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First off, I'm so glad I found this forum - I've learned so many helpful insights over the weekend reviewing other apnea-related posts! Really appreciative that there are so many active helpful participants sharing their knowledge and experience.
I've come to ask for some assistance - both in the OSCAR results I'm getting, but also recommendations for adjustments.
A bit of background. I've had 2 sleep studies, one that was an overnight in a hospital, the other which was a Lofta study. The hospital study resulted in correcting a deviated septum (AHI was ~6), the Lofta study last year resulted in a ResMed Airsense 11 purchase (AHI ~8). Both studies indicated mostly OAs, but there were a few central apneas. Pressure recommendation from Lofta was 4 - 20, but I gave up after a month.
All that said, I'm giving it another go and getting mixed results. Last night, for example, all events were Clear Airway (which is surprising). The AHI scores are low, but I'm still very tired with brain fog. I've been waking up twice each night to use the bathroom. I'm hoping I'm tired just because sleep duration isn't long enough, but I'm also hoping these aren't really CAs but something else? Also, I use mouth tape, an intake nasal dilator, and mostly sleep on my side (I think).
I've attached two zoomed out screenshots and one zoomed in on CAs from last night. Of note, last night I adjust my min pressure to 7 with EPR to 2. The previous were min 4, EPR 3.
Any advice or recommendations? Thanks in advance for anyone that can provide insights on how to improve!
Thanks for your response! Regarding medications, 10mg of enalapril in the morning for high blood pressure. I also take a beta-blocker as needed for infrequent bouts of SVT (1 per ~2 months).
Sleep study results in the screenshots below. The first is a brief summary from 2018 - the study occurred in a sleep center in an academic hospital. The second is from Lofta in 2023.
I will increase the max pressure to 15 as recommended and maintain 7 as the minimum. EPR is set to 2.
Nothing significant in the sleep studies as they indicate you have a mild case of SDB. I see what I would call RERA’s in the OSCAR charts with the arousal breaths, but there may be other factors causing that.
Give the suggested settings a go and let us see how it plays out.
Following up about 10 days later with an update and additional questions. First off, as recommended, I adjusted my settings to:
Mode APAP
Min pressure 7
Max pressure 15
EPR 2 full-time
No ramp
Unfortunately last week was about as bad as it gets sleep-wise for me - exhausted during the day, headaches, etc. - but I was also prone to taking off my mask in the middle of the night (still quite new to PAP therapy). That said, the past two nights have been my best nights of sleep in months. I tightened the fit of my mask's head straps, which seemed to help a lot. Also made the following adjustments:
Min pressure 7.6
Max pressure 12
EPR 1 full-time
My question is about the many 'clear airways' I experienced last night. Is it possible that these aren't really CA events, but just body position shifts where leakage occurs and I'm holding my breath while I get re-situated? Several of the CAs seem to follow right after a small spike in leak rate.
Any idea what might be going on?
*Note that I was awake during the big cluster of CAs around 3:45am, so not relevant
While your leak rate isn't bad, if as you say, leaks occur with movement, then the mask seal is less stable than it appears. It should tolerate a bit of moving about. Are you using any type of hose holder?
The Central Apnea flags can certainly be just simple breath holds while moving. You just had 4 Central Apnea on your test under pAHIc 4%, so these CA flags are either breath holds, treatment emergent Central Apnea, or a combo of both.
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Hi there, I appreciate your comment. I'm not entirely sure if my leak rate is good or bad, though I noticed there are leak spikes right before the machine picks up a CA event. My hypothesis is that the leak spike is a result of a positional change, but it's not something I can't confirm. In the event that the CAs are treatment emergent or legit central apneas, are there recommended settings to adjust (e.g. EPR)?
Regarding equipment, I use a ResMed N30i nasal cradle mask, though I also have a tube holder mounted on the wall to minimize tube disturbances.
I wouldn't worry about the CAs if I were you. The zoomed-in views show that you experienced arousal breathing before those CAs. Arousal breathing is deeper and messier-looking than regular asleep breathing. Often there's no way to know what causes arousals.
There are two theories about arousal breathing and CAs. One is that the deeper breathing slightly depletes the CO2 in your blood, which causes you to pause between breaths a little longer than usual while CO2 builds up to the level that will trigger a breath. The other theory is that sensors in your chest wall detect a larger-than-normal expansion of your rib cage and trigger a pause to get you back on track.
Either way, CAs can sometimes come in clusters, as deeper recovery breathing after a CA sets off a new one.
Bottom line: as the arousals become less frequent, so will the CAs. And for many people, the body adjusts its mechanisms over time, making it less likely you'll have CAs after arousals.
