Did the sleep technician make opposite adjustments of what is needed?!

[InquiringMind2890]

I'll just lay out a brief history...

16 years ago my dad had his aortic valve replaced and had undiagnosed sleep apnea for many years.

Last year he finally did a sleep study and was given a CPAP machine for his OSA. Previously he'd had 35 events/hour, but seemed to be controlling the # of events while on CPAP to approx. 5 events/hour. However, he still didn't really feel rested using the CPAP.

The last 3 weeks or so he's been noticing AHI's of 18+/hour, so I decided to look at his OSCAR charts and was surprised to see Cheyne Stokes respirations nightly. Previous to Oct. 25th he'd have maybe 1 CSR a week, but since Oct 25 he's had 3 or more PER NIGHT, and most of last between 20 minutes, and even go for 45 minutes or an hour.

Now it seems he has many more Hypopnea and OSA events too, as well as the large # of central/clear airway apnea's. In September he did an echo, and that was normal with a LVEF of 60-65%, but this was before he started having the increased CSR's, so I'm thinking another echo would be good to have because we're not sure why his breathing has changed this drastically so suddenly.

Throughout this year with CPAP he's consistently been on a pressure of 8, but after visiting the sleep technician last week he LOWERED it to 7, and set the EPR to ramp only. Does that make sense? If he's clearly not getting enough air and having increased Hypopnea, should the pressure be increased? Should we be getting a second opinion? I've also been reading that an ASV machine would be better suited for him rather than his CPAP, but am really concerned with these CSR patterns.

Here's a screenshot below of last night, and I can share the SleepHQ link as well for the previous nights of data if anyone knows how to read all that 

[airmax]

Wow this is interesting, keep us updated!

[staceyburke]

You are having positional apnea.  You can see positional apnea where either H or Oa events are clustered together.  Getting rid of as many as you can will lower your AHI.  Positional apnea can NOT be controlled by pressure changes.  You have to find out what position you are getting into and cutting off your own airway.  Have you changed your sleep position?  Sleeping on your back?  Using more (or new) pillows?  These things can cause positional apnea by chin dropping to your sternum and cutting your airway.  Think of it of a kinked hose – nothing can get through – you have to unkink the hose…

IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar.  I have a link to collars in my signature at the bottom of the page.  It shows people who are not wearing a collar and the SAME person wearing a collar.  There is a huge difference between the two.

Some of the central may also be positional apnea but Im sure the O and H ones are.

[Jay51]

Just follow Stacey's suggestions about positional apnea to help get those cleared up.  

In regards to the CSR:  They might be legitimate since you father has had aortic valve surgery.  A good thing to do would be to definitely show his Cardiologist this exact OSCAR chart.  Hopefully you can get optimized well, but if not, this can be evidence if you need to demonstrate the need for ASV, etc. in the future (by your explanation, the trend seems to be more and more CSR as time advances).

Machines with "back up rates" like ASV (for central sleep apnea) and ST (A) for lung disease, neurological, etc. can stop CSR by causing a breath to break up the cycle of CAs seen in CSR.