New to CPAP - First Night Great, Second Night not so much

[oasised]

Hi Guys,

I was recently diagnosed with OSA - with an AHI of 40 or so during the sleep study. I just got my AirSense 10 on Friday last. First night started off a bit meh, with the Ramp feature limiting the pressure in the mask and making it hard for me to relax. After 45 minutes or so I could feel the air starting to flow more and fell asleep. Despite the Nasal Mask being a little to tight on one side, I woke up amazed at how I felt - was this what I've been missing all this time? AHI was around 1.8 - a great improvement in my inexperienced opinion.

I had read through the forum (what a fantastic resource by the way!) and see a lot of people recommend to turn off the ramp feature - turned it off and did a little test and it felt so much better! I was excited to go asleep last night.

Waking up this morning couldn't have been further away from what I felt after the first night. I'm tired, I have a headache and when I checked my AirSense it said I had an AHI score of 18! This included some central apneas which is something I wasn't expecting at all. 

I've attached the OSCAR reports for both nights, what do you guys think? Is there anything I should change?

[Sleeprider]

That isn't just "some" CA, that's a whole bunch. Looking at your first night, I would have suggested increasing EPR and trying to reduce the flow limitation that drove pressure, but the abundant CA on the second night makes that problematic. Did your sleep study identify any CA events?

[oasised]

Hi Sleeprider,

Thanks for the reply. No my sleep study showed no CA at all. The doctor was very confident an APAP would take care of the OSA and I'd be good to go. I just had an hour nap there, I reduced the humidity to 2 as last night was my first night using the humidifier(set at 4) and I felt the air wasn't as fresh as it was on the first night if that makes sense. No AHI at all, but obviously a very short sample time.

Is it possible to something else could be flagging as a central apnea? If it where CA what is the approach to handling them?

[Sleeprider]

If it turns out to be a one off event then nothing to worry at. If it happens again we can look at some closeups and see how the events occur to see if that gives us anything useful to work from.

[SarcasticDave94]

Hi oasised, and welcome to Apnea Board. A nasty bit of purple lines there. CA are consistently inconsistent as we see where one day makes a big difference. I'm sure Sleeprider has it covered, but I figured I'd pop in while on coffee break and say hi. Let's see what tomorrow brings us.

[Gideon]

Welcome to the forum

One thin no one should do is chase events that only occur once so I agree on seeing if you do get another night similar to your second.

Please post a redacted copy of your full sleep study. All to often we see centrals called out when none are stated. For Example Mixed and Complex Apnea are Centrals. We have seen studies with a very high AHI classified as OSA with only 1 single event being obstructive with the remainder being Central. Not saying your is that way, but better to see and be sure. Post a 2-minute and a 15-minute zoomed image of the central cluster. With the 15-minut one catch a little bit at the start. That will let us see the character of your centrals.

[oasised]

Hi Guys,

Thanks for the replies - I'm amazed at how much of a resource this place is. I've requested a copy of my Sleep Study but could be a couple of weeks because the Centre is closed for vacation (I'm in Germany, it's common for businesses to shut up for two weeks in the summer!). 

Last night was much better, AHI of 1.66 - felt great waking up this morning - but still a few CA events. I've attached last nights OSCAR read out and a zoomed in version from the other night with all the CA's.

Has anyone any thoughts?

[Gideon]

Why did the CSR start on 18 July, and yes that IS a CSR pattern. What happened just before the patterned started. We likely would want to see in a 2-minute zoomed image but you should ALWAYS post your full night because in the worst case it tells us nothing.
Do you have any heart conditions? Breathing issues other than Apnea? CHF? This is significant enough that your cardiac, pulmonary, sleep, and GP should be aware of it.
You didn't have it on 19 July last night and that's good. Have you had any other incidents of CA clusters that may happen to also be CSR? Fill us in.

Also a two minute view so we can fully see the nature of ths periodic breathing/CSR.

[oasised]

Hi Bonjour,

I only got my Machine on Friday last, so I'm pretty new to all of this. I keep having to Google some of the Acronyms used here, and this sounds quite scary as I'm only 34. I have paroxsymal Afib - we've figured out it's only ever triggered on me from waking up from a Sleep Apnea event, hence the Sleep study and now this. Apart from that I've slightly high blood pressure . I'm taking propafenone and Verapmil to control both of them and working to lose weight. I've reposted the whole night from the 18th of July below and a two minute zoomed in version of just before the first big cluster of CA events and the first 2 minutes of the the cluster itself. Like I said this all new to me - how does this look to you?

[Gideon]

There is a group starting at 4:09:20 and another at 4:09:50 both of which show some central characteristics, slight waxing and waning. Flat tops or slanted tops on the individual breaths indicate flow limited breathing. You have some flow limits of most of your breathing.
In the groups startting at 4:46:00 again you have slight waxing and wanning, see the smaller heights on the curve at the start and ends of the groups of breaths, this and the CA event between the groups says Central influenced. I doubt a doctor would call this CSR and in typical CSR the ends would be much smaller. Without doubt it is Periodic breathing. I would note to your doctors that you have periodic breathing with Central Apneas and it may be marginally CSR. CSR is identified with being associated with CHF which I doubt you have but it warrents being checked out especially since you have AFIB.

Also study the breathing cycle and how CO2 plays a part. When I say Central Characteristics I mean CO2 influenced because your CPAP has increased the efficiency of your breathing ans is tending to wash out CO2 from your blood to near and below your Apneic threshold where your body will not signal to breathe until the CO2 is above the Apneic threshold causing the waxing and waning with CA events between.