[Pressure] New xPAP user - Question about Centrals on OSCAR

[AeroM]

Here is a 10 minute standard view from last night with a fair number of CAs and one hypopnea, let me know if there is a different 10 minute period that would provide better info:

   

Link to titration summary table with corresponding AHI from the CPAP Titration sleep study if that helps:

     

Link to side-by-side of the Graphs from my two sleep studies:

https://photos.app.goo.gl/3geYX4hR41pYZzx19

Crop-redacted link to my first sleep study (with graphs):
https://photos.app.goo.gl/d9k7nr14oDYhnLoS9

Similar link to the CPAP titration sleep study:
https://photos.app.goo.gl/7njcFdAy5PtwfRA99

I noticed one point where I was hitting ~50 respirations per minute last night. Any idea how accurate the ResMed respirations/minute data is? Looks like I was running in my sleep...

Thanks!

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The emergence of PLM in your titration study (after not being reported in your baseline study) is interesting. It may be that they did not score leg movements during Hypopnea events - perhaps using AASM scoring guidelines where leg movements just before, during, and just after a respiratory event are not counted.

It may be that you have underlying PLM. While an ASV will probably get your breathing in order it may not help you feel any better if PLM is still causing arousals.

 
I saw that, anyone here have experience with PLM?

[Gideon]

The breathing in that segment is awake breathing, sleep breathing is very smooth and regular, this is irregular and quite sharp changes.
I'm willing to bet that if you look at the detail you will see a different story. Look at ho often the breathing crosses the zero line on the flow rate chart. I can see a lot of that in the zoomed view above, but the view isn't close enough for the count, You can also see that the breathing rate minus all the bouncing is normal.

[sheepless]

could be awake breathing but more likely to be plm breathing, given the pattern, and particularly since there were 108 limb movement events in the titration study.

[AeroM]

As you requested, here's a 1 minute zoomed in view of several of the CA's from the earlier 10 minute view screenshot:

     

What are we looking at?

I will try a pressure of 7 tonight per your recommendation, Gideon.

[AeroM]

This is the result after changing to a pressure of 7. Any suggestions?

   

[Gideon]

Going from 9 fixed to 7 fixed appears to cut your CAI in half. Still too high.
Which feels better? the 7 or the 9?

Because Centrals are frequently consistently inconsistent I'd like to see another night or two to see if this difference holds up.

IMHO this builds your case for needing an ASV.

Keep a log of your symptoms to recite to your doctor, and tell him that the Reduced numbers are unacceptable.

This does IMHO confirm that a substantial number, not all, of your CA events are treatment-emergent. Note that ASV doesn't care about the cause.

After a few days, since the pressure reduction seems to be successful, I'd like you to try a fixed pressure of 6. This may be too low for your comfort, my personal lower limit is 10 for comfort. The goal is to make you more comfortable while you are fighting to get ASV which is where I think you will end up.

[SarcasticDave94]

Nothing extra I can add. As mentioned, edit settings to target comfort over treatment, as treating isn't happening with this PAP.

[sheepless]

1. it looks like you've been papping for fewer than 90 days. your psg returned 3 ca and 53 h of unknown type. the fact that you had a few ca in your psg suggests you might be prone to them but 3 ca isn't significant in number. at titration you had 3 oa, 3 h and 55 ca. the fact that apap reduced h suggests they were obstructive. the fact that titration produced 55 ca suggests they're treatment emergent / pressure induced. otoh, the presence and degree of ca is inconsistent from night to night so it isn't certain that the ca will abate in time. however, that's why you'll likely be expected to stick with the apap to see if that happens. hence, while fine to build a case for asv, in my mind it's much too early to conclude you need it.

2. during your psg you had 0 plm and 14 lm events. at titration you had 48 plm and 108 lm events. like ca, plm is inconsistent, so not having any during your psg isn't entirely determinative. while my own experience is that plm causes some sleep disordered breathing, some think that sleep disordered breathing can cause leg movements. if so, it may be that this activity is also treatment emergent / pressure induced. I'm inclined to doubt it but it's possible they'll subside in time as well. again, what you see after 90 days will be instructive.

meanwhile, keep in the back of your mind that IF you suffer plm, pap of any stripe, including asv, won't help and may in fact increase plm arousals. while you're waiting out the 90 days and building your case for asv, I encourage you to talk to your doctor about treatment for plm. it usually requires trial and error to find what works for each individual.

in addition, you could video yourself to confirm or rule out plm and to see the extent that movement may be associated with your (ca) events

[AeroM]

Thanks for taking the time to look at all those charts and tables and give suggestions guys, I really appreciate it. What you’ve said makes sense. I will continue to experiment with comfort while I build a case for potential ASV. Hopefully I will acclimate to cpap, and the centrals will reduce over the next 90 days. I will also keep the plm in mind and discuss with my doc when I see him.

[sheepless]

my experience is that docs are resistant to dealing with rls/plm issues and one has to be insistent to overcome that. take your titration results with you to 'prove' at least the possibility of plm in support of your request for treatment.