New user with high CA

[TomJim]

Greetings, I'm so glad to have found this forum and OSCAR!

First, some background:

I'm a long-time sufferer of Chronic Fatigue Syndrome (now called Myalgic Encephalomyelitis). I grew up in and have spent a lot of in moldy/water-damaged buildings, having grown up in eastern NC with it's high humidity, frequent thunderstorms, and hurricanes.

In 2019, I learned about Chronic Inflammatory Response Syndrome (CIRS), a.k.a. mold exposure or biotoxin illness. Genetic testing revealed that I had the genes that made me susceptible to the condition, and I was living in an apartment that had been flooded before, so I began taking steps toward removing myself from exposure and getting treatment for that condition, and experienced some improvements.

I got my CDL in 2020 so I could go back to work without needing to work in office buildings of questionable air quality. I've been able to work as a truck driver on and off since then. I'm preparing to return to work now with my previous employer, Schneider National. During my previous bout of employment with Schneider, they had me answer a health risk questionnaire (a standard for all employees). Because of my answers to the questionnaire, they required me to do a sleep study to rule out sleep apnea. I was certain that my fatigue/sleepiness issues were due to CIRS and the fact that they had assigned me a truck that had been smoked in by a previous driver -- smoking produces quite a lot of endotoxin, which is something that can cause or exacerbate CIRS -- so I quit in frustration.

I decided to go back to work for Schneider a few months ago, but the sleep study was still required before I could return to work, so I reluctantly went forward with it, and it appeared that I did have OSA. A second study confirmed the diagnosis.

I've been using my CPAP with a few weeks now, and notice that I have a fairly high proportion of CA to OA events. CIRS causes neuroinflammation, so that is probably a contributing factor. Regardless, what can I do with my machine to correct for this? See attached image.

Thanks in advance!

[TomJim]

Oops, image didn't stick on my OP. Here it is.

[Narcil]

Please post your sleep study data if you have it. did it include CAs?

And please read the wiki on how to format charts, we need to see the daily view with 5 graphs.

[TomJim]

As far as I can tell, neither study differentiated between types apneas. Both study images are attached to this reply.

[TomJim]

Daily view in required format.

[staceyburke]

You do have some central apnea and someone else will address that but some of those centrals could be positional apnea, at any rate 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.

[Jay51]

Great suggestion by Stacey about a collar, or pillow change, or sleeping position change and positional apnea.  

Concerning Central Apneas (CA's), in a nutshell, usually decreasing pressure helps combat them (BUT, you have to balance that against obstructive apneas, etc. - your pressure needs to be high enough to stop OA's, but not too high to cause CA's.  It takes some experimenting.  EPR can sometimes aggravate CA's also and increase them.  It might take turning down EPR or even turning it off.  

Hopefully you can find your sweet spot to achieve this balance.  If not, there are more advanced machines with a back up rate (they force a breathe to stop CA's).  This is an option in the future if your CA's don't decrease now.  

Also, when a person 1st starts therapy, CA's can increase in what is called treatment emergent central apneas.  They usually go away withing a few weeks or so.  If not, more tweaks to pressure will be needed; and possibly a different type of machine.

[TomJim]

Stacey:
I almost always fall asleep on my side and wake up mostly or fully on my back. I definitely have worse OA lying on my back. I tried wearing a makeshift side-sleeping trainer but it didn't really work. Oddly, my airway seems to be more restricted lying flat on my back than it does with a thick pillow that makes my chin tuck; if that's true, I don't think the collar would help. Perhaps I should invest in a real side-sleeping trainer instead of jury-rigging one?

Jay:
I have decreased minimum pressure to 4 which is the minimum setting for my machine. When I first started on April 16, I was woken up several times by the feeling of not being able to exhale because of the pressure being too high (each time the pressure was >12).  I used the CPAP for four days, then quit because of that suffocating sensation. I resumed on May 1, reduced max pressure from 15 to 10, and I'm now at 76% compliance for the past 30 days, so that's about three weeks. Am I still in the window for treatment-induced CA?

At any rate, I thought EPR would help alleviate that suffocating problem, but perhaps not if my max pressure setting was low enough? I'll turn off EPR and see how it goes tonight.

[SarcasticDave94]

There were a handful of 4 CA within the test results under the pAHIc 3% line of image 3 with a chart.

You're best off with more than 4 cmH2O pressure as minimum. You'll want to minimize the range a bit on that pressure, however you'll still be too prioritize Obstructive based events therapy settings.

If any Ramp was involved it should be turned off if at all possible. Minimum of you can't go without. EPR 1 or 2 might be ok.

The suffocating sensation is not having enough air pressure.

Side note, I used to drive regional, last was Ward Truck Altoona, PA. Total years with several companies was 11. Bad back said get out of the truck.

Good luck to ya.

[TomJim]

Here are Sunday and Monday night's daily graphs. Honestly I'm not sure how useful they'll be. I tried out a new mattress encasement for the last two nights, which was supposed to be breathable but definitely was not, so I woke up very hot several times on both nights.

On Sunday night, I wore my side sleeping trainer, and my API was better than usual that night. I didn't feel well after either night, though.

Device Settings
Mode:APAP
Pressure Min:4.00 cmH2O
Pressure Max:10.00 cmH2O
Antibacterial Filter:No
Climate Control:Auto
EPR: Off
Humidifier Status: On
Humidity Level: 7
Mask: Pillows
Patient View: Off
Ramp: Off
Response: Standard
Smart Start: On
Temperature: 29 ºC
Temperature Enable: On

Dave: Thanks for the well wishes!