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Frustrated, Cannot get AHI Down After 2 Weeks
#11
RE: Frustrated, Cannot get AHI Down After 2 Weeks
A couple more points: 

Remember that the purpose of CPAP and sleep therapy is to ensure that you breath as necessary while you're sleeping and that your blood oxygen levels remain stable.  If you're breathing through your mouth, you're breathing.  Nothing is necessarily wrong.  It is perfectly normal to breath through your mouth some of the time, both while you're asleep and while you're awake.  Just ask your dentist about all of the people who complain to them about morning dry mouth and the wide variety of products to treat it.  And if that's a problem for you, keep a glass of water beside your bed and take a swig if you wake up with a dry mouth.

To be sure, if you have a nasal pillow, your machine will think there's a problem when you breath through your mouth.  It will record that you are having an apnea, even if you're breathing quite normally through your mouth, and aren't having an apnea at all.  And if you have machine that delivers FOT pulses, the machine will start shaking your nose, and disrupting your sleep, even though there is no reason at all for it to do so.  You'll probably think the mouth breathing is the problem, and yet you probably were breathing through your mouth during part of the night for the last 20 years and it never bothered you.

Central apneas are also quite normal, though not for everyone.  For people who get them, they are very common while you're awake.  People stop breathing for 10+ seconds throughout the day without giving it a second thought.  If you put on a pulse oximeter, you'll find that you can hold your breath for 10 seconds once a minute, all day long, without having any real impact on your blood oxygen levels.  That's equivalent to an AHI of 60!  During sleep, people often have central apneas during REM sleep, which is not surprising since REM sleep is when you dream of doing things that you might do when you're awake.  And since REM sleep increases later in the night, you'll see larger clusters of central apneas the longer you sleep.

Resmed has aggressively pushed people to buy their very expensive ASV machines to treat central apneas.  I think that's part of the reason why Resmed doesn't want to allow people to disable the FOT pulses on their cheaper machines.  The pulses make the machines unusable for people who have centrals, and force them to update to the more expensive machines wrongly believing that the centrals are keeping them awake when it is actually the FOT pulses delivered by the machine that is doing so.  Not surprisingly, the more expensive ASV machines don't deliver FOT pulses at all, nor do the machines used in sleep labs.

There is very strong evidence that ASV machines **prevent** centrals, by shoving air down your throat, but not so much evidence that they result in better overall outcomes in the long-term.  In the short-term, people who switch to them may just be sleeping better because they don't send FOT pulses that wake them up every time that they have a central.  

And for a small group of people, ASV machines have already been *proven* to increase the long-term risk of heart attack and death.  I suspect that as they continue to be used, more data will be available on this subject, and it won't surprise me at all if those machines turn out to have worse long term outcomes than just leaving centrals alone.  

If you do get a camera system to record yourself, put it to the side of your bed so that you can record your face and your torso.  Although the rise and fall of your chest is not easy to observe at normal playback speeds, it is very obvious at 2x and 3x playback.  If you see your chest rise and falling at the same time that the machine records a cluster of apneas, watch for skips in the rise and fall.  If you see continuous rise and falling, then you're not having a central.  Next, check your mouth to see if it is open and listen for breathing during that time at normal speeds.  If your mouth is closed and your chest is rising and falling but the machine records no airflow, then you're most likely having an obstructive apnea.  If your mouth is open and you can hear breathing, you're fine b/c you're breathing.  If your mouth is closed and your chest has periods where it is not rising and falling, you're having central apneas.

And definitely get rid of any machine that gives you FOTs.  They're not very effective at recognizing obstructive vs. central apneas, will give a wrong answer 100% of the time when you're breathing through your mouth with a nasal pillow mask, and will almost certainly disrupt your sleep.  If you want to stick with ResMed, the cheapest ResMed AirSense 10 CPAP will not deliver FOTs and the VAUTO can be set to do so as well (S-mode with easy breathe off). 

Finally, EPR and Bi-Level are the enemy of people who have centrals.  Just use the lowest fixed pressure that keeps your airway open.
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#12
RE: Frustrated, Cannot get AHI Down After 2 Weeks
Reznik,

I myself was being well treated with my ResMed ASV. My heart condition was improving with the 2 years of very good ASV therapy. Even a chemical stress echo showed that. BUT here's where my ASV missed it, and it's not the fault of ASV. My Central Apnea and COPD combo aren't what ASV was designed to handle. That's no fault of ResMed or the ASV.

I do believe it's a bit of a disservice to state the ominous sounding:

"And for a small group of people, ASV machines have already been *proven* to increase the long-term risk of heart attack and death..."

The flawed SERVE-HF study had to be where you're getting this info from. There's to be a newer, more accurate study to replace SERVE-HF. ASV does not add to heart issues.

As for not treating Centrals, that's why I have insomnia and frequent migraine headaches now. This too is flawed info. If one is diagnosed with Apnea, either Obstructive OR Central, they need treated not ignored.

I'm trying my best not to make this seem a personal attack, which is not at all what I'm trying to do, but it seems the majority of this post is anti-ASV, anti-ResMed, anti-FOT, anti-Central Apnea treatment. I don't even know if the OP needs ASV, but I'll state this phrase again, the info in your post is flawed. You're not telling the whole story, and it appears to be not much more than bashing ResMed, ASV, FOT, and slanting your take that Centrals are not worth treating.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: Frustrated, Cannot get AHI Down After 2 Weeks
(06-20-2021, 08:03 PM)SarcasticDave94 Wrote: As for not treating Centrals, that's why I have insomnia and frequent migraine headaches now. This too is flawed info. If one is diagnosed with Apnea, either Obstructive OR Central, they need treated not ignored.

