Requesting help with Clear Airway issues

[genasea]

Hello and thank you for looking at this. I sincerely appreciate the sense of community this forum provides.
I am not able to get much, if any, help from doctors on this aspect.

I was recently diagnosed with OA after me being reticent to having a sleep study done and suffering from the lack of sleep for about 3 years now. The sleep study says I have a AHI of 25 (this study was conducted with a WatchPAT One with no mouth tape on). Due to a upper spine injury many years ago, I can only sleep on my back literally 100% of the time. No other sleep position is possible. 

The sleep study states that I have no Central Sleep Apnea, and recommends an APAP machine. As such, I purchased a Airsense 11 machine, and have been wearing it for 2 weeks straight.

I have tried a few different pressures and settings, and have settled on 13 being a reasonable number to significantly reduce the OA and H levels. However, when I am going to sleep, I have a significant amount of CA being reported. It appears, based upon the sleep study, this is likely being induced by the machine.

I have tried a EPR of 3 on full time, as this is the setting I feel the most comfort with for getting asleep, and staying asleep. I also tried turning EPR off, and still have the CA's (and much worse sleeping during the night).

I have not displayed the 'Pressure' and 'Leak Rate' graphs as the pressure is a constant 13 and there were zero leaks all night.

Please let me know you thoughts and if you need any other information to determine what I can do to attempt to eliminate or reduce these CA's.

Thank you

[genasea]

In looking through many other posts for dealing with such issues, I came across some experienced members that stated if the flow rates were waxing and waning (which I am taking to mean rising at first then gradually tapering off - as in a wedge shape pattern shown on the attached image) this was possibly the result of not enough CO2 in the lungs for the brain to trigger a breathing response. I am a novice at analyzing the data from the CPAP device, so not sure if this is the correct interpretation or not.

Additionally, I posted some excerpts from my recent sleep study in case this would assist in the diagnosis.

Thank you in advance for any insight you may have.

[staceyburke]

You did not have centrals when you were at the sleep lab and started having centrals and so we would think that are treatment emergent - but you have been on cpap for 4 years and treatment emergent should have gone away by now.  So you may need a different machine that is more expensive. Or we could try just an experiment to see if you have positional apnea. 

You are having positional apnea.  You can see positional apnea where either H or Oa events (in your case clustered together) 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.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.

The good thing about this is a collar would cost 20$ and fairly easy to size.  Of course it needs to be big enough to go arounf your neck and the height of the collar is the distance between your chin and you sternum.

[SarcasticDave94]

Another thing to consider, altitude. You list Colorado, what altitude would this be? Higher elevation may increase the possibility of CA.

[Dormeo]

I note that the OP was diagnosed recently and is obliged by a spinal issue to sleep on his back. I also don't see evidence of positional OA or H apnea; there is one place where an OA and and H occur close together, but that's it. The clustered events are CAs.

Genasea, you did have some CAs in your WatchPat sleep test. That's the line that says "pAHIc3%." The CA index was small, though, and I wouldn't place any weight on it.

You may well be seeing some transitional CAs. These occur as your neurochemical systems do a hand-off as you fall asleep or wake up. Waking breathing and sleeping breathing are regulated in the body a little differently, and sometimes the transition has some glitching.

Your zoomed-in views show a pattern of CAs mixed with recovery breathing. The recovery breathing is deeper, and that may be provoking the next CA. This period of unstable breathing may, as I say, be related to sleep-wake transition.

I would just give those CAs some time. It's likely your body will adjust and you'll see fewer and fewer CAs as time goes by. You are seeing some brief drops in your O2 sats during the clusters of CAs, but the total time below 90 isn't enough to worry about.

Meanwhile, don't hesitate to use the EPR of 3. It may slightly contribute to CAs, but your ability to sleep comfortably is more important. You're doing a great job of addressing obstruction in your airway, and your leak rate is a marvel.

[SarcasticDave94]

My mistake, yes that first segment with several CA may be the sleep wake junk (SWJ) effect. Basically the SWJ would be a person bouncing between wake and sleep in the early or late areas of the sleep therapy. It'll confuse your breath control and a really junky chart segment shows up.

Just a possibility.

[genasea]

Hello and thank you to everyone for your time and responses.

To answer a few questions, I live at 5000' - the flat part of Colo :')

I have read the posts regarding the cervical collar and have slept with it on and it made no difference in the CA's. I have the one that is a full wrap around the neck (like for a whiplash injury). I also just ordered the 'ultimate' one based upon the recommendations in this site. It will be here next week so I can try that.

As Dormeo mentioned, I did just begin my treatment and am new to the CPAP. I have been fortunate to wear it every night since it arrived on Dec 12 2024.

I was not aware that pAHIc3% meant CA's - thank you for the clarification.

From the timestamps of the CA events, it does appear that it is occurring when I am falling asleep. And then (for the most part) does not occur again until I begin to wake up in the morning (unless I have interrupted sleep during the night at which I repeat this cycle).

I am willing to give the current CPAP more time and my body more time to adjust if this is likely to resolve itself.

I have been reading about my machine not being a BIPAP, and am curious if a BIPAP (e.g. Aircurve 10 Vauto) is likely to remedy these CA's?

On other threads, I see some pretty smart people discussing EERS, and am also curious if I should attempt to fashion up one of these 'circuits' if that may help with these.

What are your thoughts about these or other aspects I may be missing?

Thank you in advance for your time, it is greatly appreciated.

[SarcasticDave94]

If there's a moderate level of Central Apnea, a bilevel like the ResMed AirCurve 10 or 11 VAuto might be fine. Here you can still only avoid some, with the Trigger setting on High or Very High.

The VAuto is not a device with backup breath rate, such as ASV. This ASV has the backup breath rate controlled by a specific Central Apnea treatment algorithm. This is mostly only used for predominant CA, showing on the sleep study report. The ASV contrasts others in that it actually treats CA not avoids.

[genasea]

Hello Dave,

Thank you for your explanation.

When you say predominant CA, can I presume that that is different than what I am experiencing as shown in the OSCAR reports?

Meaning, would it be beneficial for me to look at an ASV machine? Or is that not something that would be beneficial given my particular CA's?

Thank you again

[Dormeo]

I can chime in here. I think you would need to have a higher CA index before a different machine should be considered (or an EERS device), and I think that's what Dave was saying about an ASV. You just need some time for your body to adjust. The odds are good you're CA index will start going down; it'll be a bit up and down as time goes by, but mostly settling.