Sudden increase of CAs, dysautonomia?

[phlamingo]

Hi all,

I have dysautonomia/POTS (developed two years ago, along with chronic fatigue syndrome, both most likely due to an asymptomatic Covid infection), with the main symptoms being orthostatic intolerance, tachycardia, fatigue, and some GI stuff. I've had OSA for around 15 years, untreated until two years ago. Currently using BiPap with 1 liter oxygen bleed-in (to address hypoxia that was not resolved with CPAP). Have average AHI of 0.27 since my last setting-change almost a year ago (EPAP 9.0, IPAP 16.0) with 0.12 being clear airway apnea.

Last night, my AHI jumped to 3.89, CAI 2.07; and for the two hours of sleep I managed to get tonight, AHI 3.83, CAI 1.91. I have been waking up multiple times, pulling off my mask and gasping for air. This happened to coincide with a sudden increase in my dysautonomia symptoms over the past two days, which landed me in the ER last night with severe malaise, tremors, fatigue, and tachycardia, where I got two liters IV fluids, felt much better and came home. Then tried to sleep. 

I'll be calling my sleep doc this morning, of course. I assume that this is not an equipment malfunction, but should I call the supplier anyway? Has anyone experienced a correlation between central apneas and other dysautonomia flares?

Thanks!

For your enjoyment, a screenshot of twenty minutes of "sleep": 
   

[Sleeprider]

It's not an equipment malfunction. Something about your sleep position has changed. The apnea in this screenshot is all clustered and is likely positional. Read the positional apnea wiki and think about whether you have changed pillows, sleep position or in some other way have moved into a position that facilitates chin-tucking or an obstructive angle between the head and neck. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

I'm not going to suggest changes based on a one-off poor result, but you are using a pressure support of 7 cm with fixed bilevel pressure of 16.0/9.0. In many individuals, this would flush CO2 and result in a reduced respiratory drive, or central apnea. There is enough going on in your therapy, that we really need to see what is typical for you rather than react to one bad session. That said, there is a setting in the trigger sensitivity we can use if needed to reduce CA events.

[phlamingo]

Thanks, Sleeprider. I can't correlate it to position. During my few hours of sleep this morning, I tried left side, right side, supine with slight head elevation, greater elevation, and almost sitting up, but awoke gasping, multiple times, in all positions.

[phlamingo]

Thursday night:
   
Friday night:
   
Saturday night:
   

[Sleeprider]

I think that pretty much confirms my suspicion.

[SarcasticDave94]

FWIW an AHI of 3.89 is still treated. I'd like to have that score myself.

Looks like you've got several layers of treatment as it is. I wouldn't over-think an off night.

[phlamingo]

SarcasticDave, good point. I made the mistake, this morning, of only looking at the data and numbers, which don't accurately represent what is going on because not all of my events were long enough to be apneas. I also didn't clearly describe what my sympathetic nervous system feels is the extreme and urgent nature of my situation:

This morning, at about 3:40, after 80 minutes of sleep, I awoke gasping for air. I had to remove my mask to get enough air. After catching my breath I went back to sleep (with mask), but immediately awoke, gasping again. For the next 45 minutes, no matter what sleeping position I tried (L side, R side, supine, head elevated 6 inches, then 12 inches, then sitting upright), as soon as I fell asleep, I stopped breathing. Sometimes, I could feel my throat closing as my body relaxed (regardless of position), other times I was breathing easily as I fell asleep. Most of the time I could catch my breath while keeping the mask on, other times the limited flow of the BiPAP was not enough and I had to take it off for a moment. Eventually, I just couldn't make myself put on the mask and try to sleep again (panic, fear, anxiety), so I got up and tried to figure out what to do (look at data, try to make sense of it, post here, make appointments, etc.).

To update, I messaged my provider, but she didn't have remote access to my machine and said to make an appointment. So I did. For November 10. Called DME provider, they sent her the information for remote access, so am sending her a new message this evening, hopeful for help tomorrow.