Complex Sleep Apnea? Suggestions?

[Unkikonki]

Hi there,

I was diagnosed with OSA with an AHI of 27 back in March (see screenshot below). I've been doing unsupervised CPAP therapy (ResMed AirSense 10 Auto-PAP) for the last 3 months with rather disappointing results. I recently decided to disable EPR but it hasn't had any positive impact on AHI yet.

So far, the vast majority of events detected by the machine are CA. Far away, in second place, come Hypopneas. And that's it, no Obstructives or unclassified detected at all.

Could you take a look at the graph and tell me what you think please? Does it look like treatment-emergent central apnea to you? And how about the hypopneas?

SLEEP STUDY

OSCAR - ENTIRE NIGHT

CLEAR AIRWAYS

HYPOPNEAS

MIXED - CLEAR AIRWAY + HYPOPNEA

[Unkikonki]

EDIT: I'm aware that the maximum pressure should probably be a bit higher, but historically it's always stayed below 12, even when set to 15. I will increase it to 12 regardless, but I don't think that's the main problem.

[SarcasticDave94]

If you've started CPAP therapy recently, these CA are possibly treatment emergent centrals given the Central Apnea in the test were low.

You'll possibly want to edit settings a bit to avoid those CA. If any of these apply, Ramp needs to go to off, EPR should be turned down starting by edit down 1 point, if things don't improve, you'll maybe need to make pressure closer to static.

Another possible answer is these might be from a positional apnea situation. In context here, positional Apnea is an alignment of head and neck that kinks the airway simulating Apnea. Best solution for this is either flatter pillows and physical means to prevent chin tuck that causes it. Soft cervical collars have been used to great effect for a number of members.

[UnicornRider]

Welcome back my friend.

You have unresolved Flow Limitations.

It will take pressure support to keep those airways open.

I agree with SD the Flow Rate waveforms show distortion that could be related to chin tuck or  flow limitations. therefore a Soft Cervical Collar may help or low pillow.

You need to stay on this thread, I shall cry out for administrative assistance to combine all three of your threads. That will make it easier for forum members to follow your historical progression and provide more effective suggestions.

I would like to see an OSCAR Report Overview page with a three month range selected and a Statistics' page in the Monthly Report Mode. These will show us where you been on your therapy settings as well as your body's response.

Try:  Pressure Min  10,4 (cmH2O)
      Pressure Max  12.0 (cmH2O)


.

[UnicornRider]

I happened to notice but neglected to inquire about the breaks in Flow Rate seen at ~04:50, 05:45 & 07:05.

Can you zoom in on those? Are they legitimate breaks that you can justify?

Thanks.

[Gideon]

Your "centrals" are mostly following a disturbed sleep and you are likely semi-awake and holding your breath rolling over.
Attack your flow limits and hypopneas with increased pressure differential, EPR/PS. Try EPR=3

Repost including charts.

[Unkikonki]

If you've started CPAP therapy recently, these CA are possibly treatment emergent centrals given the Central Apnea in the test were low.

You'll possibly want to edit settings a bit to avoid those CA. If any of these apply, Ramp needs to go to off, EPR should be turned down starting by edit down 1 point, if things don't improve, you'll maybe need to make pressure closer to static.

Another possible answer is these might be from a positional apnea situation. In context here, positional Apnea is an alignment of head and neck that kinks the airway simulating Apnea. Best solution for this is either flatter pillows and physical means to prevent chin tuck that causes it. Soft cervical collars have been used to great effect for a number of members.

Thank you. It's been over 3 months since I started CPAP therapy and those CA have always been there.

Regarding position apnea, I'm starting to suspect that turning on my back is what is triggering most events. Notice how there's barely any events during the first hour or so of sleep? I thought this was mainly because, from what I read, sleep apnea tends to worsen during REM sleep, and apparently deep sleep tends to make most of our sleep during the first cycle of the night. However, I'm starting to think that it might actually be because after an hour or so, I unconsciously turn on my back, which is the worst position for my apnea. I'm already using a low pillow and also tried a soft cervical collar.

Welcome back my friend.

You have unresolved Flow Limitations.

It will take pressure support to keep those airways open.

I agree with SD the Flow Rate waveforms show distortion that could be related to chin tuck or  flow limitations. therefore a Soft Cervical Collar may help or low pillow.

Could that also be because of turning on my back too?

You need to stay on this thread, I shall cry out for administrative assistance to combine all three of your threads. That will make it easier for forum members to follow your historical progression and provide more effective suggestions.

You are right, I'm sorry. I thought this post was more concise and illustrative of what is actually going on, I will stick to it. By all means, feel free to delete my previous posts if that helps to keep things clean and tidy.

I would like to see an OSCAR Report Overview page with a three month range selected and a Statistics' page in the Monthly Report Mode. These will show us where you been on your therapy settings as well as your body's response.

See screenshots at the bottom please.

I happened to notice but neglected to inquire about the breaks in Flow Rate seen at ~04:50, 05:45 & 07:05.

Can you zoom in on those? Are they legitimate breaks that you can justify?

Thanks.

Yes, those are legitimate breaks. if I recall correctly, at 4:50 I got up and went to the toilet, and between 5:45 and 07:05 I could really fall asleep. I tend to turn machine off and on when awake for long intervals to create breaks and avoid feeding the chart garbage data. In fact, you will notice I removed a lot of data from OSCAR (over 10,000 minutes), mostly from nights where I used the machine for less than 4 hours or it was just too fragmented to be of any use.

Your "centrals" are mostly following a disturbed sleep and you are likely semi-awake and holding your breath rolling over.
Attack your flow limits and hypopneas with increased pressure differential, EPR/PS. Try EPR=3

Repost including charts.

 Is it normal to roll over and hold your breath so many times?

Using EPR 3 tends to lower the Hypopneas to the expense of more CAs. Is this a trade-off I should accept for now?

[Gideon]

I can't tell what impact EPR=3 had on you, if not EPR=3, do try 1 or 2. I'd rather try higher than back off. I hope that the increase in EPR will resolve the restlessness and as such cut back on your arousals which are very disruptive.

[Unkikonki]

UPDATE

Treatment hasn't improved, centrals are still very prominent. I used the same settings for 9 days (Min 9.8 Max 12.4 EPR 3) and then slightly changed them to Min 10 Max 12.4 EPR 2 during the last 5 days. The results haven't really changed much from what they used to be. My AHI keeps fluctuating between 5 and 9, and I keep waking up feeling tired.

That being said, using the machine is still better than nothing, as I confirmed during the 3 nights I slept away from home without the machine (28/12 to 30/12).

After 4 months of continuous use, do you think I am well past the acclimatization stage? I mean, if the centrals haven't decreased by now, is there any change they will in the future? Could it be something else?

[PaulaO2]

How long are those events lasting? The CA?

And yes, it can take 3 mos or more for you to acclimatize. The brain can get really confused.

Raising the max pressure isn't going to help because it is more than adequately handling the OAs.
And, to be honest, an AHI of 9 something isn't worth the panic or rush. You're getting treated. Now let's get it figured out. Take things slowly, one change at a time, so you know which change is working and which didn't.

One thing to consider is actually lowering the max pressure, wait several weeks, raise it a bit, wait more weeks, etc. For example, try going down to 6 min, 10 max. Then up to 11 or 10.5. Then up again.