Could really use some advice/help

[Lukki]

Hello! Apologies if this post is a bit long.

A few years ago I had an at-home sleep study done (Alice NightOne) and the results were:

0 central apneas/hr

0.9 obstructive/hr

0.2 mixed/hr

6.1 hypopneas/hr

for a total of 7.2. I was diagnosed with mild obstructive apnea and given a CPAP.


I've used the machine on and off for the past 3 years, mostly adjusting the settings myself because I had a bad experience with my first doc.

Anyway, I've been seeing a new doc because I'm tired and my AHI is almost always over 5 - with roughly half and half centrals and hypopneas.

First appointment he insisted on 3 months of new data (same settings as before), and said if there were central apneas we'd start looking at other machines.

Well, 3 months later there were centrals but he wanted to keep adjusting the CPAP. I expressed my concern and tried to push for a new machine, and I was scheduled for an in-lab study that insurance probably won't cover 5 months away and he lowered my CPAP pressure to 7.00 cmh2O. AHI the same. He said the study would be an ASV titration or something but on MyChart the appt says "CPAP" along with sleep lab instructions. Up until now a lot of other things have happened that make him seem incompetent so idk.

I tried to find a listing for an ASV on Craigslist but haven't had any luck. I also don't know for sure if it's what I need.

Thanks for reading! I've really been struggling with fatigue, so any advice would be very appreciated.

[RickEiben]

The insurance game is hard to win, but can be done, if you want them to supply one for you. It took me 2 months. You will need the correct supporting paperwork - hopefully your DME supplier knows all the t's to cross and i's to dot. Otherwise, Click on the supplier list at the top and contact the suppliers that sell new and used equipment for an ASV on this forum. Good luck.

[staceyburke]

Welcome to the board.  Many of your H events look to be positional apnea.  It is also called chin tucking because it is caused when your chin drops down to your sternum cutting off your own airway.  No pressure change will help you have to find a way to stay out of that position.  You can have this problem sleeping on your back, side or stomach but most people have them wile sleeping on their back.  Another way is sleeping with to high of a pillow forcing you head out of alignment.   If those easy fixes do not work you may need to use a collar.   I have a link to collars in my signature, please take a little time and look at it.  They make a huge difference.

The 2 other problems I see are a little harder to help.  Centrals and Flow limits are both causing you problems.  The thing that helps flow limits may cause more centrals but we need to try and see if you can get a balance between the two.

Flow limits are apnea the same as O and H events but to control them we use EPR (exhale pressure relief).  My suggestion would be the following setting...

Pressure fixed at 8
EPR on full time set at 2

Give the settings a night and lets see how you do...  that with the positional apnea fix will help you sleep much better.

[cdplatt]

I'm usually suspicious of CAs as they seem to be triggered by other events - like your hypopneas - i.e., you may be partially awake.  Your machine should be able to control those hypopneas, then you could see if the CAs remain and whether you need a new machine.  

My thoughts:

There are a number of research studies that suggest Full Face Masks can be less effective than Nasal Masks or Pillows type masks for controlling apnea and for long term success - of course mask success is a highly individual outcome.   Have you tried other mask types?  If you're a mouth breather, a nasal type mask with tape or a chin strap may lead to a better outcome.  That was the case with me.  I thought I needed full face, but didn't get good results until I switched to nasal and tape - it was instantaneous improvement - by a large margin.

Have you tried the machine in APAP mode rather than CPAP?  I'd try setting it in APAP mode with a minimum pressure of 7 and EPR turned ON - level 2 or 3.

Conquer the hypopneas and see what if anything happens to the CAs.

[Gideon]

Based on your charts your CAI, your centrals, are consistently under 5.
One of the qualifications to get an ASV is to have a CAI of over 5.

IMHO you would be better off using a VAuto with the Trigger setting set to High or Very High. That means that the VAuto would be more sensitive in shifting from exhale to inhale.

This is a nonstandard use of that parameter but many here are successfully using it specifically for managing low levels of central apnea. Ask about getting a trial doing such.

[Sleeprider]

Lukki, the lowest cost way to try ASV is to buy the older generation Resmed S9 Adapt. The DotMed website has usually had some ASV listing for the Aircurve 10 ASV or S9 VPAP Adapt. Most listings include run hours. Sellers have ratings and you should use a secure payment method. ASV devices are kind of rare, and Craigslist is not a reliable source.

[Lukki]

First of all, thank you to everyone who has responded!

Some additional information: I started with a full-face mask on APAP mode, and at some point picked up some nasal pillows and changed to CPAP mode.

My AHI was frequently under 5 using nasal pillows, but I still felt fatigued. I figured it was because I sometimes breathe through my mouth.

After doing some research (most of which on this site before I had an account), I tried taping my mouth and using a chin strap, but I just couldn't get used to either and I became increasingly sleep deprived until I had to stop.

A little while back I tried using a wide scarf wrapped around my neck in place of a soft cervical collar (I couldn't physically drop my chin) and it stayed on all night, but everything looked the same in OSCAR. I wish I could remember which night I did that.

I've never tried EPR, so I will try turning that on tonight and report back. I haven't used the CPAP in about a month so I'm hoping I'll sleep okay.

Thanks again everyone!

[Lukki]

I set the pressure to 8 and EPR to 2. Here are the results.

Please let me know your thoughts on this, thanks.

[cdplatt]

Hypopnea looks better, but still a bunch of CAs. Did you have many CAs when you tried the Nasal mask? Your sleep study showed 0 CAs.