[Diagnosis] Need help interpreting my results

[erkme73]

First post, go easy please.    

Backstory:

I'm 50, male, about 200lbs, 6'.   About 15 years ago, I had a serious event that landed me in the ICU for a week with severe sepsis.  I was hypoxic to the point where most of my organs shut down.  While I made a full recover, I did suffer some nerve damage to my long thoracic resulting in a year-long battle with a winged-scapula.    Ever since, I've had struggles with sleeping where I feel like I'm drowning, despite little or no snoring (at that time).   I even put a camera in the bedroom to record the incidents of "drowning" to see if I was gasping for air (I wasn't).  I suspect I 

Seeing the Airsense 10 on sale for $300 about two weeks ago, I managed to snag one using family influences to obtain a script without a sleep study.  With the auto-titration, I hoped I would be able to get valuable data without the study - or at least help make the decision to have one conducted.

It arrived a few days ago and I've been playing with it ever since.   As suspected, I'm seeing what looks like primarily central apnea - presumably from damage to my phrenic nerve during the sepsis.  

I've ordered an at-home sleep study kit from WatchPat which is cleared by FDA to differentiate between obstructive and central apneas.   That hasn't arrived yet.

In the mean time, I'm hoping the experts here can have a peek at my overviews of the last three data sets.   I can provide any additional requested information.

My plan is to take the results of the sleep test to my primary and go from there.

   
   
   

[Sleeprider]

Your results show several different pressures. My recommendation is a minimum pressure of 7.0 and maximum pressure of 10.0 with EPR 3. The most similar chart was December 7 where EPR was in use with a minimum pressure of 4.0. The reason you need the higher minimum pressure is that EPR subtracts pressure from the minimum pressure so 4.0 minus 3.0 really doesn't work well and just results in an unresponsive 4.0/4.0 (inhale/exhale) pressure. On 12/7 you also had quire a few OA events which was probably related to the low pressure an inability of the CPAP to respond fast enough from the low pressure, however the clusters of events are often "positional". You can see all apnea evens were very clustered. Here is a wiki that discusses the issue. If you are using multiple or firm-tall pillows, you may need to reduce loft. If this comes from a sleeping position, a soft cervical collar is often a solution. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[Old Steve]

Most of the apneas appear to be positional (head tucking).  It is like bending a garden hose to shut off the water except in this case it is cutting off your air. Pressure will not help this.  If you sleep on your back try sleeping on your side, if that doesn't help, a soft cervical collar might.  You also have some air leaks that need to be taken care of.  Also, remove the calendar from the OSCAR chart so more info is visible.  See what you can do with the positional apneas and post some more charts. You can search cervical collars on this site to see what I am talking about.  Also, welcome to the board, there are plenty of people here that can help with your CPAP settings once you get the positional apneas under control. 

[erkme73]

Thank you both. I will look into this and report back.

[paulag1955]

Be aware that chin tucking is a thing even if you're sleeping on your side. Think fetal position. You don't want that. Your head needs to be positioned so that your neck is straight.

[erkme73]

Ok, calendar removed from screenshot.   I changed the pressures to the recommended 7-10, and EPR 3, fulltime.  

As far as the positional issue creating the excessive CAs, I only wanted to add that I have a camera above my bed that films me all night.   When I review the timeline for the CA events, in almost every case, I'm laying completely still leading up to and through each of the CA events.   I can watch my chest rising and falling, then suddenly stopping.   Usually it'll resume without any movement of my head or body.  It's literally like I just forgot to take few breaths.

I can probably upload a clip but that seems a bit creepy.

Here are last night's results:

   

[paulag1955]

Did your sleep study show that you were having central apnea events?

[erkme73]

I haven't had my sleep study yet.   I'm doing things backwards, apparently.  I have a WatchPat in-home sleep test en route now.  It's supposed to be able to differentiate between central vs. obstructive - so that should be absolute.   I was hoping in the mean time to clear up what's being shown in OSCAR.

[paulag1955]

Based on what you're seeing with all the central events, it might be worth trying a fixed pressure with EPR. My central events were cut in half when I switched from autoset to fixed.

[BoxcarPete]

Based on what you've shared so far, I'm thinking you may have legit Central Apnea and are on the right track to get this medically verified. It is possibly related to your prior nerve damage, but the cause isn't so important as the treatment. In this case, an APAP machine is not the right device for you. Look into machines in the ASV class, they will boost pressure for you till air goes in your lungs if you forget to breathe, which is not something an APAP is meant to do. The A is for auto-titrating, which adjusts the "Constant" Positive Airway Pressure you are delivered based on how things are going in real time. Doesn't help you if your airway is unobstructed but there's no spontaneous effort to breathe.

I know nothing else about those machines, but I wish you luck in getting an effective treatment for your condition!