Need advice - Clear Airway Apnea and Cheyne Stokes

[skiphudspeth]

I've been using my Airsense 11 with Brevida nasal pillow mask for about 4 weeks.  Had high (>50% air leaks) until I started using mouth tape 3 nights ago.  Every recording while using mouth tape shows Cheyne Stokes soon after falling asleep.  Any ideas on why Cheyne Stokes may be showing up after starting to wear mouth tape?

I'm generally in very good health and get lots of exercise.   I have brachycardia (resting heart rate in 40's to 50's).   I'm hoping to feel much more rested after sleep than I do now.  

My data is also flagging Clear Airway apnea.  Wondering what other's experience has been with treating CA.   

Thank you!

[PeaceLoveAndPizza]

I don’t think you were asleep during that time, so question the CSR flagging. ResMed sometimes flags periodic breathing as CSR. Others will chime in if I am missing something. Many get CA’s when they are starting therapy, which are called Treatment Emergent Central Apnoea’s (TECA or sometimes TECSA). 

Some questions…

How did you end up with your current settings? 

You have quite a bit of mouth leaking going on, something to address with a soft cervical collar, mouth tape, and/or a full-face mask. I use an SCC and FFM, but others have their own secret sauce.

You could try using a bit less EPR and a bit more pressure. EPR may trigger CA’s.

And remember to clean up your Dropbox, it’s full…

[Jay51]

Great points as usual by PeaceLoveAndPizza.  I have seen many charts here where CSR was innapropriately flagged.  Just a handful of true CSR.  This actually looks like real, "sign wave" pattern CSR breathing IMO.  I will defer to an expert as to their interpretation of this though.

[Jay51]

In addition to the questions that PL&P poses, anything in your medical history (besides bradycardia you have already mentioned) that could possibly point towards Cheyne - Stokes?

[skiphudspeth]

Some questions…

How did you end up with your current settings? 

You have quite a bit of mouth leaking going on, something to address with a soft cervical collar, mouth tape, and/or a full-face mask. I use an SCC and FFM, but others have their own secret sauce.

You could try using a bit less EPR and a bit more pressure. EPR may trigger CA’s.

My CPAP initial settings (Configured by my Sleep MD) were:

Pressure Min     5.00 cmH2O
Pressure Max   12.00 cmH2O
EPR            Full Time    
EPR Level   2 cmH2O
Ramp    Auto
Ramp Pressure    5 cmH2O

I changed the Min Pressure from 5 to 8 on 12-12-23.  Before falling asleep I was having trouble breathing in through my first pillow mask (Resmed P10) and found it easier to breathe with more pressure.  It looks like I may have also changed the Max pressure from 12 to 14 at that time as well.

After starting tor read the apnea board discussions I realized it was naive of me to think I could change pressure setttings without impacting the apnea treatment.  I'm now thinking of returnind the pressures to their orignal settings.  I have a virtual appoitment with my sleep doctor on Wednesday (and hope I won't be in too much trouble!)

I've been using mouth tape the last 4 sessions and found it greatly reduced leakage most nights.  I had noticed that air was leaking out between my lips with my jaw closed.  Completely sealing my mouth with tape feels risky (scary), so I've been cutting a small hole in the middle of the tape to allow some breathing if my sinuses become constricted.  (I'm titrating the hole size to get minimal leakage and still breathe through my mouth if needed)

[skiphudspeth]

I dont know of anything in my medical history that could trigger Cheyne Stokes.  I don't have a history heart problems or stroke.  What other conditions could be contributing factors?

[Crimson Nape]

It could be because Resmed used this term for periodic breathing. Many have been "concerned" when they see this.

- Red

[Jay51]

"It may be caused by damage to respiratory centers,[4] or by physiological abnormalities in congestive heart failure,[5] and is also seen in newborns with immature respiratory systems and in visitors new to high altitudes.  Causes may include heart failure, kidney failure, narcotic poisoning, intracranial pressure, and hypoperfusion of the brain (particularly of the respiratory center)."  - from the online Wikipedia.  

PL&P makes a valid point that it appears to occur only during your sleep onset when you are falling asleep.  Cheyne Stokes would occur more consistently throughout the entire night of sleep with the above conditions though.  

Hopefully this is nothing serious.  I only posted because one close up chart you posted looks identical to Cheyne - Stokes respirations.