Return to treatment - CA's and Periodic Breathing

[Kev73]

Hi Folks,

I was diagnosed about 10 years ago. Titrated to 11 cm and issued a Phillips Respironics Remstar Auto (with Smartcard!)  
Trying to get myself properly treated was a struggle from the start. Narrow nasal passages that seem to always be at least somewhat blocked.
I can't even remember how long I managed to hang on, but eventually CPAP fell by the wayside. I had a couple of attempted restarts over the years, but never kept at it.

Fast forward to a couple of weeks ago. I decided to finally be pro-active and try to get this sorted out one way or another. I lost my dad last year to a heart attack and I'm sure it was related to untreated sleep apnea. I'm 44 with a wife and son. 

The old Remstar, while still working, was making odd burning smells while in use even after changing out filters/hose/mask. My DME has provided me a loaner while I wait for my Dr. appointment which is scheduled for this coming week. (I haven't seen my physician for 5 years!)

So, that's enough background. On to my first two nights of treatment.

Night one was a horrible mess. Machine was set 5-20 cm, C-Flex 2. I woke up three times with the machine racing at high pressure. I hit ramp and attempted to get back to sleep. Amazingly, I made it the full night but my AHI was 23.35 that morning.

Night two, I made a few adjustments: Set pressure to 9-14cm, switched to A-Flex level 3 and disabled the ramp. I slept right through and woke up with my alarm. Great night! (or so I thought) When I checked my AHI on the machine.. 11.96 . Much better, but still horrible as Sleepyhead says. 

When I started looking at my charts in Sleepyhead, I noticed that I had practically no obstructive apneas. The majority of my AHI was composed of Clear Airway Apneas and Hypopneas. This was new to me.. years ago I didn't see any CA's at all. Zooming in on some of those, and I started noticing what appears (to my limited knowledge) as Cheyne-Stokes breathing. I've noticed I have some weird breathing patterns during daytime as well which i just figured were some kind of nervous tic. Now I'm wondering if it's related to what I'm seeing in my charts.

I have my charts up on Imgur, but can't post any links as a new user. Any advice on how to reduce CA's would be appreciated.
Once I have enough posts, I'll put up the links.

Thanks!

[Gideon]

Welcome to the board

When you see your status shift  from "new member"  to "member" you will be able to post images.

For now add a space and just post the link as text.  "htt p://IMGUR.com/xxxxxx.png"

Fred

[trish6hundred]

Hi Kev73,
WELCOME! to the forum.!
Better luck to you with CPAP therapy this time around.
Hang in there for more responses to your post.

[Kev73]

Thanks for the warm welcome!

Have been reading for awhile.. this board is a fantastic resource.

As suggested by Fred, here are the links to my charts:

Full Night
htt ps://imgur.com/b1Wv9XF.png

Regular Pattern
htt ps://imgur.com/HbB9vsN.png

Periodic Breathing (Cheyne-Stokes?)
htt ps://imgur.com/aCLnLIt.png

Some odd variations..
htt ps://imgur.com/bM6winj.png

Thanks for taking the time.

[Gideon]

I see Hyponpeas and Clear Airway/Central Apnea occurring together.   

To give a better picture Please post the full night of your first night.  and tonight when you get it.  

I suspect that you likely will not end up with an Auto CPAP but possibly an ASV machine.

Fred

[Kev73]

Here is my first night. I'll post tonight's in the morning.


htt ps://i.imgur.com/gwrfG8S.png


Thanks!

[Sleeprider]

Kev73, here are your charts...comments below:





So far this has all the appearance of complex apnea with both obstructive and central events.  I have been wrong before, but I thing you're headed towards a different therapy called adaptive servo ventilation (ASV) which can resolve both obstructive and central apnea events.  

I have to assume, you never had a titraton study.  In any event, it would be very helpful if you could post or transcribe the results of your sleep study and titration study.  Specifically, we are looking for evidence of central apnea (CA) in either study. Your change in settings from 5-20 to 8-14 resulted in a significant improvement. If you want to try to optimize the 8-14 results, I would take the EPR setting or 2 and simply turn it off.

[Kev73]

Thanks for posting my charts. :-)

I had a sleep study done followed by a titration (my wife has a good memory.. I forgot I went twice) ;-)
It was many years ago now. I unfortunately don't have any paperwork from it.
All I recall was being prescribed CPAP at a pressure of 11. I requested an APAP for the data abilities and used Encore to track results.
I don't recall anything about centrals, but then again, I don't think Encore showed data that back in 2009.

I'll see if I can manage without C-Flex/A-Flex. If I can't get to sleep without it, I'll try a lower setting at least.

Thanks for your help.

[Sleeprider]

You are currently at 9-14 pressure, and I think it would be interesting to move that in 1-cm increments to see if things come below 5 AHI. I suspect the pressure may simply be too low for your PR System One machine. The Philips machines are a bit slow in getting to an effective pressure, so a higher minimum helps with that, and the higher maximum lets us see if the pressure needs are met in that range. It is also possible you have a positional apnea issue. If you find that bending your head forward can make breathing more difficult (chin tuck), or even cuts off your airway, this is a very common problem. Many members here have tried a loose fitting soft cervical collar to keep the head and neck in better alignment.

I'm not prepared to say you have complex apnea at this point because the machines are notoriously inaccurate in determining apnea type within these clusters. I would rather see a trial at 10-15 and possibly a soft cervical collar. If the AHI remains high with centrals, then AFlex may be contributing.

[Kev73]

Shocked and saddened with the news in Vegas. Absolutely heartbreaking.
My thoughts are with those who have been affected by this tragedy.

Last nights sleep seemed to be a catch-22 for me. I turned off the Flex but kept everything else the same.
The machine seemed much noisier than the night before and it took a long time to fall asleep.
I woke up after less than three hours with a sore nose and realized the machine noise was keeping my wife awake as well, so I ended up taking it off.
Looking forward to getting a quieter machine.

The AHI did show another improvement, though I can't say I feel it this morning. Full night chart below.. if you would like any detailed shots let me know.

I don't seem to have any issues with breathing when I tilt my head forwards, but I'll keep the cervical collar in mind.
Tonight I'll try 10-15 with no A-Flex and see how it goes.

Thanks again for your assistance!