[Diagnosis] New Guy Needs a review - Treated but untreated.

[Madapples]

Correct, if it was the heart something would have shown up by now and I probably wouldn't be healthy enough to be constantly Googling my symptoms. But, according to that graph, my clusters of centrals look just like CRS. At least from my untrained observation.

Oh, and I failed to mention, I currently live at 6000ft above sea level and just learned it could be Altitude induced as these sleeping patterns started two years after moving here. With two weeks left, I truly hope this was the case the entire time!

[Shadowpup]

…Medicare to cover the initial costs, and then Tricare agreed to cover the leftovers?

That’s affirmative.  My sleep doctor did all the heavy lifting.  The first meeting I had with her I handed over some data collected on me during my participation in medical research.  It was March of the 2020 COVID panic. She had me titrated during the hospital shutdown(slowdown?) literally by the back door.  A fire escape door at the back of the hospital in the dark of the night.  Then had a ResMed Autoset in my hands in one week.  Then moved me to an ASV by August 2020.  She or her nurses did all the interaction with Medicare/TriCare.  I wish everyone on this board could have a sleep doctor as talented as this lady.

[Gideon]

The periodic pattern is that of CO2 induced breathing. While it looks similar to CSR the cause is different. And yes, altitude can induce it. It is possible that it is CPAP treatment emergent. One or both of these are likely contributing to your consistently inconsistent CA numbers.

Your 40+ nights appear to be positional meaning you are tucking your chin and thus cutting off your windpipe.. you can try pillow modification, think flatter, thinner, less firm, 1 vs 2 pillows. Morelikely you will need a soft cervical collar, see the link in my signature. This is frequently an overnight fix.

[Madapples]

The periodic pattern is that of CO2 induced breathing.  While it looks similar to CSR the cause is different.  And yes, altitude can induce it.  It is possible that it is CPAP treatment emergent.  One or both of these are likely contributing to your consistently inconsistent CA numbers.

Your 40+ nights appear to be positional meaning you are tucking your chin and thus cutting off your windpipe..  you can try pillow modification, think flatter, thinner, less firm, 1 vs 2 pillows. Morelikely you will need a soft cervical collar, see the link in my signature.  This is frequently an overnight fix.

Thanks for the time you put into your response, I appreciate it. 

So, I do have a collar and I got this collar back in march. https://www.amazon.com/gp/product/B01N9H...UTF8&psc=1
I went with 3 inches because anything smaller gave me the feeling I was chin-tucking. 3inches keeps my chin almost at a 90degree angle. 

Attached is the first night I used the cervical collar. Was actually my lowest score to date! But after the first night right back to the 20-40AHI nights until I started waking up with cricks in my neck due to the collar so I have been using it sparingly ever since. Most of my better nights are with the collar but my numbers are still not good enough so I don't use it every night. 

[attachment=34145]

[Sleeprider]

I was suspicious of high altitude central apnea, but your profile showing your residence in Western New York threw me off. I think altitude is contributing to your issues. Your recent experiment with the soft cervical collar was successful, and you should continue with that collar and perhaps experiment with the 3-1/2 or 4-inch collar to see what works best. Past graphs have shown the clustering we associate with positional apnea and chin-tucking, so this makes some sense. There is kind of a rule in respiration that what goes in must go out (inhale/exhale) and your chart back on the last page was pretty weird. It looks like weak inspiration with a sharp exhale followed by a fairly long pause of zero flow. I can't decide if I'm looking at flow limitation or leaks, awake breathing, or just a poor pickup of your actual respiration.

[Madapples]

Sorry for the confusion, I am currently in the middle of a move from Cheyenne WY. to Western New York. I have two, three weeks left here. So I've been at 6,000ft+ for the last 5 years.

I actually think that specific screenshot could be awake junk with me likely being awake due to my anxiety I hold my inhales/exhales a lot and then give a big sigh type breath. That's probably what this specific screenshot might be interpreting.

[SarcasticDave94]

True, altitude can play a bit of havoc with Centrals.

[Madapples]

Hello again,

After spending hours scouring my data I noticed patterns that my airway was clearest when the pressures was around 13-15 so I started there AND then went back to an old pillow I know worked for me years prior. Here is the last two nights of data.


I still had some centrals but almost all of them have a spike in flow before the central so my understanding that could be due to movement and chin tucking?

       

[Madapples]

Okay, 3rd night in a row hovering around 5 AHI

Last nights, chart and the 10 mins leading up to the first central of the night, was is the big spike, is that a big breathe in and then holding it?

This is the question I ask...thanks for the consideration 
[attachment=34278]

[Madapples]

The last attempt at one last follow-up post looking for any bits of tips and then I'll leave you alone.  

Double posted because I realized I uploaded the wrong screenshot.


Last nights Chart

The third day in a row hovering around that 5 AHI mark for the first time since I started therapy in March.