. I would love to have way fewer CA events than I do currently.

What do you smart folks think? Keep fiddling with pressure? Look into an ASV or Bi-Pap? I have a follow-up appointment with my sleep doc in a month.

I am very grateful for all the wonderful advice and generous spirit on this forum. Any thoughts and suggestions would be much appreciated.

Andy

[DariaVader]

I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

[ginzo]

Good luck, wish I could help. If you ever run into issues with LL's, I'm your guy! I was the LL king when I came/found this wonderful place. I'm still studying SH also to find little improvements.

[AndyB]

I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

Interesting idea. I may give that a try tonight . . . .

[zonk]

Although my AHI results indicate that I am usually "technically treated" for sleep apnea by being under 5.0, and I feel pretty good, I always wake several times each night.

I think, might help identifying the cause of waking up several times, sleep hygiene issue, air feel too cold or too warm, stuffy nose, dry mouth ..
Before CPAP, used to wake up several times, now once and at times sleep through the night

Does the the time of waking up correspond with an apnea
Any % of time in CSR or RERAs

[vsheline]

I would be tempted to experiment with a straight pressure of 12 and no EPR and see if you are one of the folk who is sensitive to pressure change

Interesting idea. I may give that a try tonight . . . .

Hi AndyB,

Or, tonight you could try EPR of 1. And tomorrow, EPR of 0. Might help you get used to the lower pressure relief, which is likely to be less comfortable.

EPR makes it easier to breathe. One of the (many?) possible triggers for Central Apnea is when we slightly hyperventilate, which can wash out too much CO2 from our blood and lead to loss of respiratory drive. Less EPR tends to reduce the likelihood of this happening.

For some people, higher pressure is associated with CA. For others, bilevel or EPR or A-Flex or C-Flex Plus. For others, medications. For others, past tramatic brain injury. For others, slow blood circulation. Or some other medical condition or combination of conditions.

Take care,
--- Vaughn

[AndyB]

Or, tonight you could try EPR of 1. And tomorrow, EPR of 0. Might help you get used to the lower pressure relief, which is likely to be less comfortable.

Thanks Vaughn -- I'm willing to tinker, so this is another interesting suggestion.

[Shastzi]

When using a standard FFM I was having a lot of problems with CA's too. Until I read a few articles on CO2.
When I use the Fitlife mask, it has a LOT more dead space in it. It also feels a good bit more 'stuffy' but tolerable.
Yata! Almost no CA's.

Clue #2: My Devilbis mask has only 12 small holes and I get almost no CA's with it as well.

My Quatro FX ventilates a lot better so I get a ton of CA's with it but all the other stats are great.

What to do....

I took some blue painter masking tape and used that to cover some of the vent holes in the FX.
I left 18 open just for just for margin and tried it out with a dry run. It felt a bit stuffier just like the other two masks.
Then I tried it out over night.
Lo!
The CA's all but went away.

That makes me think that there is a sweet spot with the ventilation for each mask and
most OEM's don't bother to nail this down they just set it up figuring more ventilation is better.

Not quite so!

As usual YMMV. It's worth a try though.
If this simple trick doesn't work then be sure to consult with your
doc. You might need an Auto Servo machine.

Best of Luck!

[AndyB]

When using a standard FFM I was having a lot of problems with CA's too. Until I read a few articles on CO2.
When I use the Fitlife mask, it has a LOT more dead space in it. It also feels a good bit more 'stuffy' but tolerable.
Yata! Almost no CA's.

Clue #2: My Devilbis mask has only 12 small holes and I get almost no CA's with it as well.

My Quatro FX ventilates a lot better so I get a ton of CA's with it but all the other stats are great.

What to do....

I took some blue painter masking tape and used that to cover some of the vent holes in the FX.
I left 18 open just for just for margin and tried it out with a dry run. It felt a bit stuffier just like the other two masks.
Then I tried it out over night.
Lo!
The CA's all but went away.

That makes me think that there is a sweet spot with the ventilation for each mask and
most OEM's don't bother to nail this down they just set it up figuring more ventilation is better.

Not quite so!

As usual YMMV. It's worth a try though.
If this simple trick doesn't work then be sure to consult with your
doc. You might need an Auto Servo machine.

Best of Luck!

This is very interesting, and is consistent with my general understanding of CAs and possible CO2 washout issues.

Lately I've been trying 2 FFMs: an Amara View and an AirFit F10. Each has different vent rates and dead space volumes. I don't think I have enough data yet, but so far it appears i have fewer CAs with the F10, with a vent rate to dead space ratio of 0.191 (vs the Amara View at 0.215). I need to enlarge my sample set before drawing any conclusions.

Thanks again!

[Dee digits]

Is a "CA" a counted awakening? Sorry, I'm a recently diagnosed Apneaoid