[Treatment] Still high AHI, strange Sleepyhead results

[avoidthelava]

Hi Everyone, 

I am hoping to get some advice about my strange results. 

I was initially diagnosed with an AHI of 34, and have been on CPAP for the past 9 months. The symptoms (constant fatigue, weight gain, excess sweating, lack of focus, high irritability etc.) came on pretty rapidly about 1 - 1.5 years before I started treatment. 

Despite the fact that my monthly AHI is still averaging quite high with around 7-9, Over this time my quality of life has improved significantly.
I can make it through the day without needing a nap. My mental clarity and work performance has improved, and I've started to feel 'alive' again. However I still feel there's a lot of room for improvement to get back to the person I was 3 years ago. 

Looking over my results, it seems that my issues are almost entirely 'clear airway events'. I understand this to mean that my throat is not collapsing or restricting airflow into my lungs, but rather that I just stop breathing for a few seconds. This has completely changed my understanding about my condition and given me a new motivation to get to the root cause of this problem, with the target to achieve an AHI well below 5. 

So, looking at my results, what approach would you take to help identify and improve the situation? Could it be muscular-skeletal related, eg. a weak diaphragm or weak abdominal muscles? I do wake up with a very stiff back and do a lot of foam rolling before and after bed to help release it.

I'm currently not living in my home country and do not yet speak well enough the official language so there is a kind of barrier there to health professionals. The medical system here is free, but quite slow. That's why I'm approaching this forum first to educate myself before going down that path. 

Attached are my sleepyhead results from last night and the historical overview from my entire time on CPAP.

Thanks to anyone for your help and guidance. 


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[Walla Walla]

I would reduce your EPR to 1cm to help reduce your CA events.

[Sleeprider]

Walla already nailed the problem. You are using EPR at 3 and this is likely increasing your CA events. I am going to guess that reducing EPR to 1 or 0 may reduce your AHI to less than 5.0, but may not fully resolve the problem. It's worth a try. I think with EPR at 1, your pressure range can be revised down to 6.0 minimum and 10.0 maximum.

Read this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721059/

[avoidthelava]

Thanks a lot Walla and Sleeprider for your suggestions. 
I changed the EPR setting to 1 and reduced the pressure range to 6 min 10 max and gave it try overnight. 

Unfortunately it seems to have made the results worse - AHI up to 13.45.

Tonight I will increase the pressure back up to 8 min 14 max and see how it goes. 

Do you have any other suggestions to try at the same time?

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[Walla Walla]

I think the best thing you can do with this machine is set it at a fixed pressure of 6cm and turn EPR to off. Your probably going to need a ASV machine in the long term.

[jaswilliams]

Looking at your graphs, I see nothing more that I would change.. I would be going for comfort at this point and ensuring I have no obstructive apnea, nor hypopnea, you may find like I did that the hypopnea is miss scored CA's due to periodic breathing. There is nothing more to be done with the CA's if they dont reduce over time then the next step will be a Bi-Level machine then possibly ASV that is the protocol the doctors will follow....

[Sleeprider]

Avoidthelava, you have complex sleep apnea syndrome, and your next stop is ASV. Reducing EPR, and stabilizing pressure normally works to reduce the CA events. In your case, based on one night you had an unexpected result. Hopefully you had a chance to read the article I linked in my last post. The next step is to make your doctor aware of the high level of central apnea you are experiencing with CPAP. It will help you to understand the normal progression towards ASV of individuals with this problem. Your CPAP machine cannot treat central apnea, and your results will continue to be inconsistent and unpredictable. If the central apnea do not resolve as you adapt to CPAP, then you can look forward to being treated using ASV which will work very well.

[avoidthelava]

Thanks everyone for your advice, I've come to learn a lot more from this forum about my condition than from the various medical professionals that I have dealt with so far. I now understand the different types of Apnea's and which ones I have been suffering from. The frustrating thing is that from my initial diagnosis, the majority of events from the beginning were centrals but all discussions where only about obstructive events. 

Thanks walla and sleeprider for helping to improve the situation by reducing the EPR. After going back to my normal pressure for two nights, my results improved a lot and last night achieved my first result under 5 AHI! (Lots of leaks as I didn't sleep in my own bed due to travel). 

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I read through the links provided about the increase in Central Apnea events after usage with CPAP machines and did some additional research. After exporting the sleepyhead data into excel to compare the 3 different types of events, this clearly has been happening in my case. 

The data shows that the CPAP therapy has been effective in reducing my obstructive and hypopnea events, however in the last 3 months my centrals have been steadily increasing. 

[attachment=6965]

My next steps are to discuss this with my doctor. At the same time I am looking for suppliers of the Resmed AirCurve 10 ASV in Europe as my patience with the medical system is wearing thin, i'm considering just going out of pocket for the machine.

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