4 months in: falling off the treatment emergent central apnea cliff

[SleeperAwake21]

Hi all,

Background: Now 4.5 months in on my Philips DS2.  Pretreatment sleep test AHI was 45, and am still stuck around 10 despite some promising initial trends. (The data gap was due to a nasty URI for several weeks).

Min-max pressure settings are 6 and 15cm, although I never see the max being approached (last night mean was 7.6 and 90% pressure was 10.4)  I am using a Wellue SleepU oximeter to track SpO2 - and to alert me via the alarm when it plummets.

Central apnea: The past several months have featured treatment emergent central apnea, especially just after I fall asleep.  As soon as I do, my SpO2 just falls off the cliff, and the finger alarm on my SleepU encourages me to start breathing again. If I wake and fall asleep during the night the patterns repeats itself.

I just had my periodic sleep doc checkin, and she (when she saw my uploaded SpO2 traces) said the pattern was classic for treatment emergent central apnea. I have appended a recent trace which shows  my record number of finger alarm activations (black triangles) for a sequence.

Sleep doc had me reduce my FLEX setting from 3 to 1. I am tolerating the FLEX change (in terms of exhalation pressure) fine, but am seeing little overall response in central apnea.  She said try this for several more months and see if it resolves.  Sleep quality is unsurprisingly poor for me - other suggestions for what I should try?  I am thinking turning FLEX off altogether as a next test.

Thanks!

   
   

[SarcasticDave94]

I'm making the assumption for now that the dropping SpO2 session was actual and not some measurement failure. You've had these all along historically while here it seems.

I don't see the diagnostic sleep report unless I missed it. What I'm after is the events type and counts to give the CA a proper category. The supposed treatment emergent Central Apnea has gone past the accepted 3 months. Time to refuse this excuse and demand better therapy. Idiopathic CA maybe is more like it. And on top of it all, those SpO2 drops are supposed to indicate an issue not to be ignored.

If this were me, phone call doc, hey this still isn't going well, CA and SpO2 drops still here, when are you going to pay attention and FIX it? Oh it's ok and I should just ignore the symptoms? Err, hmm, ok you're fired. CLICK. Fire and replace is my opinion.

[SleeperAwake21]

Thanks. Original sleep test is attached (after anonymization) - was all obstructive and no CA as far as their test was concerned. That said, my original impetus for seeking a sleep test was the experience of drowsing during naps and realizing I was simply not breathing.

[SleeperAwake21]

Oh, and verifying that those SpO2 drops are real is my wakeful wife sometimes poking me and saying "Breathe!" when they occur.

[Geer1]

Try turning flex off. Flex 3 to flex 1 is only a minor reduction, flex 1 to flex off will be a much more substantial change and should help with treatment emergent CA.

[SleeperAwake21]

UPDATE: Sleep doc similarly suggested dropping FLEX to 0.

But ... I could only tolerate it for 4-5 days: sleep was much worse/shorter, and centrals actually went up.  So I am back on FLEX=1 and am back to seeing some of the central cliff when I fall asleep, but my SleepU only needs to trigger the alarm on those occasionally (I have it set at 88% SpO2.) Pressures stay between 7 and 12 so the CPAP isn't calling in the heavy artillery.

Now that I'm running the alpha for the newest OSCAR, I can see my nightly DS2 traces and also import my Wellue SleepU data so all of it is in one place.

[SleepyTeacher]

This was very helpful in spotting treatment-induced CA's compared to real ones. Ty