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After years of fatigue, brain fog, etc. and unsatisfactory treatment at the hands of various sleep doctors, was diagnosed with UARS a year ago (based on a 360-degree X-ray) by a respected sleep dentist in NYC. He prescribed an oral appliance which unfortunately proved to be mostly ineffective at treating the condition. After consulting with LankyLefty (Jason Sazama), began using a CPAP with (pressure of 8, EPR 3) in conjunction with the appliance. Experienced some initial success (improved energy, less brain fog) but then again began experiencing a lot of fatigue. Have been monitoring my data using OSCAR and it's clear I am experiencing many central apnea events that looked to me like the Cheyne-Stokes pattern. I shared screenshots with a sleep physician who said the events were not Cheyne-Stokes but instead indicated "Treatment Emergent Central Sleep Apnea" (TECSA).
Fun! Any recommendations on addressing this? How common is it for CPAP therapy to induce central apneas? Am I suddenly a candidate for ASV? (It's amazing the number of acronyms a person must navigate in treating these conditions...)
I'm attaching the screenshots (from a various days over the past month). Any advice is greatly appreciated.
It’s very hard to tell what’s going on from a micro-segment of the night. Would you mind reading the Oscar instrux and posting in the board-standard Oscar layout? Macro for now, micro later.
There are several different reasons for Clear Airway markers generated by the unit, and not all are Centrals.
I purchased the CPAP machine last summer while I was waiting for my oral appliance to be manufactured. I used it for about 3 weeks in September (on auto mode). Even at that point - prior to using the appliance - I was experiencing occasional clusters of central apneas. Once the appliance was ready, I stopped using CPAP and used only the appliance from October to June; however, I did not see the benefits I was hoping for. Since mid-June, I have been experimenting with both the CPAP (fixed pressure of 8, EPR 3) and appliance simultaneously.
Attached are some full screenshots as per the instructions ("snoring" graphs were all zero).
i've found that my CAs correlate almost perfectly with position changes, i.e. arousals. i don't think it's treatment-emergent per-se, i think that CAs during sleep-wake transitions are common and wearing the mask (especially with higher EPRs) can exacerbate them. my doctors said not to worry about it if the AHI was under 5.
07-21-2024, 10:57 AM (This post was last modified: 07-21-2024, 11:00 AM by nycteach.)
RE: CPAP-induced central apneas?
Yeah, Jason had suggested trying a fixed pressure instead of auto pressure (as more effective for treating UARS). My sleep dentist concurred, saying that studies show that fixed pressure is most effective. But even using auto pressure I was experiencing some central apnea events.
These central apnea events are occurring in clusters over a 10 minute period - I think it's unlikely that in my case they are resulting from position changes.
Did you have a lot of CAs in your sleep study? If not, they probably are just treatment-emergent and will lessen as time passes and your body adjusts to cpap therapy. If you don't know the answer, post a redacted copy of your sleep study. If you don't have a copy, ask your doctor for one. By law, he has to give it to you.
For people who experience treatment-emergent central apnea, turning EPR down can sometimes help. Try 2 and see how it goes.
It's not unusual to see a series of CAs or a period of waxing/waning breath. Deeper recovery breathing can result in a brief period of dwindling breath or a pause in breathing. That in turn can result in deeper recovery breathing. Rinse and repeat. The mechanism may involve CO2 levels in the blood or it may involve neurochemical sensors in the chest wall.
Agreed with Deborah K. You need that sleep study, better is the full detailed one. HIPAA law gives you the ability to request and receive. Requesting this result isn't permitted to be denied in the US.
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