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[CPAP] Not sure my CPAP is doing any good
#1
Question 
Not sure my CPAP is doing any good
Here is my O2 ring data for the evening:




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#2
RE: Not sure my CPAP is doing any good
Do images not really work? The preview showed the images just fine but on posting it freaked out. How do I insert images?


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#3
RE: Not sure my CPAP is doing any good
Great, lost all my text in the first post, grrrrrr. 

Here is my O2 ring data, looks fine to me. 

Lets start at the beginning. This all started with a couple of ER visits starting on Thanksgiving with chest pain. Caught a virus of some kind, not Covid, not the flu, RSV maybe? They couldn't test me for that as there was a massive outbreak in my area and they were out. They sent me home with a diagnosis of Costachronditus. 

Less than a week later I was back at the ER unable to breath laying down. Admitted to hospital with fluid in my lungs and a diagnosis of heart failure. Since then my cardio doc says there is nothing wrong with my heart as both the echocardiogram and stress test showed ZERO issue. He says (as did I while in the hospital) "perfectly good heart had a really bad week". Virus plus probable sleep apnea where the culprits, slowing my heart down with lack of O2.

Almost a month later I FINALLY get the diagnosis of sleep apnea and a CPAP to start getting used to. One week in and rather than make things better it seems the CPAP is doing little good as my AHI only gets worse every night. Only my wedge pillow is allowing me a decent nights sleep.

I think tonight I will be trying my first night without wedge and with CPAP. (Prior wedge free nights produces O2 stats dipping into the 70s and feeling like a zombie all day.)
I just switched to the P30i last night, first two nights were F30i (hated that), next four were N30i (most comfortable but not capable of pressures over 10). Tonight I will boost to 12 as I think the P30i might handle that.

Looking at last night's data it seems all of my apneas are my body just deciding not to breath. I see no evidence the CPAP is preventing OA's or that the OA's noted are real. (I have learned that holding my breath while rolling around will trigger false OAs so I don't think I triggered those last night.)


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#4
RE: Not sure my CPAP is doing any good
In your case mouth breathing triggers periodic breathing. Just my 2¢.
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#5
RE: Not sure my CPAP is doing any good
(01-14-2023, 06:05 AM)multicast Wrote: In your case mouth breathing triggers periodic breathing.  Just my 2¢.

Could you explain that a bit? I am normally not a mouth breather but for the first time last night I did wake up twice with air rushing out of my mouth. I can't sleep if I can't breath well through my nose. Here is last nights CSR session. To me it seems the machine is falsely calling OAs when they look just like CAs to my untrained eye. Am I wrong?

Are you saying because my mouth popped open I went into the CSR patter?


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#6
RE: Not sure my CPAP is doing any good
You are bouncing between hypo and hyper ventilation compete with over and under shooting.  This is typical of what I call a CO2 driven Breathing pattern.  

The difference between a reported central or obstructive is if the FOT (that buzz you see prior to an apnea senses an obstruction or not..


What starts it?  An arousal if we re lucky.  Otherwise guess.
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#7
RE: Not sure my CPAP is doing any good
So.... Is the machine helping me? Do I need to bump up the pressure? Are these readings good/bad? Should I try a chin strap to prevent my mouth from opening?

I have only had it a week but I don't really see any 'progress', just seemingly random results each night.
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#8
RE: Not sure my CPAP is doing any good
It is helping you.  The only change I would make now is your min pressure.
Set min pressure = 7 to allow the full use of your EPR.  Maybe bump it up past that a bit later.

You don't need to tightly manage your max pressure.  Thus I'd set it to 15.  You should not even notice this since I strongly doubt your pressure will get that high.
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#9
RE: Not sure my CPAP is doing any good
Another user pointed out that recently you were diagnosed with CHF.  The periodic breathing is IMHO CO2 driven and perhaps misreported OA events at the Nadir of the waxing and waning as they show central characteristics.  These, out of an element of caution, should be shared with your heart doctor.  Why is because CSR is very closely associated with CHF.

For every day you have had this periodic breathing,

1: print the full day detailed charts

2: print 10-20 minute views showing these periods of periodic breathing

For a day also print the minute Vent and tidal volume.

With CSR I'd expect a longer duration and a higher instance of CA at the nadir, but this is close enough to bring to your doctor's attention.
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#10
RE: Not sure my CPAP is doing any good
You would think my cardio doctor would be interested in this. The very first day I saw the CSR come up I sent him a screenshot of the OSCAR data and asked if this was something we needed to do something about.

He didn't respond or think it was anything important. He just wants me to check in in six months for a regular follow up. He is/was convinced there is nothing wrong with my heart. I get the feeling if there isn't a surgery for him to perform I am not worth his time. He referred me to my sleep specialist.

How can my sleep specialist even help if all they get are the AHI numbers the machine uploads to the cloud? They are not even scheduled to call me and check in for over a month.

I have tried to do some research on CSR (as my cardio doc is of little help) and what I found seemed like it's controversial. One study I saw seemed to indicate it was potentially the bodies way of giving the mechanisms a rest.

Which comes first, CSR or CHF? Does CHF cause CSR or is it just 'associated' with it?
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