New CPAP User, possibly Complex Apnea?

[henrynguyen5]

Hey All,

I've been using Airsense 11 for around 2 weeks now, with no real sense of improvement. I'm still waking up very tired and being exhausted throughout the entire day despite my AHI dropping significantly. I've settled on the Dreamwear Nasal Pillows + chin strap which is very comfortable for me. What worries me is that my sleep study is split between Mixed and Obstructive apnea's, and I'm wondering if my CPAP is failing to treat those. From what I've read, it seems like I'll need an ASV. I don't mind paying out of pocket for whatever is needed as long as I can get it ASAP.

Tonight I'll be disabling EPR to see if the centrals get reduced as I've read the CA avoidance plan just a few days ago. Attached is my redacted sleep study and the last two days of treatment.


Kind regards,
Henry

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Here's my sleep study report, since it wont fit in OP.

[sheepless]

with ahi under 2 you aren't likely to get much help from the system and even less likely to score an asv. of course you can buy one from a private party and it might result in ahi less than 2 but I doubt the difference will be very noticeable.

you had a bundle of respiratory related arousals in your sleep study. you might look into uars (upper airway resistance syndrome). with apap, epr helps (bilevel pressure support is better) but your central apnea might go up. you're having a few more ca than in your study. that might have been a better night for ca which is notorious for being inconsistent; otoh, it suggests they're pressure induced/treatment emergent. they don't seem to line up with higher pressure so some of that may be treatment induced which typically abates in 30-90 days. providers almost always want you to wait that out.

[henrynguyen5]

I’ve had EPR set to 2 last night, had it set to 3 for the week prior, I could revert back to 3 and give it some time to see if it gets any better.

And yeah, my RDI is much higher than my AHI, I’m guessing I’m waking up over and over again. I typically remember waking up 4-7 times a night for no particular reason, then falling asleep almost immediately after. This occurs primarily when I’m dreaming.

Even though my AHI is under two I’m still very tired from the moment I wake up, to the point where its really affecting my mood, memory, and ability to work.

[staceyburke]

Welcome to the board. There are many knowledgeable people here that can help. 

I don’t see that you have many centrals. In fact the only real time you had numerous events was while sleeping on you back. That is what I would try to stop. 

I don’t think a different type of pap machine will make a difference. Many people have treatment emergents centrals. You do not have that many and I think many will go away after a few weeks.

[Sleeprider]

I don't see your centrals as a significant issue, and lowering your EPR will increase flow limitations, which I think are a bigger problem for arousal. Flagged centrals are fairly common when starting CPAP and the improved ventilation of EPR for the first time, but many of these events are just artifacts of arousals or moving in your sleep. Your results are excellent based on the Oscar charts, and the average central apnea index is still under 1/hour. Central apnea did not present as an issue in your sleep study, so I think it is reasonable to expect these events will eventually diminish to very low levels. Your AHI has diminished with increased pressure, and that is the direction you should pursue.

Your most recent settings of 8.0-11.0 with EPR 2 look very promising, and my suggestion would be to stay with those settings for another night or two.

[henrynguyen5]

Thanks so much for the help everyone! I may be overreacting, it is hard not to when you are very tired Thank you for the reassurance, it is really appreciated!

staceyburke: I find that I cant fall asleep on my side, but I just stumbled upon the sleeping falcon position.
Ill try out this sleeping position and see if its any better.

Sleeprider: There’s no centrals in my sleep study, but there are mixed apneas instead. Is that not a central + obstructive at the same time? Should I keep EPR at 2 or increase to 3? I do find that EPR 3 is very comfortable.

[SarcasticDave94]

According to:
https://www.medscape.com/answers/295807-...le%20arrow).

Mixed Apnea start as a Central end as an Obstructive.

Sample image from the article...

[attachment=38786]

Handle EPR as will give you best comfort. Stay off the Ramp as well, to avoid extra CA by the variables Ramp introduces.

[henrynguyen5]

Okay, ill either keep EPR 2 or 3 and use those settings and see if my sleep gets better!

[Ratchick]

I think a lot of people used "mixed" apnea two ways - to either describe (as Dave says) when an event starts off central and ends obstructive, but also to describe "complex" sleep apnea, where there is a split between pure central apneas and pure obstructive apneas, treatment-emergent central apnea or apnea occurring with other disorders like COPD etc.

[henrynguyen5]

Today's OSCAR results attached. I think I'm waking up whenever I go into REM, two things happen:
1. The elasticity of the chin strap is weaker because I enter REM later into the night, so its not holding my jaw up as much, I'm using a phillips respironics chin strap.
2. I sleep talk in REM

The combination of the above causes me to break the seal in my mouth, then the resulting leak makes me consciously wake up over and over again (7+ times) in 15 min increments. I've ordered a knightsbridge dual strap, hopefully it'll be much better.