Seeing large number of clear airway events after starting new medication

[PapaColin]

Hi everyone, 

I was diagnosed with mild OSA, with an AHI of 6. I was also diagnosed with idiopathic hypersomnia based on my MSLT and the fact that the CPAP never helped me with excessive daytime sleepiness despite having 1-2AHI for 6+ months. During my sleep study, I had 10 central events, 9 of which occurred during REM. 

I have been taking XYWAV for the past 3 months, which is a medication for treating IH and narcolepsy. It’s a very heavy sedative so it’s known to cause or increase apnea events.

Due to a recent septoplasty, I haven’t been using my CPAP. I recently started using it again for the past week and I am noticing a large number of clear airway events every night. 

I have included a screenshot of my OSCAR data. 

Are these true clear airway events or are they something else? If they are, is it treatment induced apnea caused by my pressure being set too high? Or is there some potential I need another machine? 

I was also wondering if I should increase my pressure since I saw the mean pressure was around 15. 

Any help you all can offer would be much appreciated.

[SarcasticDave94]

Did you get your diagnostic sleep study report around the time you joined Apnea Board? You should be have requested one after the test.

I'm asking due to your questioning on Central Apnea. This Detailed test report would give information about all events, which can help now as well. The prescribing doctor would be who you'll request it, and they aren't legally allowed to refuse it under US HIPAA.

The info most relevant to this discussion is how many events total and individual, and what did they diagnose in writing. Note this can be different than what they told you.

As for those current CA, there's several possible causes, they might actually be positional apnea involving neck kinking and restricting the airway, it could be actual CA where your test would indicate how bad they were during the test which reflects back to current, maybe also they're false flags in some way.

They are very likely not going to be treatment emergent if you've been on CPAP since last May. Have you continued to use CPAP from the beginning regularly?

[PapaColin]

Hello, thanks for responding. Hopefully I’m responding to you correctly. 

I do have the full copy of my sleep study, not just the physicians interpretation. I slept for 412 minutes. During this time, I had 10 central apneas, 9 of which occurred in REM. I had one obstructive apnea and 33 hyponeas. 

I haven’t really switched my sleeping position, I sleep on my side or on my back and I don’t wake up with any neck pain or anything from sleeping weird, although that may still be a possibility. 

I did stop using my CPAP for about 2 months since I had a septoplasty for my deviated septum and enlarged turbinates. I’ve been using it again for about 10 days now. 

Could it just be treatment emergent apnea? It just seems like a lot of events to me. Last night was even worse, I had 13.48 CA events per hour last nigh at the same pressure.

[SarcasticDave94]

OK to clarify in the positional aspect I mentioned, this isn't the sleep position thing but a chin tuck aspect of how your head and neck align in such a way to restrict the airway. How thick is the pillow you're using?

You've been on CPAP a while, X months or so, then had to stop for surgery and are back on at 10 days, sound right? Then it's likely not treatment emergent CA.

You've had 10 Central on the test, 1 Obstructive, then 33 Hypopnea. Hypopnea can be Central as well, not certain yours are though.

Care to post a New Attachment to show at least the diagnosis area on the PSG diagnostic? Redacted of personal info please. Also of note, take a look at that test result and see if they mention Centrals anywhere, besides that 10 CA count.

You may want to try EPR 2 as the only edit. Let us know if that makes things better, worse, same. It may reduce CA, but can increase other things, so be ready to return to prior if it's not going well.

[PapaColin]

I am using a purple pillow, which I would say is of medium thickness. 

Yes, everything you said regarding my CPAP usage is correct. I've also been taking XYWAV for about 3 months, which I worry could be causing the increase in centrals. 

I have attached 3 pages from my sleep study containing the apnea data. 

I will try lowering my EPR to 2, thanks for the suggestion.

[SarcasticDave94]

OK good job. One final question for now, your self evaluation of therapy prior to the pause for surgery and after, they're feeling basically the same with similar events?

You don't get a big prize for an extra long CA, you had 1 at 30 seconds, and another which did drop SpO2 to below 90%. The CA are part of the issue it seems, maybe more. Let's see what happens on the reduced EPR. This is key though, if the edit makes therapy feel bad, please change it back and just post about it with the OSCAR. We're not wishing to torture.

PS I had a 90 second CA on my '17 PSG, with a score of 124 CA and 24 OA. Most have a few CA regardless, some they're more an issue than for most.