[Diagnosis] Questioning CPAP when experiencing proportion CA events

[Geer1]

In the lead up image you posted you can see that there is a clear arousal prior to the apnea cluster, this arousal was either due to the leak or was a spontaneous arousal during it. I have marked the arousal in the attached image for you to reference.

What isn't clear is if you were only temporarily aroused(not obviously awake) and these apneas are due to the transition back to sleep state or if you were actually awake in which case these events aren't real and are called sleep wake junk. 

You can find a little more info at the following link (for both wake breathing and in the next section about sleep transition centrals). 

http://www.apneaboard.com/wiki/index.php....22_events

After your first apnea cluster you turned the machine off. Do you remember if you shut the machine off right after waking up or if you were awake for a while before doing so (trying to fall back to sleep etc)?

[Aussie Lee]

Greer1 
Thank you for the info and analysis... it's all starting to make more sense.
With regards to the first apnea cluster, I woke in a bit of a panic and turned the machine off straight away. It took me a few minutes to settle and restart the machine. 

I don't remember an arousal or being awake at the time of the second (highlighted) cluster so would assume it was a period of transition back into the sleep state.

Thanks for the link... looks like i have lots to learn!

[Geer1]

I had a feeling that might be the case based on the data you shared.

It seems these are definitely post arousal, sleep transition centrals. Instead of your body just having one or two and then picking up a normal rhythm for some reason it overshoots and then undershoots until either it evens out or wakes you up. ASV is the only machine that can even this out for you but what you can try for now is to work at minimizing arousals which will minimize the number of times this happens.

Sharing that arousal example with your sleep tech would be a good idea so they know what they are dealing with.

Do you use any medication etc that may affect your sleep?

[jaswilliams]

I have CA’s only during REM sleep yours could be similar as the ca’s occur in blocks typically 1.5 hrs after going to sleep. If on the other hand you are awake then the ca’s can be discounted

[Aussie Lee]

Attended my appointment with the sleep clinician today.

 Deep Breathing Wrote:
If your therapist is doing what mine did, she is trying to narrow down the pressure range with a view to finding a single fixed pressure. When that doesn't work, she'll cast around for options eventually realising that ASV is what's needed.


And this is exactly what my clinician is attempting to do. 
She has made the following changes

Ramp pressure is 8 (up from 6) with EPR set at 3 and time set to Auto.

Fixed pressure of 11 (previously auto max 15) as according to her stats this is my optimum pressure at the moment.

So we shall see how this plays out over the next couple of nights.

I am concerned that a fixed pressure of 11 will lead to more mouth leaks as these seem to occur whenever i go over 10.5.

Clinician is convinced that she will be able to get the CA's under control with a fixed pressure and did not think an ASV machine would be needed when i mentioned it.

We shall see ...I'll keep you posted

[Sleeprider]

You had CA events as part of your diagnostic test, and continued to have them with CPAP. Will there be a magic pressure that makes them disappear? I'm skeptical. There is a solution that will work, and it's just a matter of time and money until you decide whether you can live with your current level of efficacy or whether the best investment of your time and money is a more advanced machine. Wish you the best of luck with fixed pressure. That is exactly what I would do, but at a lower pressure. Your auto CPAP trial to date has show anything over 9.0 triggers a lot of complex apnea, and you have a low OA rate below 7.0 pressure, so that is the range I would shoot for as fixed pressure.

As I said back in Post #16, it's good you are able to give CPAP a try, but you need to listen to what it is telling you...higher pressure makes for higher AHI. Fixed pressure may work better, but I predict 11.0 won't work and I would have you at 8.0. I also still think this ends with ASV simply based on the fact this is not treatment emergent.

[JoeyWallaby]

You'll find that magic pressure... any day now   

[SarcasticDave94]

I do hope your doc gets you to where you're going nice and quick. The magic carpet ride may take you longer than patience permits.

[Aussie Lee]

   
Thank you everyone,,

Love the mickey image... and yes it is a magic carpet ride which I am for the moment committed to riding....but i'll only give it another 2 weeks... to the end of my trial.

And Yes I am with you all on this... I am fully expecting to end up with and am advocating for ASV.
It's just a matter of convincing the clinician!
Though at the end of the trial if she doesn't come to the same conclusion I will most probalby take matters into my own hands and just purchase the asv unsupported and post on the board to help with setting it up correctly.


Trial at 11 cm then dropped to 10cm
Last night after an hour on fixed pressure of 11 cm I reduced it myself to 10 and got away from the large leaks issue- mouth breathing...or should I say my pressure relieve valve (mouth) gave way.

Had a more continuous sleep after but woke with a nasty headache.

It will be interesting to see what the clinician has to say after she logs in to my data tomorrow.

Thanks again Apnea Board Brains Trust (ABBT) ... loving your work

[SarcasticDave94]

Unless your doc prescribes a set point on ASV, I'm guessing we'd probably start you on ResMed suggested titration settings. I would suggest heavily leaning towards ResMed branded ASV. It'll knock out anything your apnea throws at it. Hope you'll be getting progress soon.

I've got a ResMed ASV myself, and it was providing excellent support until I had to let my COPD progress and throw a wrench in the whole thing. Due to that, I get a new try at sleep study to try and generate results pointing to another device. Now I've thrown the thread off-topic on this snowy eve.