Inconsistent Sleep Patterns and Confusing Sleep Studies - Please Review

[mperry99]

       

Over the past 8 months I have had three sleep studies ordered by two different sleep clinics and after using my CPAP / APAP since April 13 I am still confused as to what is happening and where I should go from here.

Background:  77 year old Male, 5'11" 195 pounds.  Resmed Airsense 11 F20 Full Face Mask.

I have attached two OSCAR screenshots.  The Oct 6 screenshot shows me using the settings recommended by my first sleep study, and the Oct 7 screenshot shows me using the settings from my most recent sleep study.  The second sleep study was a complete bust!

I'm trying to figure out whether I am heading in the right direction with the therapy, and if not, what changes I should consider.

In particular, I would like to get a clear explanation as to what is causing most of my events to be Clear Airway, which have always been at or above 75% of them whether the AHI is high or low (e.g. AHI of 13.7 on Oct 6 and 4.4 on Oct 7).  Does this truly indicate that my main issue is Central Sleep Apnea?  If so, should I be considered for an ASV machine?  If not, what should I be doing to reduce these Clear Airway events.

Thanks very much for any insights you can provide.

ps: I didn't attach my three sleep studies due to the limitation on the number of attachments but can do so in subsequent posts to this thread if that would help (personal information redacted of course).

pps:  My CPAP machine is set for Mountain Standard Time (= Pacific Daylight Time) as I started with the machine in Arizona, and am currently in Michigan.  I didn't want to change the time setting and lose the data.  And, I am headed back to Arizona in a couple of weeks.

[OpalRose]

Hi mperry99,
Welcome to Apnea Board!

If you're able, post your sleep studies here, even if it takes a few posts to do so.
We'd like to see the complete studies, not just a summary. Looking to see if you experienced Clear Airway events on those studies.

Thanks!

[mperry99]

OK, will do.

Here are the first 2 of 4 pages of the original at-home sleep study.  Pages 3 and 4, will come on the next post.

       

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Here are the pages 3 and 4 of 4 pages of the original at-home sleep study.

       

[mperry99]

Here are both pages of the second sleep study.

       

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Here are both pages of the third sleep study.  
Thanks for your help.

       

[mperry99]

Here are some zoomed-in views from both Oct 6 and Oct 7 that may also shed some light on what is going on.

       

[OpalRose]

What was the reason for not tolerating the Bipap titration? Although, I doubt Bipap would help much with the CA's.

Bumping thread!

[mperry99]

It wasn't so much that I couldn't tolerate the BIPAP titration, as I hung in there without complaining to the technician.

But, the pressure seemed to be way too high, and there was nearly constant leakage (the kind that sounds like a loud whoopy cushion).  I started with my own F20 medium mask that had been working fine, and the technician also had me try both a new medium F20 a large F20.  Same result.

So, I did not get to sleep at all during the first half of the test.  Then midway through the technician asked if I wanted to terminate the testing, or continue with a CPAP vs. the BIPAP titration.  I chose to continue with the BIPAP titration.

What happened during the initial BIPAP titration made no sense to me and the technician didn't seem to have a good explanation either.

[mperry99]

Hi OpalRose,

I posted the sleep studies you requested.

Will you be able to give me any insight on what is going on?

Thanks.

[gainerfull]

Do you happen to have the pressure / titration chart from the sleep lab titration? It will show a list of pressures tried as well as the sleep events recorded at the pressure.

My hunch is you'd be better suited using a tighter range of pressure or ideally switching to the constant pressure setting (CPAP) starting at 10cmH20 (without seeing the chart I mentioned). Once we find the minimum pressure you need to keep obstructive events at bay we can add EPR (expiratory pressure relief) on top to tame those flow limits should you continue to have bad quality sleep.

[mperry99]

Thanks for taking a look.

I don't have that titration data unfortunately.

But, I'll try your suggestion and see what happens.