[Diagnosis] Need some diagnostic assistance, really concerned ...

[tjmaz1222]

   
   
   
 I realize I'm brand new to using a CPAP machine but last night's data really concerns me.  I was diagnosed with severe obstructive apnea July 31st after finally taking an in home sleep study.  My untreated numbers were 35 events per hour laying on my right side and 72 per hour on my back.
Last night's data almost looks like I wasn't using my machine at all.  Very concerning.  Following Sleeprider's advice, I was wearing a soft collar last night but that didnt seem to make a difference.
One variable is I am dealing with the remnents of some kind of broncial issue.  Itchy throat and a dry cough.  Was told by my roommate that I was coughing during the night.  My question is, could the coughing cause flow rate waveforms to be as they are in my attachments?
Any input on this would be greatly appreciated!  Thanks in advance!

[Walla Walla]

I'm not an expert but it looks like you have complex apnea and I don't think the current machine your on is going to be much help. Hope I'm wrong but if not your going to need an ASV machine. I'm sure someone better informed will chime in.

[PoolQ]

good you are asking. Not a simple answer so wait for a more senior person to get back to you. Hang in there as there are people here that can help

[tjmaz1222]

Based on the research I'm doing I'm beginning to agree with you WallaWalla

[Sleeprider]

tjmaz, the periodic breathing you posted does meet the criteria for Cheyne-Stokes respiration, at least from a cursory review, and it needs to be followed up with your doctor. A home sleep study would not be able to properly detect this, and the complex nature of the apnea needs to be investigated further. I would copy these charts to your doctor and request an appropriate clinical titration study that evaluates BPAP and ASV.

Meanwhile, let's try something different. Set your machine to CPAP mode at 9.0 cm with Flex off. I think we can probably get much less ominous looking results with this approach. Worth seeing what happens anyway.

[mesenteria]

The first chart apparently registers plenty of centrals, but also lots of obstructives, with no appreciable leakage.  Yet, what it seems to show as potentially a string of successive CA's are all quite short in duration, barely enough to have the machine label them.  However, in the next two charts, things are a lot worse...apparently.  I can't see what's happening without opening the timeline (left clicking on the chart to open it several times in succession so that the measurements are more discrete).

How much humification have you set in your machine?  Coughing could be allergies, the dregs or onset of a cold/flu, but it could also be an indicator of mouth breathing and/or too low humidity in the air feed.

[tjmaz1222]

Will try that setting, thank you.

[tjmaz1222]

Humidity level is set at a '3' right now. Will bump it up to a '4'.

[Sleeprider]

As we move forward, it will help if you keep all of your therapy posts in one thread. Your first post included two charts at over 10 and 14 AHI respectively. A similar complex apnea pattern was in those charts, but the periodic breathing component was not there. I just want to say I seriously doubt you actually have Cheyne-Stokes Respiration (CSR), but you seem to have a potential for complex apnea, where a combination of obstructive and central apnea make treatment with CPAP unlikely. Even complex apnea does self-resolve with some individuals, and many doctors want you to continue on CPAP to give it a fair trial before moving to bilevel or bilevel with backup rate (ASV).

I'll stay with my suggestion to alert your doctor that therapy is not going as expected, and it's my hope that a simple CPAP solution with fixed pressure results in improvement. We have had many members that have had similar problems, and you should be assured it is not life-threatening, but may require a different approach to get the expected results. Be patient, and keep your doctor in the loop. Any input he or she may have is of course welcome, especially since at this point you are only working off of a home apnea test.

[tjmaz1222]

Thanks for the input. Will definitely keep you posted on how this issue evolves.