[Diagnosis] Hello! Hola! New to CPAP, first night of SD card (Help Appreciated!)

[punkrockcholo]

Good morning,

After a period of decent sleep, I've fallen back to higher AHI recently and I don't understand why.

The first two attachments are from better nights, and the last attachment is from one of the bad nights.

OAs are pretty limited the past week, but CAs are through the roof. And there are a lot more Hypopneas. For what it's worth, my sleep study (severe OSA) showed 97% OA, 2% CA, 1% Mixed?.

[punkrockcholo]

Continuing on the thread of recent sleep, I am also attaching a screenshot of two nights ago where I tried reducing min pressure and EPR by 1. 

CAs were present as I struggled to fall asleep, but then events tapered off. However, FL came back up a bit. Is this a better approach?

I went a few months feeling better, never having to nap but the last few weeks have been difficult. Still not falling asleep like pre-PAP use, or anything like that, so YAY CPAP (and thanks a lot to this board, by the way) but I'm just not feeling like I'm getting the best therapy as of late.

[Dormeo]

Here's some information from a Medscape article:

Physiologically normal apneic events

Central sleep apnea during sleep-wake transition

Up to 40% of healthy individuals may exhibit central apneas during sleep-wake transition. The central apneas occur during the period that chemoreceptors are resetting and instability of ventilation control occurs. They are usually brief and not associated with significant oxygen desaturation. The clinical significance of this entity is unknown. Once stable sleep is reached, normal individuals should not have more than 5 central apneas per hour of sleep.

Postarousal central apnea or post-sigh central apnea

During a PSG review, central apneas are commonly seen following an arousal or after a sigh and are usually inconsequential. They are thought to be a result of Herring-Breuer reflex or hypocapnia induced by hyperventilation caused by a sigh or arousal.

It looks to me as though you've started experiencing wake-sleep transition central apneas.  I don't know why that would be.  Are you taking any new drugs?  Sleeping somewhere new?  New stress in your life?

What you might do if this persists is to buy a recording oximeter to see how your oxygen levels are doing during these CA clusters.  Your levels are probably fine, but it might be reassuring to you to check.

You aren't getting a lot of sleep, it seems.  Can you try to alter your schedule so you have at least 8 hours in bed on the machine each night?  If you're having more trouble falling asleep these days, that could help with day-time sleepiness.

If you didn't feel worse with the lower EPR, you might stick with that for a week or so to see how it goes.  Some people are bothered by higher FLs; others aren't, so the uptick in FLs may or may not be of any significance for you.

[punkrockcholo]

Dormeo, I recently started taking Protonix (7 day treatment that ends tomorrow) for possible GI issues. I was experiencing chest and abdomen discomfort, but bloodwork came back OK for all heart-related items. EKG was normal, but Dr. ordered me a stress test. I do have lower thyroid hormone lately (still normal range, but on the lower end) and Dr. said it was possibly tied to my calorie deficit the past couple of months. I'm not crash dieting or anything, but just cutting back on junk.

The Protonix, however, started Monday, and my CA onset began the Friday before. What's interesting is that the entire two weeks before my increased CAs (Friday Feb 16 to present) my AHI was 0.97 - 2.18 based on OSCAR.

I'll check out the oximeter threads and purchase one. Any recommendations?

[Dormeo]

Given the timing, it sounds as though the Protonix is not the culprit. I hope your doctor will keep an eye on your thyroid values.

If you go to the Welcome page in Oscar, you'll see an icon labelled Oximetry Wizard. It has information about oximeters that are compatible with Oscar, as well as tips about how to handle your oximetry data. Hope that helps!

[punkrockcholo]

Hello again.

So I've been having a heck of a time lately with these CAs. I have felt better every subsequent day, so I'm not sure if I'm improving or just getting used to the arousals. Attached are the past three nights. While very fragmented, I do want to specify that there were hours of sleep either before, during or after without the CPAP. And my energy levels have been OK. Much better than life pre-CPAP.

Question #1 - Is there such a thing as transitional CAs due to these sleep-wake periods Dormeo mentioned? Rather, does the "phenomenon" go away or improve? I'm not on any new medication but I have been experiencing some strange chest/abdomen sensations and my Doc believed it might be GI-related. I will be seeing my Primary tomorrow so then there's...

Question #2 -- If whatever I'm experiencing is more serious, and/or based on past assessments by PeaceLoveAndPizza, is this something that can better be treated by BiLevel therapy? I can ask my Doc for either a new prescription or another sleep study to hopefully lead to this new prescription.

AirCurve 10 S? VAuto? ASV? What actually treats what I'm experiencing now, and perhaps my previous issues when first starting PAP therapy?

Any and all help is much appreciated. Thank you.

[punkrockcholo]

Question #3 -- Is my tidal volume low? Not the 95% but just eyeballing it.

Ah! Trust the process.

[Dormeo]

Normal TV depends some on the size of your body, in particular, your chest. Unless you are a very large person, I'd say your TV is quite normal for sleep-breathing. With a doctor appointment coming up, you can just ask him or her.

I'd also ask about whether transitional CAs go away. I haven't read anything suggesting that they do or don't.

As I mentioned, I think there would be some value in using a recording O2 monitor, compatible with Oscar. That way you and your doctor can see whether these short periods of transitional CAs are having any significant effects on your O2 levels. That in turn would be part of what would guide a decision about trying a different kind of machine.

ASV machines treat CAs, but they're quite expensive and can take some getting used to. So I wouldn't myself race to the conclusion that that's something you need.

I'm glad to hear you've been feeling better! I hope you can more consistently get your sleep with your machine -- and plenty of it.

[punkrockcholo]

• Saw my primary and cardiologist, and "everything checks out." Bloodwork good, stress test normal, no exercise-induced arrythmias and no blockage? Mets score of 13.4.
  

OK, and the introduction of CAs? PCP ordered me a sleep study so I'm waiting for that.

• Received my CheckMe 02 Max so I'll begin monitoring that tonight.
  

In the meantime, my OSCAR data is affecting my mental health.

Do my charts tell anything strange? My INSP time is often higher than my EXP time. Don't know how this correlates, if at all, but I'm having a heck of a time lately.

Help!

P.S. Not sure if this means anything, but shortly around the time my transitional CAs began popping up I began napping for about an hour without the mask in the evening just before my bedtime. Could my naps be affecting my PAP therapy? Just throwing anything on the wall here to see if it sticks.

Could I try to change the settings a bit? Perhaps lower EPR to 2 again? Lower min? Fixed pressure? Anything? Bueller?

[Dormeo]

I'm glad you got a clean bill of health from the cardiologist -- and that you have another sleep study coming up.

On the charts you posted, your median ins. times are lower than your exp. times. Also be aware that if you have some cardioballistic artifacts, that can distort the numbers. (The CB artifacts show up as little oscillations above/below the zero line between breaths. CB artifacts are nothing to worry about! They just occur because your good strong heartbeat can telegraph itself to your airway.)

It's a very bad idea to nap before bed time, and to do it without the machine. I strongly recommend that when you get sleepy enough to nap, you simply go to bed. That, or make an effort to stay awake a bit longer, and then go to bed. I don't know whether that has anything to do with your transitional CAs, but it's basic sleep "hygiene" not to do that.

I'm concerned that the *data* are affecting your mental health. Might you consider taking a break from using Oscar? You can review your data maybe once a week.