[Pressure] Need Advice On What Settings to Adjust Resmed Airsense 10

[Stoaty]

I am a 66 year old male, BMI 24 diagnosed with sleep apnea 3 years ago.  Home test from Kaiser gave AHI - 2 when sleeping on left side, AHI - 16 when sleeping on right side and AHI - 56 when sleeping on my back.  Average was 6.7 for the night.  Got Resmed Airsense 10 Autoset and found settings that worked well for me with help from Sleepyhead and internet forum (auto was terrible):

Max pressure - 5.6
Min pressure - 4.6
EPR - 1

With these setting I got average AHI of 2.5 over a 6 month period.  Didn't take machine on a vacation, felt fine, stopped using machine.  Did well for several years, then 2 months ago developed episodic vertigo that was eventually diagnosed by ENT as vestibular migraine.  I also was having sleep problems and feeling tired during the day with mild headache between migraine symptoms.  

Two days ago I realized that sleep apnea might be the cause of symptoms and trigger for migraines.  Started using Resmed again with same settings that had worked before.  The first night I had AHI of 5.5, virtually all central.  Felt quite a bit better the next day with headache decreased about 30% and fatigue decreased 60%.  Second night I lowered max pressure to 5.4 and got AHI of 10.5, virtually all central, with significant episode of Cheyenne Stokes breathing in the second half of the night.

Weight is about the same as was 3 years ago, maybe 5 pounds lighter.  I am puzzled by the results.  Recommendations for adjustments to make?  Thanks.

   

[Ratchick]

Hi and welcome!

Is this chart normal for you?

I ask because CPAP isn't going to fix those centrals you have going on. And for the record, yes - my central sleep apnea is HORRIBLE for my migraines. This is part of why I stay on CPAP even while it's only partly reducing my AHI until my doctor gets into gear and gets me on ASV.

Do you have your original sleep study? I'd like to see the breakdown of those events in the different positions. I thought at first I'd see lots of signs of positional apnea, but now I'm more interested in if those centrals are treatment-emergent or you have incorrectly treated/diagnosed mixed/central/complex sleep apnea, not just OSA.

[Stoaty]

No, this is not a normal chart for me.  I don't have access to the original study, just what I was told by Kaiser.  For the first 6 months I had very good results with AHI - 2.5.  I went off CPAP after about 6 months except for a few weeks a year ago.  Just started back 2 days ago.  Now I am getting almost purely central events even on the low pressure levels I have set.  Here is a typical chart from a year ago.  

   

[Ratchick]

OK so your entire AHI was central back then too, albeit low enough that it could be either Sleep-Wake Junk or just the normal odd central that most people get. The problem is that, because you've been off CPAP for a long time now, I would imagine that your body has adjusted to being without it again, and so you're seeing now at least some treatment-emergent central events because the improved respiration is blowing off more carbon dioxide (and the rising carbon dioxide level is what prompts most people to breathe, not the lowered oxygen level). This can improve over the first few days or weeks, up to around two months, but really we'd need to look at the data close up. But we may need to alter some of the settings to reduce them, depending.

Can you zoom in and show maybe a 1-hour, 10-minute and 2-minute segment of the centrals? That will help us to see what's going on there.

Also, if possible, can you contact your doctor to get your original sleep study? You are legally entitled to have it, and it would definitely help us to know for sure what was seen at diagnosis too.

[SarcasticDave94]

On the sleep study, tell them HIPAA law permits you to request and receive it. No isn't an acceptable answer.
My guess, and that's all it is right now, you're probably diagnosed as Obstructive despite higher Central counts. Typical of all these Dr. Ducks in sleep medicine. Partially due to insurance regulations, but they get it wrong almost 100%. Throw in Central or mixed Apnea, and getting it right is even worse of a chance.

I'm going on a limb and say CA were maybe pre-existing condition and that's why you've got an odd low pressure setup.

PS let's turn your EPR Off for a night. See if it works for you, getting this better off.

[Stoaty]

I have requested Kaiser to release sleep apnea test report to me.  Also turned off EPR.  I am wondering what I should try in terms of pressure setting.  Seems to me that if I am not having any significant obstructive events that I would want to decrease the maximum pressure in case this is treatment emergent central sleep apnea.  I have attached zoomed sections of flow rate.  The top half was for the Cheyenne Stokes portion, the bottom half for straight clear airway.  I didn't have room to add additional graphs besides flow rate.

   

[Geer1]

You are already as low as you can go for pressure (4 is minimum) and EPR was also minimal (1.4 max) because of low max pressure.

Your data from a year ago shows a periodic nature as well. When you say back then you realized you had to use lower pressures was this because you had a high number of central apnea if you didn't?

[SarcasticDave94]

It's probably a good idea to show a default Daily shot of OSCAR with the left panel and the following charts: Events, flow rate, pressure, leak, floor limit.

[Ratchick]

I'm gonna take a guess that this is either treatment-emergent or treatment-exacerbated of an underlying tendency to central events. Once you get the full sleep study, we can take a look and see if you were correctly diagnosed with OSA or whether there was also a central component to your apnea too.

@SarcasticDave - that chart is in the first post, I believe?

[Stoaty]

Follow-up:  Turned off EPR and set both min and max pressure to 5.6.  Had 3 sessions last night about 2 hours each (getting up to take a leak).

Session Results:

First: AHI - 0
Second: AHI - 0
Third: AHI 10.2 (virtually all central, no Cheyenne Stokes)

Total for night: AHI - 3.05 virtually all central

Key difference from previous night was median inspiration/expiration times:

Night 1 - 2.50/2.00
Night 2 - 2.32/2.32

I feel the best I have in about 2 months.  Plan to keep these settings for a couple of weeks and see how things go.

Thanks to all who replied.