[Treatment] 40+ AHI WITH cpap, feeling hopeless

[Bobblan]

Hello everybody!

I just got recommended to post here from Reddit.

I've been on CPAP-treatment for over 7 years, got my first machine back in 2017 and been using it ever since. 

I got diagnosed with severe sleep apnea with the home study showing 48~ AHI with mixed apneas.

I've had various "success" with it, but never really bothered to look at the numbers that much, since my doctor said I they werent to be trusted.
Now that I'm older and more inclined to actually care about my quality of life and my sleep in general, I see that was blatant missinformation.

I just got a new machine 3 weeks ago that shows centrals & obstructive apneas (my old one didnt), so I've been monitoring it closesly
just to see why i'm so tired on certain days and other days wake up feeling refreshed. 

the first few nights were "ok" I had 20+ Ahi which 19 of them were central and I didnt think much of it, except for that 
oh so familiar sinking feeling in my stomach, "oh so this didnt work either, might as well give up" is what I thought. 
Then I had a few nights with circa 5~ Ahi, all centrals and no obstructive and i felt refreshed and happy for once, 
this didnt last very long however, as most days my AHI can go up to 40+... Not getting much treatment there. 
so its a vicious cycle of it actually "working" and then not working again, and I dont know WHY?

So my question and what I need help with in general is really just if someone could look at my Oscar-chart and see whats going on? 

Im attaching my Oscar file, please tell me if you need a better picture or more pictures or if there is something wrong, any help at all is endlessly appreciated.

[gainerfull]

This looks like at least a component of your issue is your sleeping position as you are experiencing some positional apnea. Have you tried using a soft cervical collar?

[Bobblan]

This looks like at least a component of your issue is your sleeping position as you are experiencing some positional apnea. Have you tried using a soft cervical collar?

Oh okay, thats good to know, my girlfriend also noticed I move around a lot during sleep and sometimes "choke" my breathing by laying on the tube itself.

I have not tried that, does that prevent movement issues, or can reduce my centrals?

Thanks for helping

[Sleeprider]

Did your sleep test indicate any central apnea? While it's a bit counter-intuitive, I'd like to see you turn on EPR full-time at setting 3. It;s just a guess, but it will either resolve the flow limits or not. If we can't suppress the CA events, there are some other approaches we can try. Basically we need to resolve the CA events in the next few weeks or look at an alternative therapy approach. Please format your charts to show Events, Flow Rate, Pressure, flow limitation and leaks. The other data are not as useful.

[Deborah K.]

Don't worry about your sleeping position for now.  SleepRider is right, as always.  Your Central Apneas are your main problem.  He will guide you through this.  Posting a copy of your sleep study will help him figure things out more quickly.

Also,  

[SarcasticDave94]

Warning: purple ink will run out soon

Interested to hear about the back story on the CA.

[Bobblan]

Did your sleep test indicate any central apnea?  While it's a bit counter-intuitive, I'd like to see you turn on EPR full-time at setting 3.  It;s just a guess, but it will either resolve the flow limits or not.  If we can't suppress the CA events, there are some other approaches we can try. Basically we need to resolve the CA events in the next few weeks or look at an alternative therapy approach.  Please format your charts to show Events, Flow Rate, Pressure, flow limitation and leaks.  The other data are not as useful.

From what I can remember back in 2017 it was a lot of mixed apneas with an AHI score of about 48 ~.

I tried with EPR-3 tonight and my AHI was 56.7, with like 54 of them being central according to the machine..
I slept for about 12 hours and I am feeling okay, but starting to become very depressed over this issue, I just dont know what to do,
I dont know whats causing it, or what Im doing wrong, what did I do "right" the nights I had an ahi of like 5?

I have work right now (can barely function), but I will try to format it tonight and post an update for you to take a look at,
I Really really appreciate you guys taking time and looking at this.

Posting my charts later tonight when I can, thank you.

Edit: My average pressure last night was 19.1.

[SarcasticDave94]

Dunno folks, but it is likely idiopathic centrals. Jump right to ASV? Maybe. It would resolve all things Central pretty quick. There is VAuto (which ResMed Sweden appears to have too) and trigger high that maybe does the trick. I'm getting the impression the AirSense 11 has limited tricks to get a decent middle ground for avoiding enough CA while the ability to treat obstructive events still exists. What I mean is maybe there's too many CA to be able to avoid here.

54 is 10.8X higher than what's considered treated.

As for the up then down AHI, as in some nights you're treated and other nights not even close, that's the Central Apnea nature of things. Consistently inconsistent. It's not something you're doing wrong, you may need a different machine to work against these CA.

[Bobblan]

Did your sleep test indicate any central apnea?  While it's a bit counter-intuitive, I'd like to see you turn on EPR full-time at setting 3.  It;s just a guess, but it will either resolve the flow limits or not.  If we can't suppress the CA events, there are some other approaches we can try. Basically we need to resolve the CA events in the next few weeks or look at an alternative therapy approach.  Please format your charts to show Events, Flow Rate, Pressure, flow limitation and leaks.  The other data are not as useful.

Hello again

Sorry for not replying for a few days, been awfully tired sadly.


How do I go about to "format" these charts? I dont fully understand how to do that. 

I attached an image of some statistics, but not sure it this is helpful at all, please let me know if there is more information you need

Best regards.

[SarcasticDave94]

The last of these 3 charts is closest. There's a method to get to standard chart view but I've used it in quite a bit. Typical again that last chart not zoomed first is a good starting point.

You may have to edit the pressure to be closer together to maybe avoid some centrals. 8-15 maybe but let's see what others suggest. It maybe isn't enough to treat yet avoid CA also.