Clusters of Central and Obstructive Events

[KoolKestrel]

I was diagnosed with severe sleep apnea during a home sleep study in August (67AHI, all Obstructive) and was given a ResMed Airsense 11 (fixed 7.0 (cm H2O)). Immediately I started having Central events. (Treatment-Induced?) Because the Central events weren't lessening after 3 months, I was switched to a ResMed Aircurve 10 VAuto about a week ago. I have been following my progress on OSCAR and have been noticing clumps of events occurring a couple of times a night. There may be 20 events labeled CA and OA within a span of 20 minutes. What is the significance of these events? I have searched other posts and haven't come across a similar situation. Any help would be appreciated. This is my first post.

[staceyburke]

Welcome to the board...  We need data from OSCAR to be any help.  Please look at may signature (bottom of the post) for the charts we need to see.  Use the F12 button on your key board to take a screenshot and attach it with the button on the bottom of your text.  We will be happy to answer your questions.

[SarcasticDave94]

Welcome to Apnea Board,

It is certainly possible to have treatment emergent Central Apnea. For most that have these, the cause will be an increased exhalation of more CO2 than what your nervous system is accustomed to. Again, most that will remedy within 3 months.

Your VAuto has a trick that might help. Edit Trigger to High or Very High to avoid some CA by way of making the trigger to inhale more sensitive.

Two charts you might want to post: the diagnostic sleep study report and an OSCAR chart.

[KoolKestrel]

        Thanks for your answers. I tried to attach an OSCAR graph to my original post, but it doesn't seem to have worked. I'll try again.

Didn't hit Add Attachment. I think it worked this time.    

[PeaceLoveAndPizza]

It would be helpful to see some specific information. The link in my signature “Formatting OSCAR Charts”, explains what graphs to include in the chart. 

How did you end up with your current settings? I wonder if your pressure support of 5 may be part of the concern. One thing to consider is dialling it back to 3 or 4. Something like:

Mode VPAPAuto
EPAPmin 5
IPAPmax 15
PS 4
Trigger Medium

From there we can see how you respond to it and increase/decrease pressure, pressure support, and/or trigger accordingly. Some centrals are expected as you adapt, but we try to minimise them as best we can.

[Sleeprider]

Clusters of mixed apnea are often positional (chin tucking). The CA usually turns out to be obstructive flow limitation. With your bilevel at PS-5 and mostly apnea-free therapy, my money is on a positional issue.

[KoolKestrel]

Thanks, everyone. There is a learning curve to all of this. Thanks for your patience. I welcome all of your comments.

I tried to follow directions to get a better screen shot for 12/22. A couple things got cut off the left sidebar: Ti min 0.30 Seconds; Trigger: High

I am including another chart from Thurs. 12/19 for comparison with Trigger set Very High. I changed it to High because it was a bit uncomfortable.

Regarding the pressure settings, my doctor set up my machine with them after a preliminary reading of an in-lab titration sleep study done Nov. 29. I have been unable to see the report from that study because results take a minimum of 4 weeks to get to patients.

[SarcasticDave94]

No offense, but that lab must be full of slackers. Over a month to get you the report? Call and demand it. Remind them you want your copy of the detailed report. Mention the HIPAA law that says when you request it, they must provide it.

[SeePak]

Hey Kool.

I agree with Sleeprider.
Positional, almost guaranteed!

I can show you clusters you probably wont believe !!
I have had this for almost a whole night, and over the years, with and without a neck collar which should help; and it does.
As long as it is not too tight or too loose.

AND what i am starting to realize now...

BACKSLEEPING!

Gotta stay on your side!

I believe i have been going on my back to get relief from sore hips and that is when i get the crazy clusters!
Also have Palatal Prolapse which is worsened on my back.

You will spin your tires with PAP adjustments ( like i have!) until you get rid of the Positional, either from back sleep, chin tucking, pillow too high or hard pressing on neck, etc.

[KoolKestrel]

Thank you everyone--and apneaboard.com. You've given me some great advice and information. 

I did purchase a soft cervical collar (OTC Soft Foam Cervical Collar, size M) and have been wearing it for the past 3 nights. Clusters are still appearing.

Questions:

1. Does anyone have any tricks or tips on using the collar so that these remaining clusters are minimized? I wear a full face mask and find that the collar sometimes causes mask leaks. I do not sleep on my back.

2. Under the article "Optimizing Therapy" there is a section on "Clear Airway Clusters." This section recommends reducing EPR. Would this apply to me?

Thanks in advance for any replies.