Still feeling bad after 4 years of CPAP/APAP

[gainerfull]

One option to consider beyond cpap is bilevel. Specifically, Resmed Aircurve 10 VAUTO. You can set trigger to high or very high and virtually eliminate all central apneas.

The one thing that I've never seen before is a person of your stature with such slow inspiration times - maybe this is the medication? Usually it's 1 to 1.5 seconds for most people to breathe in. I'm just over 3 seconds but I'm 6'3" / 220lbs. You'd also want to account for this w/ TiMax on a bilevel set to 4.

The reason you feel tired is because your sleep is being fragmented. Now, the question is - what is fragmenting your sleep considering your have only central events. One hypothesis would be to increase pressure as suggested so that we're only seeing flow limits during REM (every 1.5 to 2hrs). I'd be curious to see what your flow rate looks like with a puff of oxymetazoline spray in each nostril (point it into your sinuses, not up your nose). If that made the flow rate less ratty I bet you'd notice better sleep quality.

[Deborah K.]

WEUW, could you post a redacted copy of your sleep study?  It would help to see if you had lots of central in your study.  If so, it's possible that you need a different type of pap machine.

[SarcasticDave94]

If a guru like Sleeprider says you should be on ASV, I'm certain your issue is Central Apnea. If this is predominant CA you're dealing with, after this amount of attempts to avoid them, I don't think you'll get much better without that ASV in your toolbox.

Charts seem to indicate 2 things to me, CA tend to have the consistently inconsistent attribute. Up then down.

Second you need to get rid of the 40 minute Ramp. It's not the locking to 8 cmH2O that's the issue, but that you're losing 40 minutes of therapy every time you start the CPAP. And there's a potential for Ramp to bring a bit of variability to your pressure, that's bad for CA.

PS you can Attach OSCAR charts directly to posts if you Reply, not the quick reply though.

I know you've said in another thread you attempted to get ASV from the doctor. Is this the same doctor that tried to tell you that you don't actually have Apnea?

[weuw]

I know you've said in another thread you attempted to get ASV from the doctor. Is this the same doctor that tried to tell you that you don't actually have Apnea?

No it is not the same. 

This afternoon I have an appointment with a pneumologist I don't know. I will tell you the result.
These last nights I did not use CPAP very much.

Thanks for you help anyway.

[weuw]

WEUW, could you post a redacted copy of your sleep study?  It would help to see if you had lots of central in your study.  If so, it's possible that you need a different type of pap machine.

If it is in french, is it ok ?
Not a lot of central in my sleep study.
A lot of obstructive hypopneas it seems.
I can translate only the conclusion ?

[weuw]

ANALYSIS
The total sleep time is 423 minutes for a time spent in bed of 548 minutes. Sleep efficiency is 77% (normal > 85%). Falling asleep occurs in 0 minutes (normal <30 minutes). There is 59 minutes of deep slow-wave sleep (normal = 80-100 minutes), accounting for 14.1% of the sleep time. REM sleep has a latency of 76 minutes (normal > 50 minutes) and represents 27.8% of the sleep time (normal = 20-25%). The intrasleep wakefulness duration is 72 minutes (normal < 40 minutes). Sleep fragmentation includes 27 micro-awakenings per hour of sleep (N < 10/h). Respiratory disturbances show an apnea-hypopnea index of 12 per hour, with 0 per hour in the dorsal position. The average nocturnal saturation is 93%, dropping to a minimum of 90%. There is 0% of recording time spent with SaO2 < 90%. Snoring occurs during 0% of the Total Sleep Time. Time in the dorsal position is 0.0%, right lateral decubitus is 54.0%, and left lateral decubitus is 46.0%. Periodic Leg Movements: Index is 6 per hour, with 1 per hour being arousing (normal < 5/h).

CONCLUSION
Subjectively, sleep is quite good, with one awakening at 0:45 AM. PSG under fixed CPAP pressure of 10 cm water. Poor sleep efficiency with a short sleep duration. Short sleep latency but numerous intra-sleep awakenings (72 minutes). Macrostructure of sleep includes 4 sleep cycles and several wake phases. Deep slow-wave sleep is significantly reduced, and REM sleep is normal. Microstructure: well-differentiated alpha rhythm, significant sleep fragmentation with 27 micro-awakenings/h. No snoring, apnea-hypopnea index of 12/h (normal 5/h), and numerous flow reductions (total index 23/h). 9 desaturations/h with 0% of time at SaO2 <90%. Regular sinus rhythm heart rate. No arousing periodic movements. Overall, moderate persistent sleep apnea syndrome (SAS) under CPAP 10cm water with sleep fragmentation that may explain fatigue. Recommend maintaining a constant pressure of +12 and increasing compliance.

[weuw]

Here are details of events :

https://imgur.com/a/T4O5Mai