CA (cluster?) events not reducing

[T818]

I am not sure about this yet but I think stacking pillows & elevating my head make things better. but thats an uncomfortable position for me so I keep falling down during sleep. Still waiting for the caldera SCC.


"each CA to see how many are preceded by arousal breathing."
=> this seems to be true for most if not for all CA. attaching some close snapshots of these. what can I do to make this better? 
Also does restless leg syndrome has anything to do with this? I felt uncomfortable feelings and movements in my legs sometimes and thinking to get do Ferritin test.

does nasopharyngeal mass has anything to do with the flow limitation or HA, maybe OA?

[Dormeo]

If you do better with your head elevated, you might try either a wedge pillow that goes under your mattress or blocks to raise the legs of your bed at the top end.

I don't have the medical knowledge to tell you whether your mass could be causing FLs or Hs (or OAs), but to my mind that certainly seems possible.

Were leg movements reported in your sleep study?

[T818]

1st (2018) & 3rd (2022) showed PLM. 2nd test did not mention PLM. Attached are the reports.

[T818]

Reports after using Caldera SCC. still feeling sleepy. what to do?
26th I turned off EPR and had a headache all day. flow limit was 0.26.

these days usually i feel most sleepy after few hours of waking up and need to sleep extra long hours like 12/13 hrs. also if I wake up early like 9/10 am i feel like i havent slept at all. after trying to be awake for an hour or so, fall asleep within minutes after hitting bed.

[T818]

closer look of the CA events. are these arousal or actual CA? do I need bipap/ASV?

[Dormeo]

I will defer to Sleeprider on the question whether an ASV is likely to help you or not.

I do observe that the CAs follow arousal breathing, and my own suspicion is that the arousals are what cause you to feel foggy or sleepy during the day. It's possible they are connected with your ENT problems, but I don't think anyone can say for sure whether that's true or not. All you can do is try to address the ENT problems and see whether that helps.

Your two-page sleep report refers to titration with "BPAP," and your settings for the titration would not be possible on the machine you are using. (The titration had pressure support of 4, and your machine can produce EPR of only 3.) I wish your actual indexes for the titrated settings had been reported.

Was there ever any follow-up on the suspicion of narcolepsy? Why are you using a regular APAP machine when you were titrated on a bi-level machine?

[Sleeprider]

The sleep study really helps to narrow down a likely source for the arousals that precede the CA events as potentially PLM. Since bilevel titration at 10/6 pressure was successful at mitigating the PLM and RDI, I don't understand why you were dispensed CPAP. An interesting feature of the Resmed Aircurve 10 Vauto is the ability to adjust the trigger sensitivity for IPAP. We often use high or very-high trigger sensitivity to reduce central events. This seems to work by reducing the amount of inspirtory airflow needed to trigger IPAP pressure, and the increased pressure seems to stimulate an inhale, or remind the user to breathe. I even use this on my own therapy.

The Vauto is not intended to treat central apnea, but in your case, it should reduce the arousals that seem to initially stimulate hyperventilation leading to the CA event. ASV would certainly maintain the breathing rate and volume when centrals would otherwise occur, so it should be an effective treatment if your doctor agrees, however I think you should look into why the recommended therapy from your sleep test was not dispensed.

[T818]

in 2018 i was first diagnosed and was suggested to use CPAP with fixed pressure 8. after using for an year I didnt feel any better and stopped using CPAP.
as things got worse I again started following up doctors in 2022 and has 2 sleep studies in 2022. On May 2022 they didnt do titration. Dr just asked me to try Bipap after I said that CPAP not helping me. and on oct 2022 (different dr) suggested another sleep study and used BiPAP for titration. 

As I already have the APAP from 2018, I thought of taking help from this group if I can feel better changing something.  I have to buy BiPAP with my own money(as my insurance dont cover sleep relayed issues). if after buying BiPAP also doesnt work same as the APAP didnt, then I will be in loss of good amount of money. Therefore wanted to be 100% sure what do I actually  need. I havent followed up with the Dr since the sleep study on narcolepsy either.

I am following up with ENT issue. 

looking at the reports, what should I do (if ENT resolve doesnt solve the problem)? Will Bipap help? or ASV? 
I can try trial with Lumis 150 VPAP ST. dont know if this BiPAP or ASV for a month if that is suggested.

[T818]

1st (2018) & 3rd (2022) showed PLM. 2nd test did not mention PLM. Attached are the reports.

here I have attached 2 reports. 1st report from 2018 and 3rd report from 2022 oct.

[T818]

this is the 2nd report on May 2022 that didnt perform titration. this study mentioned "no PLM seen"