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CA - Treatment Emergent or Positional arousal
#1
CA - Treatment Emergent or Positional arousal
Hi all

I am just trying to get  an opinion on my recent rising ahi numbers and would appreciate any advice from the forum.

I have been chasing my tail with my settings over the past month in order to find the least restless sleep, I realize that zero ahi is a pipe dream although I did achieve this once last month, I am unable to replicate the earlier low ahi numbers I achieved in Nov/Dec when starting therapy.

I have been reading comments on this forum since I started therapy and have been making changes a long the way, the most obvious issue from my data is the rising onset of central apnea, my lack of knowledge in this field is forcing me to query the legitimacy of the ca events, are they real CA , treatment emergent or arousal/positional?

I have been checking OSCAR data on a daily basis and I have found that in over 90% of the time the CA preceding breathing pattern is interrupted, see pic 2, I will provide further in follow up post as limited to 3

a few large leaks last night but they haven't been norm recently, thanks in advance

Col


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#2
RE: CA - Treatment Emergent or Positional arousal
FYI some more info

see attached Sleep Lab Report and a couple more CA screeners

Col


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.pdf   apnea1.pdf (Size: 788.2 KB / Downloads: 18)
.pdf   apnea 2.pdf (Size: 718.04 KB / Downloads: 20)
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#3
RE: CA - Treatment Emergent or Positional arousal
hmmm 

no response have I incorrectly asked or assumed assistance? or is this a difficult subject?

Col
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#4
RE: CA - Treatment Emergent or Positional arousal
Your CAs are clustered, which is usually interpreted as a positional issue. Your sleep study shows no CAs, so that suggests they are treatment emergent.

I see your AHI shows a sudden increase beginning January 1st. What changed about then? Mask? Mattress? Pillow? Medication? If you can identify what changed in your sleep, or your life, about then, you might find a clue about the cause.

Unfortunately, I have no experience with clustered CAs, so we'll need someone else to comment on this.
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#5
RE: CA - Treatment Emergent or Positional arousal
It may not be what i see in the pattern, but I'm going to guess with the evidence of multiple PAP sessions you're having lots of disruptions of some sort that are introducing SWJ (sleep/wake junk) events. SWJ events are because you're between sleeping and waking, which is itself making more events. Most of these clustered events are either near the beginning or ending of your several sessions, the bookend areas.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: CA - Treatment Emergent or Positional arousal
Looks like central apnea but you also have some signs of restriction mixed in. Have you tried higher EPR to see if it makes things better or worse? If not I would try to slowly increase (can start with EPR of 1).
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#7
RE: CA - Treatment Emergent or Positional arousal
T example shows an arousal prior to the central which leads me to think that that central is a breath-hold as you are responding to the arousal. Yes there are signs of restriction/flow-limits.

More importantly what is different as of 1 Jan? It looks like two different machines? Am I right?

Clusters of CA events may be a positional sign, but only if the charts show the flow limitations as this one did.
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#8
RE: CA - Treatment Emergent or Positional arousal
Have you ever tried EPR? Just thinking of something we might try.
Sleeprider
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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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#9
RE: CA - Treatment Emergent or Positional arousal
Thankyou all for you responses,  I appreciate your assistance with this therapy !!

I think your interpretations have backed up my own theory so now its down to when and why this all started I guess.

The ca events are definitely waking me up recently and I am obviously tired during the day as result. 

This is definitely the same machine used over the start of my oscar data, from my own theory, I was achieving low numbers in Nov and early Dec but was still very restless, flow limits, leaks gas, etc so I started the as Dave puts it the "teetter tottering" of adjustments and the ca numbers just kept going up and inconsistent.

I have been trying a few different pillows over this period but haven't been convinced that could change my numbers so far, EPR levels have been tried at the low to med pressure levels, there were times when epr 1 numbers were low then 2 days later they were high, epr 3 gave me the highest ca readings 53 events recently (90 % of these looked like arousals to me) 

I use the over head chin strap and I taught myself to persist with nose breathing and nasal pillows, a few leaks recently with my positional changes and tubes being in the way etc I did use tape for a few weeks but my mouth breathing is now minimal. I tried a collar twice and it was ripped off early in the night, brought 5 different ones on line lol

I have attempted to replicate the settings to back when I was achieving low numbers but this has been largely unsuccessful, I take a range of different sleep assist meds from valerian to melatonin etc and generally change these up nightly.  i also use a range of supplements no script Vit D saw palmeto,  tumeric, moringa, zinc magnesium etc

I have attached a screener of my oscar data showing the setting  changes I have made in recent times to show my tail chasing exercise and the last 2 nights events, I would like to see your opinions on this. 

Tx in Advance  Col


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#10
RE: CA - Treatment Emergent or Positional arousal
You trying to wear out the buttons on your machine by changing settings each night? Wink

First rule of CPAP is that no matter what you will always have good nights and bad nights and that is especially the case with central apnea. In order to be able to tell if something is causing an improvement or not you need to use settings for multiple nights (about a week) and then look at average results over that time to see if the change was an improvement or not. The only time that isn't the case is if results are obviously good or bad (AHI spikes etc). Since your results are not obviously bad they can't get obviously better so you are looking for minor improvements.

The majority of your setting changes tried are so minor they have little therapeutic difference, as an example min pressure of 6.6 to 7.6 cm has little difference but you have tried numerous different settings within this range. Imo pressure rarely needs decimal points (I see little reason to use 6.6 instead of 6 for an example). Since your main issue is central apnea this is even more the case as pressure doesn't help treat central apnea and rarely affects it (unless using high pressure like 10+.

So next steps forward. Since you don't appear to have much of an obstructive issue lets fix pressure at 7 cm and try different EPRs to see if they help or make things worse. First we need a baseline that we can clearly compare against. Lets do min pressure 7 cm, max pressure 7 cm, 0 EPR for at least 4 nights. Then increase EPR to 1 and see what effect that has. It most likely will make things worse but we won't know till we get a good trial of it.
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