[Treatment] Where did I go wrong?

[MajorMike]

Thanks to all on the Apnea Board for being so helpful to us newbies.  53 nights of data in 58 days.  Just when I think I am making progress, the bottom seems to fall out.  

Where did I fail?

I was just getting used to sleeping with CPAP gear instead of my wife.  How boring it is!  Dreams are less colorful and I cannot say I've noticed much difference in my level of fatigue.  However, as a 2011 heart attack survivor, I understand the importance of treating Sleep Apnea and developing good sleep habits.  My days as an Army Ranger wrecked my good sleep habits for the better part of my life.

I've attached five screen shots of OSCAR data:  two from last week when all was good.  Three from this week when the cart went back into the ditch.  I don't snore much--never have.  CSAs were common in the initial home sleep tests by SNAP Diagnostics.  I don't know that this isn't part of my wiring.  Mom once told me the doctors at Letterman Army Hospital had to paddle my butt to get me to start breathing.  I thought this might be training for my future as an unruly Junior High School student.  However, in retrospect, I can recall over the past forty years of being in some sort of dream state and asking myself:  "did I just forget to breath?"

The CSR that was detected two nights ago scared me like no "green whistler" ever did, considering that Cheyne and Stokes researched the phenomena as a "dying breath" condition.  Not exactly what I want to learn.

Ignore the large leaks--I vaguely recall addressing the problems in my sleep after I rolled over, dislodging the poor quality velcro straps on the mask.  

I don't drink, I don't smoke, I don't chew, and I don't go out with the girls who do.  

What are some things I need to look at to get the cart out of the ditch and rolling straight down the trail?

My Primary Care doctor has scheduled my CPAP follow-up in two weeks, which will be performed in conjunction with my "Welcome to Medicare" inspection.  

Thanks in advance for any advice.

MajorMike

[Melman]

It looks like your min pressure is too low but it's hard to tell without seeing more of your macine data. Please minimize the calendar by clicking on the triangle next to the date and eliminate the pie chart by selecting the file menu, then preferences, and then appearance. Uncheck the box for the pie chart. That will make much more data visible. Also, please reorganize your graphs by replacing mask pressure with flow limit. You obstructive events appear to be clustered which may be due to chin tucking. A soft cervical collar will prevent that. See the link below on how to organize your data.

[DeepBreathing]

G'day MajorMike. Welcome to Apnea Board.

Where did I fail?...
...I don't drink, I don't smoke, I don't chew, and I don't go out with the girls who do.

I think you just answered your own question.

Seriously though, the change in those reports is remarkable. I did notice the first few days you had a few clusters of obstructive events which may be positional. Typically we tuck our chin down to the chest which puts stress on the airway. This can often be overcome by using a pillow which tilts the head back slightly to ensure an open airway. Alternatively a soft collar has proven helpful for many members.

So many central apneas occurring suddenly makes me initially think of drugs - have you started taking any medications including painkillers, sedatives, epilepsy treatment etc? Have you had any physical or emotional trauma in the last week? Any other medical conditions.

It would be helpful to zoom in on a two minute section of the nights with the central apnea: 22 July at 02:17 and 23 July at 01:25. We need to see clearly what the flow rate is doing at those times.

It would also help if you could reformat your charts to turn off the calendar and pie chart: that will allow us to see some data which is presently hidden. The instructions are here: http://www.apneaboard.com/wiki/index.php...ganization

[MajorMike]

Thanks Melman,

See response to DeepBreathing

[MajorMike]

Thanks for answering DeepBreathing,  

Per yours and Melman's request I've zoomed into two-minute increments on 7/22 and 7/23; removed the sidebars and calendars, and reordered the graphs to show "flow limits" on the attached charts.

No drugs.  2.5mg Bystolic (beta blocker) 5 hours before bedtime.  Also 81mg aspirin at same time + 3mg melatonin gummy.  

Before CPAP (BC) I was a prone sleeper by default, but this is very difficult with full mask.  I start the night side-sleeping, but I can tell you that I know I tend to roll into a supine position with the slightest nudge from either my wife, my dog, my cat or my goldfish--whoever is hot-bunking with me during the night.

I thought about installing a Deer-Cam to record my positions through the night, but that would be robbing assets from the really important things in life.

[MajorMike]

Also, you asked about medical stuff:

1.  A1C = 5.5
2.  BP = 102/70  (This will drop as low as 85/57 within 45 minutes of taking 5 mg Bystolic, which is why I cut the dosage in half)
3.  HDL = 55 (4/10/19)
4.  LDL = 82 (4/10/19)
5.  Triglycerides = 62 (4/10/19)
6.  BMI: 29.1  (1 Mile Run = 8:42 Minutes, 2 minute Pushup = 97;  2-minute situp = 88)
7.  Age:  65

I am in decent shape--no recent changes in health.

[Melman]

actually, we want to see the left side bar without the calendar and pie chart. You can turn them off without eliminating the side bar. The statistics and machine settings are helpful. I think an increase in your min pressure may help with the OA and hypopnea. We usually recommend something near your median pressure. The big challenge will be the central if they continue.

[DeepBreathing]

Mike, thanks for posting the charts and your other details. As Melman said it would be good to see the left sidebar but without the calendar and pie chart - there is quite a lot of data there.

Looking closely at the chart from 01:25 - 01:26 I suspect that at least some of those clear airway apneas might be misdiagnosed. Normally at the end of an obstructive apnea we see a really large flow for the first breath, the "gasping for air" that people talk about. In your case I don't see that but the obstructive and central apneas all have a similar recovery breath. You might like to look closely at other events to see if the same pattern applies.

I feel you could get a lot of relief using a soft collar or shaped pillow to ensure your neck is slightly extended and the airway remains open.