Oscar Data. No events flagged but weird flow rate pattern during REM

[Ynot]

Thank you both for your replies

[Ynot]

Has there been any users that have adapted to tecsa?

[Dormeo]

Yes. I, for example, had a CA index that hovered between 2 and 4 for some time. Then it was around 1; recently it's consistently been below .5. It's hard to be sure, but I think some of the change is due to the fact that I'm sleeping with fewer arousals, and some is due to my apneic threshold adjusting over time.

For people seeing CAs after arousals, the arousals are the thing to worry about in most instances. Even then, bear in mind that short arousals throughout the night are normal.

[Sleeprider]

"I'm just wondering, if TECSA is provoked by decreased serum CO2, would forcing a breath with ASV or increased trigger sensitivity further decrease CO2 levels. Is that problematic, or are the CA simply oversensitivity to the ps? "

TECSA is a "sensitivity" to reduced CO2 that affects the autonomic respiratory drive. Improved ventilation reduces retained CO2 in all of us, but we all have an individual threshold at which periodic breathing, hypopnea or central apnea may occur. Some people tolerate surprisingly high pressure support with no adverse effects, and others will have more apnea with relatively little PS or EPR. Trigger sensitivity changes still require spontaneous respiration, and do not convert a bilevel device into a ventilator, nor force a breath. Higher trigger sensitivity only makes the transition to IPAP occur with less spontaneous flow or effort. This earlier or easier transition does not cause a breath, but can stimulate a breath like a reminder. It is a valuable tool, and helps many users have a reduced sensitivity to PS, or at least tolerate it without the suppression of respiratory drive. ASV on the other hand will trigger IPAP with or without spontaneous effort, and it will adaptively increase PS to maintain normal respiratory rate and volume. User response varies considerably, but most ASV users are predominately spontaneous breathers, and the device does not change that.

[Ynot]

Hi sleeprider. 

I came across this idea while reading the optimizing therapy thread in apneawiki which offered a lot of valuable information. I'm just wondering, if TECSA is provoked by decreased serum CO2, would forcing a breath with ASV or increased trigger sensitivity further decrease CO2 levels. Is that problematic, or are the CA simply oversensitivity to the ps?

Nvm ASV seems to be the conventional treatment, and complex sleep apnea = TECSA. I'm probably reading too much into it. I'll try high sensitivity.

[Ynot]

I see, thanks for the explanation.

[SarcasticDave94]

Complex Sleep Apnea doesn't quite equal treatment emergent Central Apnea. Complex Apnea needs specialized therapy and is controlled that way. Complex Apnea is both Central and Obstructive Apnea before CPAP therapy. Treatment emergent CA would become worse with, or is due to, basic CPAP therapy. At least this is my understanding, as there is a big difference in therapy that works rather consistently.

[Fixit50]

"I'm just wondering, if TECSA is provoked by decreased serum CO2, would forcing a breath with ASV or increased trigger sensitivity further decrease CO2 levels. Is that problematic, or are the CA simply oversensitivity to the ps? "

TECSA is a "sensitivity" to reduced CO2 that affects the autonomic respiratory drive.  Improved ventilation reduces retained CO2 in all of us, but we all have an individual threshold at which periodic breathing, hypopnea or central apnea may occur.  Some people tolerate surprisingly high pressure support with no adverse effects, and others will have more apnea with relatively little PS or EPR.  Trigger sensitivity changes still require spontaneous respiration, and do not convert a bilevel device into a ventilator, nor force a breath. Higher trigger sensitivity only makes the transition to IPAP occur with less spontaneous flow or effort.  This earlier or easier transition does not cause a breath, but can stimulate a breath like a reminder.  It is a valuable tool, and helps many users have a reduced sensitivity to PS, or at least tolerate it without the suppression of respiratory drive.  ASV on the other hand will trigger IPAP with or without spontaneous effort, and it will adaptively increase PS to maintain normal respiratory rate and volume.  User response varies considerably, but most ASV users are predominately spontaneous breathers, and the device does not change that.

Thanks for this explanation.  I had been wondering about some of this stuff.

[Ynot]

Hi Dave,

Yeah you're probably right, and that is what i thought too.

However, I saw the following in a study: 

"TECSA refers to a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for OSA such as using PAP therapy.[1] Gilmartin et al[12] first described this phenomenon using the new term “complex sleep-disordered breathing.” Then, Morgenthaler et al[13] termed this type of sleep-disordered breathing “complex sleep apnea syndrome (CompSAS).” The International Classification of Sleep Disorders-third edition introduced the term “TECSA” as a new name for this phenomenon"

Either way, ASV is used as a conventional TECSA treatment, so I doubt that excessively low CO2, which I was uncertain abt, is an issue due to forced or encouraged breaths. 

[Ynot]

Hello everyone, 

This is last night. I slept only 5h because I’m trying to go to sleep earlier and I’m having some insomnia issues in the process (the times in Oscar here are inaccurate).

I increased the pressure to 12.2Ipap, 6.4Epap (5.8ps). I have not tried this pressure before but I knew, because of the other pressures I have tried, that this was going to result in a Central and obstructive “middleground”. Since expelling more CO2 than usual causes or at least contributes to the central issues, I wanted to see if a higher epap would help. 

I also switched the sensitivity to high. 

It looks much better. Breathing wise, this is probably the best night I’ve had so far. As it is often the case, the breathing is perfect outside of rem. During rem, flow limitations are not that prominent, no CAs, and the breathing looks more regular and stable than previous nights. 

I still have the classic central-like waxing and waning bundle pattern during some parts of rem and some flow limitation, but overall, much better. 

I did experience aerophagia, most likely because of the pressure increase. I’ll lower the pressure a bit to see if it improves. 

I think I’ll try tonight a pressure that I have tried before so that I can assess the isolated effect of the trigger sensitivity change. I think I’ll also change the sensitivity to very high since it looks like it helped. I’m thinking: 11ipap, 5.4epap, 5.6ps, which I tried before, and which led to some flow limitations and central events, but relatively not bad and in the “middleground”.