Trying to Reduce CA Events

[chrotteg]

Hi all! Wanted to give an update and get some more help on new information. I tried a soft cervical collar and surprsingly it really helped my AHI and my overal CA events. This gave me the indication that my CA events are really something else or caused by a loop gain caused by an obstruction (something I have seen Sleeprider discuss in other posts). Anyway, I got a titration study done that was worthless. They reduced my AHI to 4.5 with a cpap pressure of 6 and told me that was effective.... I was diagnosed with an AHI of 5.3 for reference. However, something interesting came from this titration study, my OH events were about 5/hour and my CA events were reduced to about 0.3/hr. So CPAP helped my CA events but didn't fix my obstructive events in my titration study... is this not the craziest sh*t? They recommended I do a lower CPAP pressure of 6 (OSCAR data attached). They are clueless obviously. They don't know whats going on as at lower pressures I get high flow limits, sh*t sleep, still have my centrals, and have the new occurence of RERAs. I took my own path and started to treat myself for obstructive events instead of CA events by increasing CPAP pressure to 9 and 10 and adding EPR of 3 (data attached). This has eliminated any hypopneas and RERAs I was seeing but of course there are CA events still. However, with this change, could this be TECA now since I have a high EPR and pressure? Or could this still be the same pesky CA's? I am also planning to see an ENT doctor for possible UARS and I do have a narrow throat. I have little hope for that as I didn't have any RERAs in my titration but I do have spontaneous arousals of like 7/hr, not sure if thats even high though.

Overall what I need help with: I am not sure if my CA events are treatment emergent or come from obstruction still (I will add zoomed in plots in a reply). I plan to adjust my therapy to possibly minimze my CA events, I was thinking of just trying less EPR tonight. I also want some insight into my next steps. If this is from obstruction, should I look into a bipap so I can raise pressure higher and have EPAP adjustment? I am hesitant on this since APAP never went above 10 for me when I had it set from 7-12 with epr off, however, with CPAP of 10 and epr 3 I still have some flow limits, but nothing concerning. Or should I convince a doctor to sign me off for an ST machine? I am not convinced my issues are really the CA events anymore but possibly more so obstructions and arousals. 

PS. I am not trying to completely eliminate AHI, I just have still slept poorly, wake up many times a night, and still don't feel very rested. 

As always thank you for all the help!

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Here are some zoomed in plots.

[stevew168]

Which of your posts is accurate then? Your mention of "ASV may fix them all, or you might need even more. (iVAPS?)" or saying you didn't mention iVAPS? Why mention it if you didn't think there's a possibility it's needed?

There is a difference in suggesting that something Might be Considered, or better than ASV, than that it is Needed.

[SarcasticDave94]

Titration tests have a bad way of being useful, unfortunately. The Central Apnea might be enhanced due to CPAP. I think what you have here is you have a higher sensitive to Centrals already, and CPAP sometimes makes them worse. Whether we call this treatment emergent or just Centrals doesn't matter much in my opinion. They cause the same thing for you.

Keep us updated on how your self advocacy settings are going. I myself am not sure how to advise on what to try. I would pass this on, in most CA events hinder sleep less than obstructive. You can bias treatment on those obstructive events, split even between obstructive and central, bias towards centrals is probably the least helpful with your current AutoSet.

@stevew168 OK you said might 16 days ago. Let's move on and help chrotteg. If you wish, we might take up the verbal back and forth jabs on your thread not here.

[stevew168]

I'd suggest getting an SpO2 ring, such as a Wellue, and see if you can correlate drops on SpO2 with these central events. From your recent OSCAR screenshots there are not many, but they might last rather long.

[BigWing]

I tried a soft cervical collar and surprsingly it really helped my AHI and my overal CA events.

You have to wonder. What bright spark decided that a good way to help someone struggling to breathe due to an airway blockage was....to wrap something round their throat?!

I know an SCC does seem to help a lot of people, but in one test for me it caused my hypopneas to increase tenfold!

[SarcasticDave94]

The soft cervical collar has been an idea, and has been in use successfully with a number of board members. That bright spark has actually helped those that have Positional Apnea, the type where your chin tucks towards your chest, restricting the airway much like a common Obstructive Apnea would.

If the collar isn't for you, fine, don't use it. Simple. I will note that not knowing your circumstance exactly, it would be difficult to compare your results to one other person.

I myself have not used or tried the soft cervical collar, however I've seen the results in other's OSCAR charts. It isn't for everyone. Some don't suffer from this particular Positional Apnea. And some within the Positional Apnea group can fix it by thinner pillows, like 1 instead of 2.

Lastly, the collar needs to fit a certain way, not tight nor too tall as in using it to nearly eliminate neck movement, but just enough to keep the chin from tucking.

[PeaceLoveAndPizza]

Soft cervical collars serve many useful purposes. They help with reducing or eliminating mouth breathing by using the weight of the head to help keep our mouths closed, help keep the neck in proper alignment for better breathing by reducing flow limitations due to chin-tucking, and also help with tension in the neck by not forcing us to tighten those muscles.

Fitting is key. The measurement from chin-to-sternum is the determining factor for height. The neck circumference determines the length. There are many materials and firmness to choose from these days.

It has helped many people, myself included. There is no reason not to consider it as an adjunct technology to use for better sleep.

[Jay51]

A soft cervical collar has helped decrease severe positional apnea for me personally, also.  One key is not to wear it too tight.  It should not put inward pressure on the adam's apple (constricting); but should be a little loose.  Then it can make contact with the outer, harder, bony underside of the mandible (lower jawbone) instead of the soft tissue underneath tongue that is located more proximally.  

One member here turned his soft cervical collar upside down and it started working for him.  I have several of them.  It was kind of like a good mask - it took several tries to get the right one.

[chrotteg]

Hey all, thanks for all the comments. The SCC has helped me overall and I've always made sure not to put it on too tight. I upped my CPAP pressure just to see what would happen, I made sure to sleep on my side, and I used the SCC comfortably. Of course, with trying to eliminate my positional apnea, I had the worst night I have had since I started using a SCC. I was very adamant on not sleeping on my back yet I still had this cyclic type of breathing with CA events, I had hypopneas and OA events. Im not sure how I did everything to eliminate this behaviour and now its back. It is only one night so I plan to just redo the same settings and see how it goes. Are these kind of events grounds to try an ASV? This could have been a fluke night or the pressure increase could have caused it, but I would hate to buy a bipap or something and these nights still occur. 

I also got an O2 ring that comes tomorrow so Ill be tracking the SpO2 soon.

[SarcasticDave94]

I looked back at your sleep study info. 13 Central Apnea to 13 Obstructive Hypopnea listed. You could make a case for ASV based on that I'd believe.

Here's the question, do you believe the Central Apnea is the issue? Second, would you demand ASV if you thought it fixed this? You may have to fight to get it.

However if you do get it, you'll be able to get it setup fast here. I would consider skipping a Titration. So many posts with wrong choices from a Titration. Big waste. Besides humidifier, heated hose if connected, Ramp which I'll suggest skipping, smart start and stop, and reminders, you're left with therapy settings of a maximum of 5, mode, EPAP straight or EPAP Min/Max, and then PS Min/Max. This is based on the ResMed AirCurve 10 ASV, your gold level choice.