[Treatment] 12 days in - what's ahead?

[SleeperAwake21]

[[First of all, a note of appreciation for those who make this board work. Surfing articles has provided a wealth of info already.]]

I am nearly 2 weeks into treatment with a new DS2, and am wondering what hills and valleys may lie ahead.

Quick background: referred to sleep doc for sleep test after waking from naps repeatedly due to not breathing. This sensation is similar to a "not breathing/don't need to breathe" sensation I can get while drowsing. I thus told the MD there seemed to be a "central" component to this.
Sleep test showed AHI of 40-45, with 20-24 long no-breathing periods per hour.  AutoCPAP prescribed, auto, 5/12 cm pressure limits.

Got a full mask for my DS2, and off I went. The first 2 days were a bit marred by incorrect upper limit (20) and mask resistance type (X2 instead of correct X1) being entered.  Thanks to this board I was able to fix those as soon as the errors were discovered.

Status thus far: Am adapting reasonably well to sleeping with this thing (avg 8 hrs/night), and mask fit is good. I feel like I am learning to adapt to it (or to better fighting it when it wants me to breathe faster than I normally want to). Being a DS2, I have no access to traces, only summary data which I am tabulating.

Average data (with no clear trend over time) since correct settings have been in place:
AHI: 10.3 (range 8 to 12)
90% pressure:  10.7
mean pressure: 8.1
clear airway apneas/hr: 4.0  
obstructive apneas/hr:  3.2
hypopneas/hr: 3.1

Am I feeling better the next day? No, maybe worse. Compounded by years of chronic fatigue.

Questions:
-is this kind of distribution between clear/obstructive/hypopneas typical at this stage? (I have read that initial CPAP can induce some of these "complex apnea" symptoms).
-is the DS2's estimations of this distribution (among clear/onstructive/hypopnea) anywhere near reliable or useful?

Thanks!

[SarcasticDave94]

Get your copy of the diagnosic sleep test and post a redacted version here. I'm looking for medical notation and the event count and type. We need this to help identify which Central Apnea/CA you have. If the diagnostic test showed a lot of CA, then you could need to be on ASV. However, if the test results do not show the CA, then treatment emergent CA would be the case.

And HIPAA law permits you to request and receive the detailed versions of the report.

[SleeperAwake21]

   
   
As requested, am attaching redacted excerpts of the (snoring-laden) sleep test. I had to go search the provider portal and found it lurking there. These are screengrabs, let me know if they are clear enough.
Thank you!

[SarcasticDave94]

OK, test results tell us of no mixed or Central Apnea. Then this that you have now is treatment emergent CA. Being this is a Philips, are you using Flex and/or Ramp in any way? Both can increase CA, so if Flex is on, you may want to turn it down by 1 click and see what happens to the CA and how therapy feels.

Ramp, the DreamStation 1 has a button for Ramp initiation. Is the DS2 that way also? Regardless, Ramp can be a negative component. If me, I'd nix any Ramp unless you absolutely must have it. In that case, a minimal time or Auto and pressure at your therapy Min pressure or at most 1 less.

Test results, oxygen drop was to a min SpO2 85% for 12 seconds. But at 89% or less was 7.9 minutes. Consider getting a recording pulse oximeter and watch this stat.

[SleeperAwake21]

Being this is a Philips, are you using Flex and/or Ramp in any way? Both can increase CA, so if Flex is on, you may want to turn it down by 1 click and see what happens to the CA and how therapy feels.

Ramp, the DreamStation 1 has a button for Ramp initiation. Is the DS2 that way also? Regardless, Ramp can be a negative component. If me, I'd nix any Ramp unless you absolutely must have it. In that case, a minimal time or Auto and pressure at your therapy Min pressure or at most 1 less.

Thanks for the helpful info.

For FLEX: yes, it is on at the max level of 3. Testing Flex at 2 makes sense, after I adjust ramp as per below and see if there are effects (changing 1 variable at a time and giving time for effects to be seen).

For RAMP: yes, the DS2 has 1-button ramp. Mine is only 15 min long and is actually set a click or so above the prescribed min of 5 (I think it's 6 at the moment). I trigger it initially to help getting to sleep fast, and also again if I get up during the night. With this configuration it just keeps the pressure down for a few minutes, but will auto-increase if it notices an apnea event in progress.  I doubt I'd even notice raising it to 7.

It is interesting how AHI varies from night to night (even without changing anything) - last night was my best so far: AHI 7.3 over 9:11 hours, with obstructive apneas representing 34% of that.

Re: tracking SpO2 - Philips allows a bluetooth link with a Nonin unit, but it looks a bit cumbersome. Do people have favorites they recommend?

THANKS!

[SarcasticDave94]

Every flavor of Central Apnea will have the consistently inconsistent attribute to them. The up and down factor you're seeing.

Oximeter: I've used CMS 50D plus and F models. The 50F is a watch like device with wired finger probe with recording capability, about 24 hours I think.

The built-in PAP connector will likely require parts that'll be pretty expensive.

[quiescence at last]

the years of chronic fatigue is likely due to not actually getting much Stage N3 (deep sleep) or REM sleep. Your study said the night was either Awake or N2 sleep. I am not sure that device you used is able to tell.

Some fairly good sleep phase trackers are out there, like the Oura Ring.

Some tells for lack of deep sleep N3 - brain fog, dis-interest, cannot concentrate, do not recognize threats in time to avoid them, in-alert driving.

Some tells for lack of REM sleep - memory problems, no dreams, or dreams that are all chaotic and scary (NREM) versus dreams that are farcical imaginative unreal but almost believable (REM).

Lack of both puts you in survival mode, and can drive blood pressure and heart rate to abnormal highs.

Continuing the CPAP should reclaim better living, though it often takes a bit of time. Given the opportunity to breathe right, I immediately started dreaming better and more often. I must also have been getting more deep sleep, because after about a month I noticed being excited again, and felt like kicking my heels up (versus wanting to but knowing I could not muster the energy for it.)

Here's hoping that AHI goes down a bit more next week, and you will notice some return of energy and imagination.

QAL

[SleeperAwake21]

Update now almost a month in: steady progress for several weeks, but now more emergent central events to deal with.

I've logged the data both as daily and 4-day running averages, since that smooths the bumps well (apologies for the clumsiness of the QPro graphing functions). Several weeks of steady progress, even getting down to AHI 5 one night.  Mask fit is good throughout, and have tested flex, humidity, and tubing heat settings to optimize sleep.

But now we are back up to AHIs of 10-13 with no apparent reason (knowing full well that this is an unpredictable malady). Several nights ago I found myself in a dozing/waking in the middle of the night and put on our fingertip oximeter. Startling awake with a flashing "77" level prompted an inquiry to the sleep doc the next morning. (There were also several similar events when I saw 80's that night and since)   The sleep doc's take is to increase max pressures on my DS 2 and also ordered an overnight oximetry study. We also ordered a Wellue SleepU to start my own study (and for the vibrating alert function).