When to call it quits?

[shewhorn]

Ugh... for the past 70 days I've been trying CPAP again... and I've been sleeping far worse for the last 70 days. I'm pretty sure the cure is worse than the ailment. Starting to wake up with headaches now.





I'm kind of disappointed because I know leaving this untreated is going to lead to bad things but... while the fragmentation got a little better... it's not because I'm waking up less during the night, it's because I've gotten better at not taking the mask off when the machine does wake me up. I'm still probably waking up at least 4 times a night.

The big issue though... and I've maintained this position (and my ex-gf who is a clinical psychologist believes I'm right based on what she observed when we were together) is that my problem is with central apnea, not OSA. I think it gets missed on the sleep studies (which peg an OSA rate of 7 to 18 over 3 studies) because it's periodic. Sometimes it's bad and it takes me a few hours to get to sleep because I keep waking up gasping for air... and sometimes I go weeks with no problems.

Curious to hear thoughts. I'd like to get back to just getting a crappy night of no sleep instead of REALLY REALLY REALLY crappy nights of no sleep.

[justMongo]

At first glance, it looks like you need to be on an ASV machine.

[Sleeprider]

nearly all of your apnea is central. Up to 15% of obstructive apnea patients will develop complex apnea (both obstructive and central) when treated with positive air pressure. Those that have central events will require bilevel or bilevel-ASV. The normal protocol is to let patients fail on CPAP before insurance will reimburse for more expensive therapy. You're one of the "lucky ones" that is failing. Don't quit, upgrade. Tell your doctor what is going on, and that you're ready to quit. You just need a different technology.

[PoolQ]

yep. your pressure is low so I would not expect it to be causing your centrals. You need to look into ASV machines, they are the ONLY ones that treat true centrals (not CPAP induced ones)

The headaches in the morning are from retained CO2 or so my doctor said. Mine tweaked my settings and no more headaches.

[shewhorn]

Thanks... will make another call tomorrow.

[Jim Bronson]

My buddy is going through the same problem. He started off with CPAP, and he began to have frightening episodes where he would awaken choking and gasping for air. He was actually afraid to use the machine at all. His sleep doc told him that he has complex apnea and needs an ASV machine. Apparently the use of the CPAP machine brings out centrals that were absent without the therapy.

[shewhorn]

Interesting... the thing about my centrals... they were never absent. I've always had them, they just don't happen all the time. The past few weeks I've been having them. Tomorrow it might stop and I'll go back to an AHI of < 2 for a few weeks.

[DeepBreathing]

G'day shewhorn.

The fact that your central apneas are intermittent might suggest there is an environmental or behavioural factor contributing. For example, do you travel a lot, have occasional very late nights, work shifts, have occasional exposure to chemicals or other environmental changes, use alcohol or other drugs on occasion? Do you have other health issues which may be periodic in nature?

The reason for these questions is that I don't think it's normal to have severe central apnea on occasions, then none for weeks. There may be a factor which is triggering them. If here is such a factor and we can isolate it, then you could work to eliminate it. Or alternatively, you could try and time the exposure to suit your next sleep test.

In any event, an autoset is probably not doing you much good at the moment. It can actually aggravate your central apnea, which is obviously counter-productive. A well set-up ASV machine will eliminate central apneas and generally control obstructive events as well. If there is no environmental factor to eliminate then I see an ASV in your future. Unfortunately these are expensive and the "system" will make you jump through hoops to get one.

[shewhorn]

G'day shewhorn.

The fact that your central apneas are intermittent might suggest there is an environmental or behavioural factor contributing. For example, do you travel a lot, have occasional very late nights, work shifts, have occasional exposure to chemicals or other environmental changes, use alcohol or other drugs on occasion? Do you have other health issues which may be periodic in nature?

I've questioned this but could find no correlation and with the exception of when I go to sleep (which also seems to have no correlation with the centrals, and no influence on them either) there's no travel, shift work, chemical exposure, etc. I do drink alcohol but when I say "drink" that would be a max of a pint in any given day. I was curious if that was playing a role as I do know alcohol interferes with REM sleep but again, I found no correlation (although I might want to repeat the experiment with a bottle of Delirium Tremens for the next few nights ). With the screen shot I posted in this thread... I'd not had any alcohol in over a week (I only drink socially).

I've been in touch with my neurologist's nurse... even gave her the model of the ResMed ASV machine so... we'll see.

[shewhorn]

Just an update. Used data from Sleepyhead to make my case which was easy... as soon as the doc saw the data he ordered another sleep study. I was a bit bummed as I only slept about 30 minutes during the study but, apparently there was enough data in that snippet of time to convince the insurance company the ASV was needed. Last night was my first night with the AirCurve 10 ASV... quite a difference!

Not a perfect night's sleep as I'm sure there will be another adjustment period to get used to the much higher pressures this machine goes up to (anywhere in the range from 4 to 20 cmH20) but... only one event the entire night (an "unclassified" event) and last night was also a record in terms of duration of use for me at over 8 hours. Usually my tolerance was only 5 to 6 hours of use per night with the CPAP. So... a step in the right direction. The next trick will be to get all that sleep in one contiguous block without waking up.