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100 - 300 CA events in one or two batches during second half of sleep
#1
100 - 300 CA events in one or two batches during second half of sleep
Hi all
I was diagnosed in February with 20 - 60 AHI.  I started on APAP (Resmed Airsense 11) in July and pressure range of 4 - 20.  I had a sleep study with titration in September and they told me it showed no central apneas, and that my apneas were managed with a pressure of 8.  I've felt no improvement in my sleep quality and my sleep apnea isn't getting any better.  I recently found this board and started using OSCAR.  All of my events are CA and occur in one to two batches each night during the last 3 hours of sleep.  I've tried reducing the pressure range to 8 - 11 and then to 5 - 8 and have turned EPR off.  Are there other settings I should try?
Thanks

             
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#2
RE: 100 - 300 CA events in one or two batches during second half of sleep
You are doing the right things.
Get and insist on it, a full copy of your sleep Studies.  This should include the charts and tables in addition to the narrative.  Why? I have seen sleep test that contained nothing but central events and the diagnosis being Severe Obstructive Sleep Apnea.

Pressure alterations can cause central apnea.

My gut is saying this might be obstructive.  I'm not seeing the steady waxing and waning I'm expecting with central.

Tell me, are you using a new pillow?  Any accidents head bumps or med changes, particularly neurological meds or issues.

Please provide 3-5 minute views of the start of the central series, a few of them.

By any chance do you have a soft cervical collar?
I think this may be positional.  And yours looks odd enough to look into this.  Read the link about soft cervical collar.  It is unusual for this to show as central.
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#3
RE: 100 - 300 CA events in one or two batches during second half of sleep
Thank you.  I requested the sleep study report and they're going to mail it to me.
I'm not using a new pillow.  I had COVID in January of 2022 and had terrible brain fog when I got back to work.  When it didn't get better, my doctor referred me to a sleep/neurology clinic.  They did tons of testing and the only thing they found was sleep apnea.  The brain fog eased up eight months later, but I'm still not the same from prior to having COVID.
I picked up a cervical collar and will try it tonight and report back.

Here are the five minute views from the start of the central series.


               
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#4
RE: 100 - 300 CA events in one or two batches during second half of sleep
I wore the cervical collar (Futuro) last night and the results seem no better or even worse.
AHI 37.21
340 CA events
8 OA events

             
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#5
RE: 100 - 300 CA events in one or two batches during second half of sleep
Good advise from Gideon. I'll just chime in that your CA events initiate with apparent respiratory volume oscillations typical of someone near the apneic threshold, no flow limitations, and I have no reason to question the flagging of these events as CA. It's possible they were not present in your sleep study. At some point you should request a titration study to evaluate if this problem is repeatable with CPAP, with an option to try ASV to treat if centrals occur. They are heavily clustered, and the long periods without events will make any test difficult as the problem may not show up. Possibility this is sleep stage related.

I'll duck out for now and follow along since you're in good hands with Gideon.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: 100 - 300 CA events in one or two batches during second half of sleep
Thanks for the review and feedback.  Here is the sleep study w/titration report (study was a few months ago).  They're currently checking to see if insurance will cover another sleep study.
   
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#7
RE: 100 - 300 CA events in one or two batches during second half of sleep
Here are the results from the second night sleeping with the cervical collar.  I don't think I'll be using the cervical collar anymore since it doesn't seem to help anything.
Do you have any other suggestions other than waiting to see if I can get a new sleep study?

AHI 39.25
CA - 328 events
Hypopnea - 9 events
OA - 11 events

               
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#8
RE: 100 - 300 CA events in one or two batches during second half of sleep
You already have EPR off. With CA events we sometimes try to use a fixed, low pressure. This needs to be enough to mitigate OA events, but no so high as to cause more CA. I'm thinking you are headed to ASV therapy, but for now, set the minimum and maximum pressure at 6.0 and let's see if it helps. We will support you in working with your doctor to move to an appropriate therapy, or obtaining ASV out-of-pocket if your insurance is not going to cover the studies and equipment.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: 100 - 300 CA events in one or two batches during second half of sleep
I don't think the original assessment is necessarily wrong. I think the reason there were no reported centrals is that they were ignored because you are awake (or in a period of sleep/wake Junk) when most of the centrals are scored. If, as reported, a pressure of 8 suppressed most apneas you should try running with fixed pressure (CPAP mode) of 8 and EPR on fulltime at 3. Periods of sleep or sleep/wake junk cannot not be directly determined by Oscar charts but they may be inferred by a observing wide variations in Inspiration Time or Minute Vent (these charts will appear "spiky" during sleep/wake Junk or wakefulness). This is certainly the case for my charts.
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#10
RE: 100 - 300 CA events in one or two batches during second half of sleep
Thank you.  I'll set the min and max pressure to 6. 
They told me they might try to get me a BIPAP machine.  Will this help, or should I push for ASV?
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