[Diagnosis] Thoughts On My Chart Welcome

[fings1]

I've been a long time lurker and learned a lot from these forums.  Lots of knowledgeable folks so would love to get thoughts on my chart.  I attached link of last night's session. I don't have 4 posts so couldn't link direct.

I've been on CPAP for 4 years. I experimented a bit to get to these settings. My latest change was to lower EPR from 2 to 0. This was done in early June.  After the change, my AHI went down from 7-8 to the 4ish range. It's been climbing a little lately. I have always had Centrals driving the AHI number, and as mentioned averaged in 7-8 area...but with big fluctuations to 15 and higher at times.  I don't have my sleep study and don't have a sleep physician, just a general doc who doesn't know this stuff too well. No drugs or abusive alcohol usage.

FYI...I've never felt refreshed after sleep, and continue to feel tired during the day. 

Appreciate your thoughts!

h ttps://imgur.com/bkDsqUQ

[Sleeprider]

Welcome to the forum. Your settings on Resmed S9 Autoset are 8.4-16.0 with EPR off and no ramp. Your obstructive apnea is low at less than one event per hour, but you have a bit of a CA problem, and there is no obvious reason for it.  Is this typical for you?

[fings1]

Hi Sleeprider...this is very typical for me. My AHI is almost exclusively driven by CAs. I am very restless in my sleep and do have symptoms of restless leg syndrome (feeling the need to move my legs).

I didn't know whether seasoned eyes can tell whether I'm awake during the CAs or whether they are legitimate.

I have been tested for vitamin deficiencies, thyroid and testosterone to see if they contribute to my tiredness and they all look good.

[trish6hundred]

Hi fings1,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy, hang in there for more responses to your post.

[Sleeprider]

Hi Sleeprider...this is very typical for me. My AHI is almost exclusively driven by CAs. I am very restless in my sleep and do have symptoms of restless leg syndrome (feeling the  need to move my legs).  

I didn't know whether seasoned eyes can tell whether I'm awake during the CAs or whether they are legitimate.

I have been tested for vitamin deficiencies, thyroid and testosterone to see if they contribute to my tiredness and they all look good.

The data is reasonably good, but clearly I can't tell if you are asleep, sleep-disrupted or much else. About the only thing I can offer is that sometimes it helps to use fixed CPAP pressure, or minimize the pressure changes to address CA.  You might want to try 10 cm pressure fixed, and see if that reduces events, or if it results in increased H and OA. Trial and error is truthfullly all i have in this case.  If you want to resolve complex apnea, the solution is ASV, but you are borderline for that treatment.

Your events are spread throughout the night and don't suggest simple sleep disruption. You appear to have mild CPAP induced complex apnea, and the ideal long-term treatment is ASV. You have been using this therapy long enough that a consistent AHI below 5.0 is a reasonable expectation. Most insurance is not going to want to pay for therapy that gains you the relief you probably seek, but you have options. ASV would be available to you on an uninsured basis on the recommendation of a doctor, particularly your primary care or friendly specialist. These specialized machines are available from Supplier #2 for $1300 to $2000 in the form of "gently used" Resmed S9 Adapt or Aircurve 10 ASV, provided you can obtain that recommendation/ prescription, and are willing to take that financial risk. Most people with your mild complex apnea issues essentially reduce their AHI to zero using these machines. I will try to help you optimize your CPAP therapy, but keep in mind that results with this kind of central apnea can be unpredictable using CPAP.

[fings1]

Thanks Sleeprider.

I changed setting to straight CPAP last night to 10.2cm. No increase in OA or H while Centrals stayed the same. I did have issues with large leaks though so I have to resolve that. I also took a nap during the day (with the old setttings) so I've just zoomed in on the relevant part below.

I'll look to lower cm tonight and see what that brings.

h ttps://imgur.com/cEUhSQn

[Sleeprider]

You made member status, so no need to put a space in URLs, you can post your own.  In spite of the leaks this is encouraging and a big part of the night was free of events.  If you are game to drop pressure by 1 cm to 9.0, I don't see any reason not to do so.  We are looking for the lowest pressure that does not cause obstructive events.

[fings1]

Alright...just got your message this morning so had only reduced pressure to 9.8. Will go to 9.0 tonight and see what happens. Not much change going to 9.8...basically all centrals although AHI was down to 4.51

[fings1]

Hey Sleeprider and anyone else following...Chart from last night at 9.0cm.  Overall AHI was down - OA and H up slightly while Cs were down.  Should I hang out at 9.0 to see if this is consistent or should i drop a few cms to get a closer balance between all?



FYI...It appears I've fixed my leak issues with better hose management. Have it coming down over the headboard instead of laying on the bed next to me.

[Walla Walla]

You should probably leave it at 9cm for a few days at least. You can't go by one night's numbers.