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Hi All - Newbie coming up on 1 month in. After switching from pillows to an F20 full face mask (+ chin strap) I feel pretty dialed in routine/mask wise and aside from an occasional wake up I sleep through the night with mask. I'm averaging about 5-6 AHI most nights with almost all events being CA's (no CA's called out in initial sleep study). Then usually once a week I'll get a night like last night that jumps me up to 10-12 with no obvious explanation. I did notice last night waking a couple times with a small leak (some air leaking up into my eyes) but I assume if I'm not getting large leak spikes I'm OK mask-wise? My leak stats have been consistently low. Overall, still not feeling a whole lot better but trying to remain patient/optimistic.
A few questions:
Any notable trends that can be seen for my typical CA events?
Is the 'Total time in apnea' stat to be trusted as-is? (Last night I was at ~20mins which seems alarming).
Overall, any notes I should bring to the sleep doc at my insurance mandated follow up in 2 weeks?
Recent Change-log:
3/25: Changed EPR from 2 to 1 in attempt to knock down CA's
3/13: Resp. tech/sleep clinic adjusted pressures to 5-9 (from 4-20 auto)
3/10: Switched from pillows to F20 full face mask to handle mouth breathing/l leaks
The usual culprit for an occasional high AHI "with no obvious explanation" is positional apnea. The tell-tale signe being tight clusters of events, as you had around from just after 5am. Some general notes below:-
There are two main distinct causes of positional apnea
Your trachea (windpipe) has been bent or otherwise distorted, when your head moves down towards your chest, enough to totally or partially block the airways. It can be happening either in the supine or lateral sleeping position.
The second possibility is in the deep sleep phase, when there is a semi paralysis of the muscles (loss of muscle tone), and the tongue, under the force of gravity, can fall back against the phalanx wall, blocking the airway. This is most often when sleeping in the supine position.
The solutions to these issues are:-
The use of a soft cervical collar for straightening the trachea,
A device to prevent supine sleeping, such as a vest with sown-in tennis balls, a wedge pillow...
backpack.
There are many references in the forum for all the above solutions.
Thanks so much for the info! I took a look through the links you provided and they are helpful.
Just curious on the positional apnea piece - would those positional events tend to show up more so as obstructive? I really only see an increase in CA's and my OA's have remained stabled ~1.
I found personally that there was a direct relationship between clusters and central apneas, as well as of course obstructives.
The best way I can try to justify this assertion is in my own exlerience. Anecdotal I freely admit.
In the early months of my therapy, I had massive custers, and they contained a mixture of all types of events split pretty evenly between centrals and obstructives.
Once I started to control clusters, the centrals and obstructives just melted away.
What I think is that they were likely "false" centrals, due to thd fact that the sensors of the machine could not cope in accurately identifying this massive onslaught of constant events in a very short space of time.
These blocks of events was really just like one big continuous event.
I have no proof, except that as mentioned above, once clusters were mastered, this mess went away.
03-27-2024, 06:45 PM (This post was last modified: 03-27-2024, 06:46 PM by jcp519.)
RE: 1 Month In - Some Questions
Try zooming in a little further on one of the clusters of CAs and posting that. Expat might be right in that those are positional in nature and not true CAs. Definitely try solving any positional issues first.
I believe that I actually posted on another one of your threads a little while ago talking about how those CAs could be from CO2 flushing. Its still looking like that could be the case because many of those CAs correspond to a small leak on the leak graph. It doesn't take much to flush all the CO2 from the mask causing that pattern of breathing. Since you're still pretty early in your treatment those could be treatment emergent CAs and can take a while to go away. I had a very similar thing happen to me, but my CAs never really went away and I ended up with an ASV.
I know this is going to sound counterintuitive, but I think you should turn EPR up to 2 or 3. You still have a 95% flow limitation of 0.05 and EPR would definitely help knock those down a bit. In my personal experience when I was on a CPAP, knocking down flow limits made me feel better even if it made the amount of CAs go up.
