Worried about periodic breathing / CA patterns

[Jorgo]

Hi all,

First time poster to the forum, so thanks for having me!

As a bit of context, I was recently diagnosed with severe, complex apnea (AHI of about 80 during my in-lab sleep study, with tonnes of mixed and CA events) and have been on APAP for about a month now.

Whilst I'm encouraged by my significant drop in AHI score, where my residual AHI is typically somewhere between 2 and 8, I'm a bit concerned that the vast majority of my events are CA events.

Additionally, I've recently delved into the terrifying world of interpreting data using OSCAR and I'm even more concerned about some weird breathing patterns.  I don't really know what I'm looking at but the below is an example of what looks like, to me at least, CSR patterns.  For anyone experienced in interpreting Oscar data, is this anything to worry about?

I've also got a follow-up meeting with my sleep doctor later in the week where I will be discussing whether I should be switching to an ASV. He seems to think that my CA events will naturally reduce over time but I'm not so sure and I don't want to have to buy another machine in the near-term!

Thanks in advance!

[SarcasticDave94]

Welcome to Apnea Board,

If you're able to get your sleep study report, it would be helpful to post it redacted of personal info. This can help us direct how to help with your therapy.

Just going by your phrase "diagnosed with severe, complex apnea", this can mean ASV will be your best bet. A CPAP may improve things overall enough, however there's times it's not enough. Your complex apnea may follow a pattern like mine have, if so a regular BPAP (bilevel) without backup rate may make the Centrals worse.

Also, with CPAP and BPAP without the backup rate involving Central Apnea, you're only going to be able to attempt avoiding the centrals while treating the obstructive portion. This would be where ASV, the best being ResMed AirCurve 10, shines. It can treat obstructive and centrals.

Final note, the Oscar chart would be best shown with the left panel data intact without the pie chart and calendar. This helps with the treatment story. If possible, add this along with a full not zoomed chart to give us a bit more baseline.

[Gideon]

Please post your daily charts and your sleep study (redacted of course).

See the very jagged breaths in your zoom. This indicates disturbed, often awake, breathing. cA events associated with that are typically holding your breath.

The daily chart will) provide a lot of info on how you are doing and the sleep study will say a ton about where you are without CPAP.
Please include the charts and tables in addition to the narrative.

[Phaleronic]

Please follow the advice and steps listed by the two posts above, we would really like to see a full screenshot of your daily chart.

[Jorgo]

Hi all,

Thanks so much for the quick responses.  I'll post some full daily graphs when I get home tonight but for now here are the details of my sleep study.

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And final 2 images of sleep report.

[Jorgo]

So here are some zoomed out data from the last few days (and one zoomed in picture from one of my worse days and the stats page).  The last couple of days have been surprisingly good but I'm not sure if this will keep going as it tends to jump around a lot.

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Final images.

[Jorgo]

Uploaded lower res images

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Uploaded lower res images #2

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Uploaded lower res images #3.

I'm so sorry about the spam, didn't realise there was an attachment allocation limit and I wasn't able to edit my previous posts.

I'd be extremely keen to understand what, if anything, I should be concerned about / possibly look at tweaking based on the data I've uploaded.

[Gideon]

IMHO ASV would be bad for you. It would cause rapid pressure changes and actually cause the centrals you would want to prevent.

Simply continue using EPR=1 as that seems to work fairly well.

I do see some moderate flow limitations (FL Stat) but nothing that screams treat me. The treatment for you would be an increase in EPR (or PS pressure support on a BiLevel/ASV) which you have proven to cause higher centrals.

Your tendency to increase centrals with higher EPR I'd expect to decrease in 2-4 months and then we could try EPR=2 again

How do you feel? And be critical. Your comfort is what to focus on for now

[Jorgo]

I'm a bit of a mixed bag to be honest. I think objectively I'm a bit less tired than before treatment, but still not fantastic. As an example, I used to have a tonne of micro sleeps to and from work on the bus, which I don't seem to be prone to doing now. However, I still get drowsy while highway driving after a short period of time and have to switch drivers at about the hour mark - something completely unheard of only a couple of years prior.

And thank you so much for the prompt responses. It is all really new to me and I really don't know what I'm looking at. I also tend to catastrophise so having this condition and not feeling like I fully understand what the data is saying, how serious it is and how I can tweak settings to make it better is really making me a bit of a nervous wreck!

[Sleeprider]

Jorgo, your therapy has improved significantly with CPAP, and this is something we often see. Even though your diagnostic study shows complex sleep apnea, your doctor's hands are tied by insurance to start you on CPAP because it is the lowest cost machine. Insurance requires that you fail CPAP and BiPAP before moving to advanced PAP devices. This wiki article discusses the process. https://www.apneaboard.com/wiki/index.ph...P_Machines

A couple things you need to know. Your central apnea rate and occurrence will be consistently inconsistent with CPAP. The presence of periodic breathing that suggests you are often at an apneic threshold is disruptive to your sleep and an indication that your therapy is not optimal, even though the event rate is low. It may be better to fail at CPAP than to optimize it in order to move more quickly towards the ASV solution you need. It is up to you to effectively communicate with your doctor that you are uncomfortable and continuing to feel the effects of your complex sleep disorder. He needs this feedback to justify moving you to the next level of therapy. Ultimately, you want an ASV titration test, or to simply be prescribed ASV. You will immediately have nearly zero events and all these artifacts will go away. I would agree with Gideon, that your therapy looks okay with a moderate event rate, and we may be able to optimize it, however I'm sure Gideon will agree with what I have outlined above...he wrote that wiki article.

Let's go with Gideon's advice above and increase the minimum pressure to 7.0 (your median pressure is about that), and use EPR 3. This will eliminate the flow limits and calm some of the pressure variation. This should optimize your therapy if CPAP is appropriate, and it will also expose if you are sensitive to increased ventilation from bilevel pressure.