[CPAP] Self Diagnosis and stumbling in the dark

[Strawman]

Hi everybody a bit of context to start. 


2000 cancer final operation in 2005 to tidy up the operational scaring resulted in sepsis total organ failure coma 6 weeks waking up to find hospital infection necrotising fasciitis had caused more damage. 2006 all good’ish took 4 years for scaring to heal early retirement sold up my place in London cashed in everything moved to the highlands of Scotland have a smallholding sheep, horses and other things bringing up the children life is now better than ever. Developed Afib somewhere along the way paroximal 2 attempts to ablate failed could not get the heart to misbehave so living with it and its OK. 

However not been sleeping well for some time and my moods are getting worse I am what they call a crabbit git. Had a wee car crash low speed (caused in part by my mood swings) an MRI revealed a compression of the spinal cord which was relieved by laminectomy on C1 to C6 had been progressing for some time now good. 

Recently been complained at for snoring she tells me its been bad for years and frequently waking and gasping unknown to me and I have ignored it, so downloaded a sleeplab on the phone and a decibel meter. For 7 hours my snoring was epic and the decibel meter averaged 68db and max of 89db who could sleep through that. 

So diagnosed myself (my history I have seen enough Drs) with sleep apnea bought a ResMed airsense 10 and airfit f20 mask and factory set to 4 -20 seemed like a decent machine had the right stuff for experiments.  

Night 1 snoring fixed and using the machine nightly no snoring and no longer getting up every couple of hours for a pee. WIN WIN. 

Unfortunately, sleep is still bad and I am still crabbit. Been all over the boards looking for help, found loads on this forum so here are some images of various nights and pressures I have been using. 

I have in my head a conclusion (will need to see another doctor) just your valuable assistance in interpreting the waves will help enormously when I do go and see one. 

Promise I will not be as long winded from now on but I thought there maybe clues in that history as to what is going on with my sleep. 
Q1. Do I possibly have sleep apnea? 

The attachments below are at the end of 2 weeks at 4 -20 auto all were similar AHI between 18 and 29.

[attachment=26217]

   

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I changed the lower pressure to 7.

       

[Strawman]

Some research on this board led me to think that turning EPR and ramp off and fixing the pressure I may be able to see a reduction in CA.This one represents the best nights sleep I have had in years.

Kept it the same last night not so good so I think you call that consistantly inconsistant.

Lowering the pressure tonight to 6 see what gives. Any help would be much apprieciated still no snoring so someone is happy.

   

   

[Gideon]

Welcome to the forum.

Find a nerologist based sleep doctor and ask if he treats central and complex sleep apnea and if he frequently uses an ASV, an Adaptive Servo Ventilator.
You IMHO HAVE Central and mixed/complex Sleep Apnea, but I cannot offer a diagnosis. The proper treatment for this is most likely an ASV vs your AutoSet. It is designed to treat this kind of apnea.
Your AutoSet was a good move in that now you know you have a primary Central Sleep Apnea.
You will likely need a formal sleep lab test to validate, in the doctors world, this apnea.

do you have any other breathing issues? COPD, Neuro-musclar disorders etc. Heart conditions.
These could impact the choice of which BiLevel with Backup (initiates breaths) you require.

I would consider getting a recording Oximeter, see the Oximetery Wizard in OSCAR for what is compatible. As many and often as you have these events you could, not do, have significant Desats. This is to eliminate those or alert your doctor since he doesn't normally look at your sleeping O2 levels.

Your background may or may not have a play in this.
Medications could cause this,
Any form of brain injury or stroke could cause this.
Neuro-musclar issues could cause this.
Some heart conditions could cause this.
the cervical issues you mentioned could cause this.

Central Apnea is a condition where the body does not provide the signal to breathe.

It would help to see a 5-minute view of a group of central apneas. Repeatedly click on the cluster until the view is 5-minutes. It will tell us more about the centrals.

[Sleep2Snore]

Hi Strawman,
I see you said your machine is set to 4 to 20 but your profile says 7 to 20.
You might find it easier to get on with setting the low to around 10, as your machine goes up to 15 +.
If you set the low to 10 the machine has less to rise in pressure when you have an event, this will have less chance of disturbing you when it rises due to you having an event. Especially as you are drifting off to sleep or just asleep.
Inverness has a good Sleep Clinic at Raigmore Hospital if you need to use it.
Aberdeen also has a Sleep Clinic at Aberdeen Royal Infirmary and I believe there is a small one further north, but I think it is part time.
If you have bought your own machine, they might agree to supply spares such as masks, filters, etc. If you are lucky they might even look after your machine. You will need to be referred by your doctor first, then you have the choice to say nothing and keep your own machine as a spare and get one from them or ask if they will supply spares and maintain the machine you have. If you live in a remote area, I would go for option 1, this way if your machine packs in, you have a spare, trust me, you get so used to your machine, when it packs up you struggle without it.
I see you have been through the wars with cancer.
I also went through this in 2014. I also had Sepsis twice and I was rushed back into hospital three times very ill. I also managed to get pneumonia when in hospital and a heart attack trying to fight all this. So I know where you are coming from.
All the best and stay safe. The hospital told me if I got Covid it may well be the end of me.

[Strawman]

Thank you so much Bonjour for your rapid response you saying what I am thinking.

General health is good blood pressure 140/150 over 80/85 had plenty of recent ECGs seem good I am large bMI 36 (unsure if thats relevant) apart from the bad doctor times all all is good. No medication.

I have completed an in home sleep test waiting for the results probably next week more ammo for the doc. Although at this moment I doubt if sleep tests are happening will see. Back up plan is to swap my CPAP with an ASV unit from supplier 2 on the list just trying to get as much confirmation as I can before laying out another bundle.

A couple of 5 min pics.

   
   

[Sleep2Snore]

Looking at your charts, it might be you need another type of machine.
It might be you need an ASV machine, only a test in the hospital will tell, though going by your results this might be the case unless things improve. However, there is no harm in talking to your doctor as it may take quite a while before you get seen anyway.
Also Covid may well be affecting clinics.

[Strawman]

Hi Sleep2snore


Thank you so much its tough at the moment was in Aberdeen for the lamenectomy was nice there I have definetly got those places on my radar but I need to pass the GP hurdle and them getting all anoyed because its their job to diagnose and all the waiting. It could be months. I have tried upping the lower pressure it just made the top end higher 18 CmH2o so have turned most things off and reduced the pressure to try and control the CA events and also to see if I induce more OA then find a balance where I am not keeping other people awake with the snoring and wait on doctors. COVID just adds to the complication.

[slowriter]

You really need to follow bonjour's advice ASAP; no setting changes on the CPAP will resolve those centrals.

[Strawman]

I agree slowriter and I am working towards that however I only bought the machine 3 weeks ago and I know more now than I did then and hopefully built up enough evidence to take to the doctors.

[Gideon]

The close up views look more obstructive than Central. They are called centrals because of the FOT. You have an apnea, then a big recovery breath, not that big but it is not ramping up to the peak which a lot of centrals do. Then they taper off and repeat.
You also have clusters of obstructive events which indicate a chin tucking.

An experiment please, let us see if we get lucky. Read the wiki in my sig about the soft cervical collar, it will make those obstructive clusters go away overnight. If you don't have one, I suspect that you do though, roll a towel around a neck tie then tie it around your neck for the night. It should resolve the obstructive apnea cluster issue and if we are lucky, some of the classified centrals it is definitely worth the try.