Thoughts and recommendations? High CA?

[JonathanBravo]

Hi all. I've just started CPAP therapy and I was wondering if I could get some recommendations or general comments about my OSCAR data? It seems that I don't have many obstructive events, but a lot of clear airway events (central sleep apnea?). It's been a few weeks now and some days I wake up feeling more refreshed than normal, but most days I wake up and I feel like I had a stroke in my sleep and far worse than before therapy. Last night I had really bad nightmares all night, and my doctor told me that my frequent nightmares could be due to the apnea.

I was diagnosed used an at home study with a pAHI of 17.4, but I haven't had a study since. I've tried a couple masks and most recently set on the P30i with a chin strap, but I was using the F30 before and that was OK. The F20 was awful for me.

   

   

Thank you

[PeaceLoveAndPizza]

Where do you see high CA’s? In the posted chart I only see a few, which likely are treatment emergent.

I would bump up you max pressure a wee bit though to help with the obstructive and hypopnoea events. Try raising it to 11.

Mode APAP
Min pressure 9
Max pressure 11
EPR 2 full-time
No ramp

If you keep getting some OA and H events, you may need to bump up the max a bit more, maybe to 12. Let’s see how this works first though.

[SarcasticDave94]

I saw a bit of CA, but were averaging 2.21 and 2.31 AHI-C per chart attached. That's within the under 5 AHI treated, below half that threshold actually. Just trying to help you get the proper perspective with this.

Were there a lot of CA on your sleep study? Do you have the detailed results from that test to post?

Try the settings suggested and let's see what can be dug out with it.

[JonathanBravo]

Hi PeaceLoveAndPizza, thank you for replying! As SarcasticDave says, there were about 14 CA events a night and I was worried that this was a lot, but you have both indicated that it isn't a particularly high number. I think my biggest worry was that I don't seem to have any/many obstructive events, but I have a bunch of CAs and maybe I have central apnea rather than obstructive.

I'm honestly struggling a lot with my CPAP right now. It's been about 2 months and I feel far worse now than I did before I started. Before I started I would just feel really groggy in the morning for an hour, but i've now reached the point where i'm groggy all day and i'm getting really forgetful. I'm only 37!

I started 2 months ago with the P20 nasal pillows but I stopped because I kept opening my mouth in my sleep. I switched to the F30i mask and that wasn't great, but it didn't matter if I opened my mouth. I would wake up a lot and I couldn't sleep on my stomach as normal, but sometimes it wasn't awful. I would drool in my sleep and it would get in the mask seal and wake me up.

My sleep nurse told me to get the P20i so I could sleep on my stomach, and my original post was my first night with that mask but it's made me feel awful now. I feel like i've been punched in the head in my sleep, i'm so dazed and confused all day. Headaches and nausea. I don't feel like i'm getting nearly as much pressure as I did with the F30i. But at the same time, when I turn up the pressure I get chipmonk mouth. I've started taping my mouth shut, but I drool through my lips in my sleep and it's really uncomfortable.

Should I change the settings and keep trying with the P20i? Or should I go back to the F30i which seemed to be on the right track, and just try to fix that? It would be nice to go back to sleeping on my stomach with the P20i, but I can settle with side sleeping with the F30i if I have to.

Is it better to have EPR on or off? The high pressure doesn't bother me until I do chipmonk mouth and I thought that having it off would help force air down my airway and help the treatment.

I don't know what to do. My thoughts are that sub-optimal treatment is worse than no-treatment or treatment that makes it worse.  Maybe I should go back to the F30i, put EPR back up to 3, use a CPAP setting of just 8 for a while. I was doing that before and I had around 3 events per hour, and I felt better than I do now (but still worse than no CPAP).

Sorry for the ramble. I'm just really struggling with this and my sleep doctor/nurse is not helping at all. I've attached the original report.

[JonathanBravo]

Sorry for the double post. I'm adding the last 2 nights of data and also the overview. 2 nights ago (240615) I had the mask on all night. Last night (240616) I had to take it off halfway through the night.

[JonathanBravo]

Hi all, i'm sorry for the rambling posts, i'll try to keep it short.

Sunday night (16th June) I used my new P20i mask and I had a horrible night sleep with chip monk cheeks and drooling, despite mouth tape and a chin strap. I felt so bad on Monday. AHI 6.16 mostly of hypopneas. 8-10 cm with EPR of 1.

Monday night (17th June) I moved back to the F40 mask and settings, and I slept much better the next morning. AHI 1.67. 8-11 cm with EPR of 3. Mostly mild CAs and few OAs. The next day I saw on the chart from the night that occasionally I hit the max pressure, so I bumped it up to 12 for the next night.

Tuesday night (18th June) I felt like I slept OK and didn't wake up too much, but I felt awful the next morning. I checked OSCAR and I have AHI of 4.01. I didn't really need to increase the pressure as I only hit 11.2 pressure for a few seconds once or twice. There is also a lot more OAs, including a 30 second one! I thought the CPAP should have responded much faster but the apnea lasted until the CPAP finally ramped up after the 30 seconds.

I'm not sure what is wrong and what to do next. I've attached the last 3 nights OSCAR reports - 16th with new mask and poor sleep, 17th with old mask and settings with great sleep, 18th with old mask and settings and poor sleep. Some of the logs are clipped to show actually bedtime - so removed a daytime nap, or time I had to take the mask off 5 minutes after putting it on so I could do something.

Does anyone have any tips or advice? Thank you.

[SarcasticDave94]

June 16th wasn't a good night, with EPR as Ramp only reducing Hypopnea treatment, and with no Ramp active this effectively killed your EPR. The 17th and 18th with EPR did look better in the therapy of Obstructive and Hypopnea, especially the 17th with even CA being low.

Those CA are treatment emergent and you'll need to be patient until you body gets used to CPAP therapy, which will reduce CA events. All CA will have the following attribute, consistently inconsistent, meaning up or down randomly without reason.

I will suggest not editing the settings to accommodate CA, because frankly you might never be able to do much to affect CA with any machine that's not ASV the specific machine for CA, which would not be one you'll need. You cannot treat CA with anything other than ASV, again not what your therapy needs. This AutoSet is capable of the therapy your needs require. It will take time to see some of the good benefits unfortunately.

[JonathanBravo]

Thank you Dave, I appreciate it. Message received - i'll stop messing around and let myself adjust to the therapy.

My OAs sharply increased last night, especially that large (for me) 30s OA. Are day-to-day large variations in OAs and overall CPAP therapy normal? Is this also likely to settle over time?

Thank you!

[SarcasticDave94]

I would think anything might be possible for variations of therapy. What might not be the best to see would be wildly variable extremes.

On the pressures edits, you can always do small edits of .2, .4, .6, .8 instead of whole numbers steps if it'll help dial things in.