Return to treatment - CA's and Periodic Breathing

[Sleeprider]

Looks pretty darn good for you. Disrupted and unsettled sleep can cause some of these problems. Considering where you started I'm actually surprised to see you get under 10 AHI. Good effort and discipline on your part.

[Kev73]

Thanks Sleeprider, the encouragement is greatly appreciated.
I'll keep at it.

Once I get more info from the docs I'll post an update.

[Kev73]

Not sure where the time has gone since my last post, but I decided it's time for an update and a request for some advice.

In the spring of 2018 I finally got a replacement machine (Resmed Airsense 10 Autoset "For Her"). My sleep doc titrated me to 10cm H2o on straight CPAP mode. He said that I'm sensitive to the pressure and there was apparently a narrow range that worked for me. Too little pressure and OA isn't treated. Too high and I get centrals. For awhile, things seemed to be going well and I was coming in under 5 AHI. The only issue I had was the mask irritating my nose which led to cold sores and infections which I would have to wait to heal before continuing treatment.

Since then, I have put on some weight due to stress in my life. I've been trying to keep going, but my AHI doesn't seem to want to come down anymore. I've tried various adjustments: Auto mode with various ranges,ramp on/off, EPR on/off etc. Nothing I've tried seems to work. I'll be the first to admit that I don't know what I'm doing.  The good news, is I've finally found a mask that does not irritate my nose and seals well, so I'm able to keep working at it.

I've attached my charts for the last two nights. I hope you can see enough of it.. my laptop has a small screen so I had to compress the charts a bit to fit them. Based on the charts from yesterday night, I could see that my pressure was hitting 14, so I opened the top end up a bit to see what the machine came up with. Unfortunately I seem to be triggering more centrals. The first hour I couldn't sleep and ended up turning the ramp back on. The rest of the night I was restless and felt awful when I got up.

I'm no expert when it comes to analyzing the charts, so I figured I'd let some more knowledgeable folks take a look.

Any advice you can offer would be most appreciated.

[jaswilliams]

I would try reducing EPR from 3 to 2 you may find that has more affect on reducing the central than the pressure range

[Kev73]

Thanks for the advice. Last night I changed EPR to ramp only so it will help me get to sleep but not affect anything after. 

I narrowed my pressure range right down to 10-11 which is my prescription + 1cm H2o to give a little room for adjustment. 

Still had a bad night.. AHI of 14.3. About 50/50 OA and CA. 

Part of the issue is likely that I tried wearing a cervical collar instead of my chin strap.. My wife said I was "gurgling" and breathing through my mouth. Back to chin strap tonight!

[Kev73]

Well, a year and a half few by and I'm back. 

I stopped using my CPAP again last summer due to constant irritation of my nose leading to cold sores which took days to heal before I could try again. On June 10th, I decided to give it another shot. I have read a lot on the forum and purchased some Lansinoh for my nose which seems to help avoid the sores (so far). 

From June 10 - July 1, things went pretty well with my AHI generally under 5. This was at my prescribed setting of CPAP mode with a pressure of 10cm with the N30i mask and a worn out chinstrap.

In July, I started running into issues. Here is a quick summary of my nights.

July 1    - AHI 4.18 (1.29 CA, 1.61 OA, 1.29 Hyp), 18.90% LL - 10cm CPAP, EPR off
July 2  - AHI 8.79 (4.16 CA, 2.00 OA, 2.47 Hyp), 25.31% LL - 10cm CPAP, EPR off
July 3  - 5, Didn't use machine due to sore nose.
July 6  - AHI 8.20 (4.37 CA, 0.14 OA, 3.69 Hyp), 9.82% LL - 10cm CPAP, EPR off
July 7  - Not used
July 8  - AHI 7.69 (3.00 CA, 0.95 OA, 3.00 Hyp), 20.79% LL - 10-12cm APAP, EPR off
July 9  - AHI 1.39 (0.88 CA, 0.00 OA, 0.38 Hyp), 12.63% LL -  9-10cm APAP, EPR off
July 10 - 11, not used
July 12 - AHI 14.71 (1.03 CA, 9.31 OA, 4.25 Hyp 2.18 RERA), 0.03% LL - 9-10cm APAP, EPR 2
July 13 - AHI 17.10 (8.70 CA, 0.76 OA, 7.02 Hyp 1.07 RERA), 5.41% LL - 10cm CPAP, EPR off

There are some good nights in there, so I have hope that I can get this sorted out. I was experimenting with a narrow range of APAP with and without EPR to see the effect. When I saw the numbers on July 12, I decided to go back to 10cm CPAP


Due to leaks (which I'm not sure are mask or mouth) I ordered a P30i on July 5th to try in place of my N30i. It's comfortable and seems to stay put all night.

My chinstrap was also completely worn out so I ordered a new one which I received a couple of days ago. It seems comfortable and works much better, however I was surprised at the sudden increase in AHI over the last two nights!

I'm seeing loads of centrals and what looks like periodic breathing (though the machine isn't flagging as such).

My situation is complex, so I'm appreciative of any assistance that can be provided. I have attached the last three nights I used the machine. Let me know if you want zooms on any part and I'll post them.


Thanks!
   
   
   

[Gideon]

!2 July, extremely obvious, chin tucking. 13 July not as severe but syill chin tucking. see this Wiki article http://www.apneaboard.com/wiki/index.php...onal_Apnea
and the fix is a soft cervical collar. http://www.apneaboard.com/wiki/index.php...cal_Collar

[Kev73]

Thanks for response Bonjour!

I just happen to have a collar I can use. Should I still wear the chinstrap as well? When I tried the collar before my wife said I was making “gurgling noises” so I stopped using it. I figured I was still trying to mouth breath with the collar on.

[Gideon]

I would hold on the chin strap, try the collar then reevaluate

[Kev73]

Sounds good. I’ll post my chart tomorrow.