[CPAP] sleepyecho - Can't reduce centrals after septoplasty

[sleepyecho]

Hi everyone,

I've been using an APAP machine since February, and I had a septoplasty with turbinate reduction at the beginning of August. Before the surgery, I used the F&P Evora hybrid mask, and my AHI was around 2–3, mostly "possible central" events. After a titration study, I was set on a pressure of 7–10 with EPR of 2. (I only started using an SD card after the surgery, so I don't have any pre-surgery OSCAR data.)

Since the surgery, my AHI has consistently been over 5, still mostly centrals. I lowered the EPR, but it didn't help. I consulted my APNP sleep therapist, and she recommended a CPAP setting of 7, but that didn't help either. I suggested trying an ASV, but my therapist is adamant I don't have central apnea and wouldn't qualify for it. I'm now using the ResMed F20 mask; the Evora hurts my nose post-surgery, and the Vitera full-face mask has significant leaks.

Do you have any recommendations on what else I can try? Does this look like a case where I could convince a provider to let me try an ASV? I have a prescription for Gabapentin, but I stopped using it after reading the new FDA finding.


I am attaching the following screenshots from my OSCAR data:
1- Using pressure range 7-10, EPR 2:     
2- Using pressure 7-9, EPR 0:     
3- Using CPAP setting 7, fixed pressure:     

[sleepyecho]

I am also attaching my sleep study pre-CPAP:     

and the titration study I have that recommended pressure 7-10:     


The forum doesn't let me post them as PDF yet but saving them allow to see all the pages.

[Jay51]

The CA's could be from your much improved ventilation after the surgeries.  

A plan might be to continue to monitor your CA's via OSCAR.  If you had the surgery in August, you have some time under your belt now (and several weeks of OSCARs).  Hopefully, in time, you may be able to adjust to this and the CA's could decrease.  If not, then you would have several months of OSCAR data with increased CA's (be sure to show a pre-surgery OSCAR if you can also for reference) to try to prove your case to your DR.

Decreasing EPR (and even turning it off) did not get rid of the CA's.  Good try and good thinking though.

[Phaleronic]

Hello sleepyecho

You're on the right path with fixed pressure, but with the hypopneas and flow limits showing up and cpap @ 7cm, you please need to raise that to 10cm and try that for a few nights; you can use EPR but I would not re-engage it until you're up to 15-17cm. I would also try it tonight before bed for 30 to 45 minutes and let us know how it feels.