CPAP not helping with sleep. Cheyne-Stokes or PB?

[BigBobulous]

I started therapy in October of last year. I went to the Doctor because I was having very rare instances of waking up gasping for air. The at home sleep test said I had minor apneas but the doctor gave me a CPAP because I told her I drink and she said I was having more apneas than I realize because of the drinking ... ? 

Anyways, CPAP has been a nightmare. After I started treatment, I began startling awake every 20-30 minutes feeling like I wasn't breathing. The doc said I had developed central apneas. She said my numbers were still low though. I told her they were low because I lay there awake all night not sleeping because I am afraid of the feeling of when I stop breathing. The doctor ordered another sleep test which I did in January in lab. I was only able to sleep for 2-3 hours, but the the tech said she got rid of my central apneas with a pressure setting of 9. I went home and tried a couple more weeks with my new settings and continued to keep waking up every 20- 30 minutes struggling to breathe. I am also seeing at elast half o fmy events as Clear Airway Events, so I hae to wonder about the idea that my centrals are fixed.

The doctor looked at my results and my CPAP report and said I was doing great and that the waking up was either anxiety or restless legs as they noticed I was kicking a lot during my test. I have never been a kicker in the past and I have read a CPAP can cause this issue. Hurrah. The doctor's last suggestion was to try not using the CPAP for 2 weeks and if I still can't sleep to give me something like Klonopin for the resltess legs. I tried one night without the CPAP and I wake up struggling to breathe even more without it.

I have an appointment with a new doc as I feel like she isn't hearing me and she isn't trying very hard to remedy the situation. In the mean time, I got a card for my CPAP (it didn;t come with one) and started recording my data. I noticed that in the last couple of months I have a couple night now that say I have Cheyne-Stokes breathing occurring. I checked it against the images posted here and I am afraid I might have the real thing. Can anyone take a look please at my data and see if :

A. You ave any suggestions for better slepp and,
B. If this is actually Cheyne-Stokes or not?

Thanks in advance.

[Sleeprider]

Is this doctor some kind of sleep specialist? You need a different doctor. Central apnea does not go away because of higher pressure, it requires a stimulation of pressure support from a bilevel machine called an "adaptive servo ventilator" (ASV) that promotes spontaneous breathing when you are able, but triggers breaths when your respiratory drive is not present. We often say, "central apnea is consistently inconsistent", and during your titration test, you just didn't have CA while the titration was at 9.0. If you post a copy of your study with your personal information redacted, I'll help you understand what happened and how to refute it. For example, on the chart you posted, you had no CA from Midnight to 4:00 AM, then it gradually increased. Anyway, your pressure is currently 5.0 to 10.0, so it will help to see the full night so we know if pressure triggers the CA events.

[BigBobulous]

Hey Sleeprider, thanks for getting back -

My doctor is a pulmonologist/sleep specialist. As I said, she seems very uninvolved. I have a recommendation to a sleep center called Fusion Sleep in the Altanta area, I am going to try them out.

My study is a PDF, what is the best way to post it here? Also, what is the best way to show a whole night, just zoom out or save in a different format? 

Pease forgive my ignorance, thanks so much for your help.

Also, did you have any thoughts on the Cheyne-Stokes pattern I posted?

Thanks again!

[Sleeprider]

My signature has instructions on inserting attachment files. If it is a large PDF you may need to split it into a couple files. I would start with the full night, and if there is a need to zoom in, I can help you target what we need to see. Resmed flags all periodic breathing as CSR, so don't worry about that too much. You seem to have what we often call a feedback loop that involves alternating hyper and hypo ventilation. It's normal, but you have a bit of lag-time built into how your brain perceives CO2, so your respiration lags behind the respiration. Here is a wiki explaining it. https://www.apneaboard.com/wiki/index.ph...entilation

This pattern often starts with flow limitation, a form of obstruction that causes a buildup of CO2, then the recovery breathing will initiate the loop gain periodic breathing. I'd like to see the full-night chart rather than just the closeup to advise you better, but I'm looking at an increase in minimum pressure and the use of EPR to prevent this from starting.

[stevew168]

The doctor's last suggestion was to try not using the CPAP for 2 weeks and if I still can't sleep to give me something like Klonopin for the resltess legs.

Klonopin is a benzodiazapine. My understanding of this class of drugs is they can become addicting if used for more than about two weeks.

Many people have had good results taking magnesium glycinate to help with RLS. Magnesium is a common deficiency. Be sure to consult with a competent doctor before trying it. I have had excellent results with this for leg and foot cramps. It has also helped me to stay asleep throughout the night.