[Treatment] Random Concentrations of Apneas

[CrizR]

Hi everyone,

Two years ago I was diagnosed with idiopathic central sleep apnea. I'm a 23-year-old male. I've been using a CPAP ever since and it does not work too well. I'm working towards an ASV, but it will be a while until then. In general, the CPAP does help, but my AHI still averages around 6-8 depending on the week. Additionally, I'll have random spikes of 15-30 AHI. There seems to be no good reason as to why these spikes occur, but I thought maybe you guys might have a bit more experience with this. I've attached a few examples of the spikes followed by some of my better days.

[Gideon]

Welcome to the forum. Let's see what we can do.

First I'd like to see a few of your centrals in a 3 min zoom view to see the detail.
Second, I'd like to see you try Flex=2 for 1 night. I do NOT expect your CA to go up if your centrals are idiopathic. (I actually expect them to go up, just a hunch, but if so other treatment options may be available.)

The Clusters of Obstructive Apnea indicate that you are tucking your chin and thus obstructing your airway. This is a common problem. The fix is a soft cervical collar or a anti-snoring or sleeping collar (just a strap in the back) Worn just tight enough to stop the chin from tucking. See the link in my signature. You had this issue on your "good" night as well, just not significant there. This you do need to get managed.

You will need the collar with the ASV as well.

[CrizR]

Hi bonjour,

Thanks for the reply and sorry about responding so late. Unfortunately I don’t have access to a micro usb reader right during my quarantine, so I can’t show you a zoom of my centrals. But I have some interesting results that I’d love to hear your opinion on.

So I ended up setting C-Flex+ to 3 this past week, and my obstructives have dropped substantially. My average ahi this week has gone down from 8/9 to 4. My centrals have stayed relatively the same but are definitely the primary issue now. 

Why do you think my obstructives went down when turning C-Flex+ on? I didn’t realize a comfort setting could have such a drastic impact. Also, because my centrals didn’t change, does that solidify the idiopathic diagnosis?

[CrizR]

I’ve also noticed that if I wake up in the morning and try going back to sleep, I have a much harder time. I usually run into a bunch of centrals as I try and fall asleep, but this is less likely to occur when falling asleep at night. For example, today I woke up at around 6am with an AHI of 3. I stayed on my phone for around an hour and then started to fall back asleep. Woke up multiple times gasping for air and then finally fell asleep for another hour. My AHI went from 3 to 8. All the additional apneas were central. Why might this be?

[SarcasticDave94]

Welcome to the AB.

Flex in either flavor may address Obstructive Apnea as you've found. If this were a ResMed and using EPR, this will act like a limited to 3 PS of BPAP. I know you're not on ResMed but Respironics. This may indicate generically that you may have better therapy on BPAP.

The CA or Central Apnea in any flavor are what we call consistently inconsistent. Keep track of CA events and you'll see they will be down sometimes and up at other times. These CA will trend up/down all the time. This variability would not be due to changing settings.

CA generically decrease with less to no pressure variation. Some OA do respond to variable pressure, seemingly like yours did. The problem is if both situations exist, the same machine can't do both vary and not and get good results for both CA and OA. However if this current event status continues, a BPAP like VAuto may help, but if CA events continue in a major count, ASV will tackle both event types of CA and OA.

Let's see a trend on general status for a few days, which helps fill in a therapy need status. Get and use the soft cervical collar that bonjour mentions.

Here's the bottom line issue: focus very hard on telling us how you feel with CA events being present. You can say something like "I had x CA events and I woke feeling very tired with a headache" just to give you an idea of what I mean. Be critical and specific. My CA was pre-existing, but I'm pretty sure if you described how you felt, I'd have been there also. Sorry, CA doesn't offer T-shirts.

[SarcasticDave94]

I’ve also noticed that if I wake up in the morning and try going back to sleep, I have a much harder time. I usually run into a bunch of centrals as I try and fall asleep, but this is less likely to occur when falling asleep at night. For example, today I woke up at around 6am with an AHI of 3. I stayed on my phone for around an hour and then started to fall back asleep. Woke up multiple times gasping for air and then finally fell asleep for another hour. My AHI went from 3 to 8. All the additional apneas were central. Why might this be?

I quoted your post so we knew what the reference was.

If we viewed an OSCAR of this attempt at sleeping, I'm going to guess the "bunch of centrals" will be what we classify as SWJ or sleep/wake junk. Transitions to sleep from wake status, or vice versa, end up with SWJ because the breathing patterns for sleep and wake are different in pattern and in control. The handoff itself tends to cause Apnea events, or at least make events easier to occur in a big messy cluster.

I'm not disregarding these and saying they didn't exist, it's just that if this SWJ happened during a full night's sleep event, we'd likely eliminate the SWJ time as counting against you. You're not actually sleeping yet. However, this SWJ can be disruptive, so keep that in mind, and tell us if that's the case.

[CrizR]

Welcome to the AB.

Flex in either flavor may address Obstructive Apnea as you've found. If this were a ResMed and using EPR, this will act like a limited to 3 PS of BPAP. I know you're not on ResMed but Respironics. This may indicate generically that you may have better therapy on BPAP.

The CA or Central Apnea in any flavor are what we call consistently inconsistent. Keep track of CA events and you'll see they will be down sometimes and up at other times. These CA will trend up/down all the time. This variability would not be due to changing settings.

CA generically decrease with less to no pressure variation. Some OA do respond to variable pressure, seemingly like yours did. The problem is if both situations exist, the same machine can't do both vary and not and get good results for both CA and OA. However if this current event status continues, a BPAP like VAuto may help, but if CA events continue in a major count, ASV will tackle both event types of CA and OA.

Let's see a trend on general status for a few days, which helps fill in a therapy need status. Get and use the soft cervical collar that bonjour mentions.

Here's the bottom line issue: focus very hard on telling us how you feel with CA events being present. You can say something like "I had x CA events and I woke feeling very tired with a headache" just to give you an idea of what I mean. Be critical and specific. My CA was pre-existing, but I'm pretty sure if you described how you felt, I'd have been there also. Sorry, CA doesn't offer T-shirts.

Okay that makes sense. I’m going to order a micro usb adaptor for my computer and I’ll update this post with specifics. 

As a general status for today here are my stats:

PS: 11
CFlex+: 3
AHI: 8.5 (CA - 34, OA - 14)
Hours: 6.5

My body feels achey. It’s definitely hard to stay awake. I can tell I won’t be moving much today, but I have had much much worse days. Memory is foggy.

[CrizR]

4/7/20

Hours: 7.24
AHI: 6.5
CFlex+: 3
CA: 25
OA: 12
Hypopneas: 11

Feeling more tired than usual for some reason despite manageable ahi. Slight headache.

[Gideon]

The raw numbers tell me that you should back off your CFlex some to try to reduce your CA.

Download OSCAR and arrange the charts per the organize link in my signature. Post the results and we can provide you with much deeper feedback

[SarcasticDave94]

I'd agree with bonjour. CA may lessen if we narrow/reduce pressure fluctuations.