What are the tactics for managing periodic breathing with OA?

[Beej]

At least a couple of times a week, my AHI zooms and SleepyHead shows that I had 1 or more episodes of periodic breathing punctuated by obstructive apneas.

example

What tactics might be useful in managing this? Going higher seemed to start triggering centrals in me.

[Sleeprider]

Generally speaking, periodic breathing is not a significant metric unless it is of long duration and occurs consistently. If you can find a pattern the leads to PB that might be useful. I find the machines may not be accurately identifying CA vs OA and I would expect PB to be associated with central apnea issues. It's not a well understood area, and if your apnea and hypopnea are usually in reasonable bounds, it probably is not something to be concerned about.

[Beej]

I get runs of 20-40 minutes with as many or more apneas during them.

[Sleeprider]

Would have to take a closer look. I know you have posted data in the past but I don't recall seeing a pattern we could address. If you want to take another shot at it, give me a link to a past post or put up current data. If your day to day results are remarkably different with very good ones and bad ones, then it is going to be more difficult to get to the root cause. Your occupation suggests that you are familiar with the difficulties of determining cause and effect.

[Beej]

Back to back nights, 1 week ago

January 21, 2017

January 22, 2017

Last 2 nights

January 25, 2016

January 26, 2017

[Sleeprider]

Your profile shows pressure at 9-13, but your graphs suggest pressure less than 9,0 fixed. The periodic breathing doesn't look like a problem and seems to be associated with the later event cluster. I'm guessing you have REM related obstructive events, and they seem to occur at nearly the same times night to night. These clusters correspond to increased flow limitation. What are your current settings (mode, max, min, EPR)? Have you tried using standard APAP rather than soft? Also, see the first link in my signature for recommended format to organize the charts.

[Beej]

Sorry, I keep forgetting to update the settings when they change.

The doc's office told me to reset everything to 7 cm pressure at the beginning of January ... even though the titration indicated 8 cm pressure was allegedly optimal, based on a sleep study where they gave me a sleeping pill. I don't know why the DME set it 7.0 cm.
The sleep studies did show that apneas were higher during REM.

I was starting to get CA happening around 9 cm pressure.

I am on 2 meds which may affect the amount of REM: protriptyline which may reduce REM and lamogitrine which may increase REM. I wasn't on the former when they did the initial assessment. I wasn't on the latter when they did the titration.

After several weeks at 7.0, I changed it to a range of 7.0 - 8.0 cm pressure because I figured the sleep study might have a bit of validity. I note on last night's it goes right up to 8.0 without stopping at 7.0.
I read in one post yesterday that EPR might be helpful for this, so I turned it on last night and set it to 1.0 cm pressure.

I don't snore much at all - maybe 1 - 2 times per night, if that, which is why I don't have it displayed on the screenshot.

Thursday - Friday

I didn't eat for 5 hours before bed last night, in case that was a factor. Last night shows it was not.

Friday - Saturday

[Sleeprider]

You have consistently high flow limitation, and the OA is a real consequence of a blocked airway at certain body positions or sleep stage. The only effective way I know of to reduce that would be additional pressure. I would try 8-9, and if you see centrals, then try a steady fixed pressure. With that much flow limitation, I would expect your pressure to climb to the highest allowed setting and stay there.

[Beej]

I'll see how it goes.