Still getting obstructive apnea periods of 60sec

[timcharper]

Hi! First post. I'm using OSCAR to analyze my data. When I wake up in the morning, I've been can tell if I've had obstructive apnea events >45 seconds by the way I feel.

Brief timeline of my history:

2019-10-09 - I'm diagnosed with sleep apnea. I feel terrible, but my AHI wasn't awful at 7.56, Hypopnea's being the worst offender
2019-12-09 - My 2 month follow up with sleep doc; he adjusts my sleep settings to 10-12; I feel worse.
2019-12-23 - I change my CPAP settings back to 6-12. Not much improvement.
2020-01-03 - I change my CPAP settings back to 10-12; again, not much improvement
2020-01-06 - My doctor changes my CPAP settings to 12 constant. I feel some improvement! But, small sample size and data I'm still having long obstructive Apneas.

I've attached charts showing my AHI and different apneas stats by setting.

At the setting of 12, I'm still getting 60-second periods of obstructive Apnea, 4 breaths, then another 60-second period of obstructive Apnea. I can "feel it" when I wake up in the morning that this happened, I feel a distinct, worse, unrested feeling. Higher frequency central sleep apneas don't affect me unless if they are impeding my sleep (I take gabapentin to suppress this). But, the really-long obstructive apneas, especially when I have multiple in a row, I think are leading to hypoxia and causing me to feel so bad in the morning. That's my hypothesis, anyway.

My question is when should I consider increasing my pressure further? In my analysis I'm not seeing a significant difference between settings so far. I think right now I'd be quite happy with significantly reducing my obstructive apneas.

I'm talking with my sleep doc; but turn around getting answer is long and communication is difficult.

---

Here's a screen shot of my sleep apnea spell in OSCAR that just happened last sleep session. Yes... those times are correct. My sleep is insane right now.

[timcharper]

Description of attachments (unfortunately I am unable to link or embed these because of my post status)

img 1&2: Sleep study

img 3: Scatter analysis of total time in seconds spent each night in each type of apnea, grouped by CPAP setting (with an additional category, initial, meaning "first month" of therapy)

img 4: Obstructive apnea sequence: (img 4)

.

[timcharper]

Here are the analysis with better labels

[Gideon]

Welcome to the forum.

A couple of comments,  Always include a full night chart for context.  The charts that you present should be Events, Flow Rate, Flow Limits, Pressure, Leaks, and Snores.  Also do not show either the pie chart or the calendar because more important info will show.

Observations
 
Central Apnea is about 1/3 of your apnea and needs to be watched.  I would like you to reduce your EPR from 3 to 2 and observe your CA and advise us what happened.  AHI of 2 is not a lot but reducing EPR could help.   Don't be surprised at further reduction of EPR being recommended.

The clusters of obstructive events is very indicative of tucking your chin.  You should use a soft cervical collar (see the link in my signature) or a anti-snoring or sleep collar.

so 2 changes
1. use a collar
2. reduce EPR to 2

[Osiris357]

Welcome to the forum. The experts will confirm this but I believe those clusters of obstructives are from “chin tucking”. Your chin is going to your chest while you sleep. I do the same and a soft cervical collar has worked wonders for me. 

As for your centrals, gabapentin may be adding to your central numbers not taking away. Possibly, but it’s worth considering

[harrywr2]

The way a Resmed Autoset works is by raising the pressure on snore and flow limit events in order to prevent the airway from closing. Once the airway is closed the amount of pressure the machine is capable of is insufficient to reopen the airway. So when presenting data the flow limit graph is important and the calender picture is not important.

Having said that your OA events are clustered which normally indicates a 'chin tuck'.( tucking your chin into your chest) Wearing a soft cervical collar(available from any pharmacy) should help.

[timcharper]

Thank you for the reply, @Bonjour! Really interesting about the chin tucking, I'll get the collar you mentioned and report if this changes things.

When you say EAP to 2, this is the lower pressure setting of the machine, right?

Tim

[Gideon]

No, NOT EPAP.

EPR, Expiry Pressure Relief.  This is considered a comfort feature but can and does have a large impact to therapy.  In your case, it is acting as a BiLevel and Pressure Support helping with Hypopnea, Flow Limits (you have a history of them), RERAs, Snores, and UARS.  Additionally, a frequent cause of Central Apnea is EPR / PS thus the suggestion to reduce it.

[timcharper]

I acquired a cervical collar and slept with it last night. I had exactly zero obstructive apneas last night! Promising! That's only happened twice in my history of using a CPAP!

Thank you so much everyone for this suggestion! I'll post some data after 10 days to compare apnea events with collar and without. Then I'll change the EPR, and then try and wean off the gabapentin.

[Dormeo]

Wow, that's a dramatic difference! I have my fingers crossed that it will persist.

When you post your data again, could you be sure to show the panel on the left (with pie chart and calendar turned off), and stack your graphs like so:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

You can squish them a little using the horizontal gray bar to get them all in one screen shot. No need for other graphs unless the experts ask to see them.

I don't know when I have seen a more striking response to a collar. I hope this will help other people too!