CA - Treatment Emergent or Positional arousal

[betterforthis]

Tx Geer

Yeah I know,  I was waiting for that comment  

only tried the minor adjustments after reading other recommendations in here , I actually just changed it to 7.4 - 14 epr1 just now after looking back over my earlier data with least ahi and flow limit issues

ok I can change it back to your setting tonight so leave on "apap" min 7 max 7 epr 0 ok done

changed pillow again just now and made a tube clearing hanging device to clear the annoying thing


couple more screeners ca last few nights close ups

Col

[SevereApnea]

Got to look after those buttons!

Try to remember the time difference between WA and the USA in waiting for replies.

I see your posted sleep study had no CA, so something about your therapy setting is causing this.

I find it hard to differentiate true CA from SWJ even after re-reading posts about this, but that's just me.
As suggested, see what changed at the beginning of Jan, something to do with your sleep position/hygiene/machine settings has increased your CA count.

I seldom achieve an AHI of 0, if I do it's a fluke or just meant I had a night of lighter sleep than usual. Certainly not to aim for. You will be chasing your tail for the rest of your life if you do.

As Geer1 said chopping and changing things too frequently leaves your bodily homeostatic mechanisms confused. This applies to both the machine settings and all the sleep aids you are taking, and general sleep hygiene. We have to accept some bad nights, and the occasional good one and some average ones. When changing up settings you can expect a few rough nights to start with. 

Try setting your charts in the Standard Chart Order to make it easier for us to see what is going on. Once you have them in the right order right click and select "Pin xx chart", that will keep it the way you want it next time you open OSCAR.

Looks like the week ahead will only be mid 30 degrees C so not too bad for Jan/Feb.

All the best.

[SarcasticDave94]

But he does deserve an award for all those trends, even if they're one night trends.

[betterforthis]

Understood, I will persevere with new settings

Tx Dave 


Col

[Geer1]

We might try a pressure test after EPR, I would be thinking a more noticeable jump to say 10 cm though. One change at a time makes it easy to know what is causing the improvement/worsening though and I think EPR is better to test out right now. For that reason you should continue to use the same pillow etc during this time though.

The one issue with trying to titrate in APAP mode is that pressure still fluctuates which can have effects. You did correctly leaving the machine in a handcuffed APAP mode rather than switching to CPAP mode, the only reason we do that is because the machine only records flow limitations in APAP mode.

[betterforthis]

Tx Geer

I did try one night with a fixed cpap and I had to wake up 3 times to change settings drove me mad

appreciate the advice everyone

Col

[Geer1]

I see your posted sleep study had no CA, so something about your therapy setting is causing this.

To be fair his sleep study had next to no OA as well. CPAP appears to have improved hypopneas (indicating they were probably obstructive) but caused or worsened central apnea.

I assume treatment emergent central apnea with the odd SWJ. A number of these apnea do appear to be post arousal. My theory is that he is seeing more central apnea now because he isn't as restless as he was and is therefor staying in a sleep state after arousal instead of being awakened. Hopefully this is the case and his body continues to adapt and centrals start going away.

[betterforthis]

Tx Geer

I am looking forward to the challenge

39C over here today btw....

a couple more screeners of the high ca over last week zoomed a different levels to see preceding patterns and post event

Col

[SevereApnea]

"But he does deserve an award for all those trends, even if they're one night trends."

yes, and for perseverance, just what us Pappers need.

 

@Col, reading your prior thread I see you really don't like wearing the neck collar. When I use the neck collar (every night now) my pressures needed are much lower than before. So for me that takes care of most of my OSA issues.*

By the way, I see you had only short time in the sleep study: just out of interest was this a pharmacist/home/in hospital type PSG? No need to name any names.

@Geer1

"To be fair his sleep study had next to no OA as well." That is a good point, I missed that. AHI of 33 mainly made up of Hypopneas. Average duration of 22 seconds. Do you see that often and would that need a different approach to PAP therapy? I mean, generally more EPR is suggested for HA, but the OP is already concerned about his CAs.

* Just coming from left-field: Question to the more experienced Board members: would this be a case for just wearing the neck collar and not using the PAP? Or set the PAP pressures real low to see what data shows? Is this ever an option?

[betterforthis]

Tx for having a look SA, 

a lab test was recommended last year when we had exhausted all cardio checks (all good) treated bp was averaging 150+/100 felt crap and fatigued ( I still think it was first covid jab) but cant prove it.) triple vaxed now, we were blackmailed into it over here but that's another topic away from this forum.

The Lab test in my opinion was a joke, I had next to no sleep it was so uncomfortable and I questioned specialist as to the how they were able to conclude the outcome based on the limited sleep time, he was adamant it was conclusive.

A change of bp meds and cpap and I had improved out of site within a month, not sure if it was the meds change or cpap or both, I average "ideal" bp numbers !!

I also doubted the requirement and did a heap of research pros/cons of the therapy and committed as this was at no cost to me as a fully entitled vet.  

FYI I have a had very restless last few weeks with these ca events

I hear where you are coming from and I have seen responses from other questioning the requirement for cpap, interesting to see some opinions, 

Col