Frightening results

[robotman]

That's the daily stats from last night. My questions are:

Is the machine doing its job?
Am I at risk for another stroke, with the continual stopping of breathing does my heart still go into crisis mode and try to wake me up, racing? (I have atrial fibrillation.)

Cheers

[robotman]

Focus on the AHI part.

[lmoretti]

You need to talk to your doctor. If this is accurate, you likely need a more advanced machine than a standard AutoSet.

[Sleeprider]

The pattern you posted is typical of complex apnea, and may be actually aggravated by CPAP pressure. When this patter becomes typical, it means the patient might need to be treated with an adaptive servo ventilator that works like a bilevel CPAP with a backup respiration rate. They are marvelous machines for those that need them.

If this is an isolated and unusual result, it may not be anything to be concerned about, but needs to be watched. A number of members here have similar problems and successfully and comfortably use bilevel ASV machines to achieve very low AHI, but your Autoset cannot treat centrals.

[robotman]

Thanks. The cpap salesman warned me he was getting results like this, but I didn't know how to read the results myself. So it seems it's not unusual for me.

It seems the wait to see a sleep specialist is 6 months to a year. In fact, I have yet to see one.

What does "central" mean, Sleeprider?

Is the machine keeping my windpipe open? Or is it not doing anything?

[3porpoise]

That's the daily stats from last night. My questions are:

Is the machine doing its job?
Am I at risk for another stroke, with the continual stopping of breathing does my heart still go into crisis mode and try to wake me up, racing? (I have atrial fibrillation.)

Cheers

Hi robotman,
Call your Dr. Call your RT( salesperson) Ask your RT if they have access to the sleep clinic and sleep technicians? Or you can call . Did you have sleep study at a hospital or clinic?
I think in sleepyhead, cheynes stokes category may be periodic breathing? Others will chime in.
The machine is doing it's job for someone with obstructive apnea only. It doesn't treat complex apnea(persistent or emergent central),cheynes-stokes .

Get a copy of your diagnostic sleep study 5-6 pages. Did it show central or cheynes stokes then or solely obstructives? Get a copy of the titration sleep study 5-6 pages. Were apneas well treated?
Sometimes for some people Cpap can cause central apneas temporarily , or pressure is reduced if they persist , depends . That's why it's important to get copies of your studies, see if they existed pre cpap.
There are some on here who have atrial fib , hopefully they'll come along soon .
I know this can be daunting, you'll get it figured out.
3

[robotman]

I hope so 3porpoise.

I had a stroke a few months ago, woke up sleeping on my back, which is where the AHI goes up on the graph I think. I strongly suspect the sleep apnea contributed to the stroke. That's why I'm spending so much time on this.

My sleep study was a fiasco. My days/nights were all messed up, and I had just woken up a few hours prior. So apart from a short sleep at the beginning of the study, I couldn't sleep all night. But I guess there was enough data in the short period I did sleep to let me trial a cpap machine.

Even if I try to book another appointment with the sleep clinic it'll probably be at least 6 months wait.

[Sleeprider]

Thanks. The cpap salesman warned me he was getting results like this, but I didn't know how to read the results myself. So it seems it's not unusual for me.

It seems the wait to see a sleep specialist is 6 months to a year. In fact, I have yet to see one.

What does "central" mean, Sleeprider?

Is the machine keeping my windpipe open? Or is it not doing anything?

Central and Clear Airway apneas are synonymous. Your Airsense 10 Autoset uses quickly oscillating air pulses to detect if the airway is open or closed during an apnea (breathing cessation >10 seconds) event. You have both clear (CA) and obstructive apnea (OA) events in your results. That is referred to as complex apnea.

When a CA event occurs, your Autoset just sits there in exhale positive air pressure (EPAP) mode and does not switch to the higher inhale positive air pressure (IPAP) pressure, unless you initiate the inhale. So you just sit there not breathing until you arouse enough to initiate your own breathing. The Auto CPAP is not designed to cause a breath for CA events, it simply holds the airway open preventing OA. This pressure can sometimes cause the CA. You have previously said you have difficulty exhaling against the pressure, and it would seem this is part of your problem.

An adaptive servo ventilator (ASV) is a bilevel machine that has low pressure EPAP and higher level IPAP, and it can respond on a breath by breath basis to detect a CA event and rapidly increase IPAP pressure enough to cause you to breath, even when you don't initiate the breath. It does this by measuring the volume and timing of your breathing and detecting the CA, then boosting pressure. It helps people with problems like yours in several ways. Low exhale pressure means you use only enough pressure in the exhale cycle to prevent the airway from closing. Higher inhale pressures, eliminate OA and reduce hypopnea and RERA to very low levels. It is comfortable. When CA occurs, it initiates the breath. Only a specialized machine (happens to cost over $3K) can do all this. Take a look at Resmed Aircurve 10 ASV, Resmed S9 VPAP Adapt or Philips Respironics BiPAP SV model 960.

[3porpoise]

I hope so 3porpoise.

I had a stroke a few months ago, woke up sleeping on my back, which is where the AHI goes up on the graph I think. I strongly suspect the sleep apnea contributed to the stroke. That's why I'm spending so much time on this.

My sleep study was a fiasco. My days/nights were all messed up, and I had just woken up a few hours prior. So apart from a short sleep at the beginning of the study, I couldn't sleep all night. But I guess there was enough data in the short period I did sleep to let me trial a cpap machine.

Even if I try to book another appointment with the sleep clinic it'll probably be at least 6 months wait.

Hi again,
Sorry about the stroke robotman.
It's a really good reason to spend all the time needed to sort this out, cause if you don't do it , nobody else is going to. Advocate.
So you've had solely the diagnostic sleep study? Your RT may have a copy ,ask them for it.
I would book a sleep Dr appt and the sleep study for titration and request to be put on the cancellation lists , you may get in sooner than you think, what have you got to lose?
I try to sleep only on my side , as AHI's go up on my back as well. Lot's of folks here do so. You could also try that to see if it makes any difference in numbers or how you feel.
3

[Sleeprider]

Robotman, if you have complex apnea with pressure induced CA, one solution you might want to try is a lower pressure setting. With your pressure at 10 and using EPR setting of 3.0 you can see you don't experience the apnea clusters. In your case, allowing the machine to respond to apnea, causes the pressure to go higher and this apparently causes many apnea and periodic breathing. We don't know that lowering your max pressure, or using fixed CPAP pressure of 10 with EPR at 3 will fix this problem, but it's worth a try. This will allow some OA events, but if it can eliminate the large clusters of CA, then we might be able to fine-tune to minimize events at a lower pressure. It's not an ideal solution, but until you can discuss ASV with your R/T it might be worth a try.