I'm trying my best not to make this seem a personal attack, which is not at all what I'm trying to do, but it seems the majority of this post is anti-ASV, anti-ResMed, anti-FOT, anti-Central Apnea treatment. I don't even know if the OP needs ASV, but I'll state this phrase again,  the info in your post is flawed. You're not telling the whole story, and it appears to be not much more than bashing ResMed, ASV, FOT, and slantingyour take that Centrals are not worth treating.

My goal is to help people who are having trouble becoming accustomed to CPAP therapy, so that they don't drop out and lose the benefits that it has to offer.  And the vast majority of my two messages was about obtaining an alternative **Resmed** machine and how to use cameras to get more relevant data.  If you have data contrary to what I posted, you should feel free to post it.  

What is the basis for your claim that your migraines are caused by "not treating central" apneas?  I have suffered from migraine headaches for 20+ years, and have never encountered a single medical professional or text that suggests that "not treating centrals" causes migraines or that treating centrals helps to resolve them.  I have seen evidence that not treating sleep apnea in general can lead to headaches.  But, headaches can occurs in the absence of migraines, and migraines can occur without a headache.  

With respect to your claims about SERVE-HF, the newer CAT-HF does not support your claims.  To the contrary,

"[color=rgba(78, 77, 82, 0.85)]While the study found that adding ASV to optimized medical therapy didn’t improve 6-month cardiovascular outcomes, it did find that patients in a pre-specified subgroup—those with preserved ejection fraction—saw positive effects of ASV therapy in improving the condition of their sleep-disordered breathing."[/color]

https://www.sleepreviewmag.com/sleep-dis...breathing/

That is precisely what I said in my first post in this thread.  ASV does appear to resolve central apneas.  However, it has not been shown to improve long-term outcomes, and the SERVE-HF study stands uncontradicted as establishing that it increases the risk of heart failure amongst certain populations.
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#14
RE: Frustrated, Cannot get AHI Down After 2 Weeks
One correction from my own post, instead of corrections in that post, I'll make it here. The headaches, I did a typo. I should have referred to them as the morning type I'd get before any PAP therapy, and get them now because I'm not treated by any machine currently. Not a migraine, but I can feel these same headaches coming on when COPD make the SpO2 level drop.

Now, the headaches themselves and constant chronic fatigue have returned. During ASV therapy these both were gone.

If a person has pre-existing Centrals, I'm pointing them to ResMed's AirCurve 10 ASV, not CPAP, AutoSet, VAuto, S, ST.

If you think you were attacked by me, 1. you're free to report me, 2. It reveals you can't handle opposing argument from others.

I do understand forums such as this are opinion based, but misleading opinions were called out by me, not a personal attack on you the person.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#15
RE: Frustrated, Cannot get AHI Down After 2 Weeks
(06-20-2021, 08:50 PM)SarcasticDave94 Wrote: . . . .get them now because I'm not treated by any machine currently. 

Well, if you're not currently using any machine, that's definitely a problem.  Until you can get one, if its possible to sleep more upright, like in an easy chair, I strongly recommend that.
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#16
RE: Frustrated, Cannot get AHI Down After 2 Weeks
That's my goal, getting treated again. That's why I've got upcoming new patient appointments at Johns Hopkins Baltimore with pulmonary disease and sleep medicine to treat Complex Apnea and COPD. I'm moving up from an ASV onto a ResMed Astral 150, if the recommendation from 2 RT's of the past and present plus a pulmonary nurse have any indication of my targeted machine.

Sorry OP for the sidetrack. Dave has left the building.

Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#17
RE: Frustrated, Cannot get AHI Down After 2 Weeks
As the OP has plenty of factors that can already disturb him outside of his sleep, and he doesn't have many centrals on testing, they're treatment-emergent and will hopefully go away soon. Even IF the FOT causes some disturbance, it's something that will STOP being an issue when his body has adjusted to the therapy and the centrals ease. And if, as it seems, those centrals are often happening in response to another, external trigger that is waking him, then it's completely irrelevant anyway - they're a SIGN of sleep arousal, not the CAUSE.

The mouth breathing was only relevant because of comfort. That's something we can suggest things for (be it the dry mouth or the discomfort of chipmunk cheeks, etc). What helped reassure the OP was that the centrals would probably ease in time and that we can try to increase his comfort on the therapy to reduce the aerophagia. Mouth breathing and obstructive events look very different on a sleep chart.

Ultimately, CPAP is often hard to start with - it's a lot of adjusting to do and at first, it can make things feel worse... but once you get OVER that hurdle, it's worth it.

And as an aside - as another person which severe central sleep apnea and severe desats, I absolutely do not find myself feeling the same without therapy. Even though CPAP is only minimising some of my 80+CAs per hour (to around 30-35 on average, +-20 either way) and I'm desperately waiting for my doctor to get off his behind and prescribe ASV, even I notice that a single hour nap without CPAP causes a crippling headache and that my migraines, which were weekly and lasting 3 days at a time requiring IV fluids and medication because of the constant vomiting have diminished to a trickle (and the one or two I've had have lasted far less time and been far less severe). The confusion on waking is mostly gone, and even though I'm exhausted still, I don't sleep 16-20 hours a day uncontrollably anymore. That's the difference between spending an average of 50% of the night hypoxic and spending 95-98% that way.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#18
RE: Frustrated, Cannot get AHI Down After 2 Weeks
So, I know one night isn't a great barometer, but the new settings gave me even worse sleep.

I had 20 events within one hour, which I have attached. This is horrible. I'm not sure I can tolerate CPAP. I don't understand how this is supposed to be helping me when the events are happening super often. How is this safer than having events without the machine?

I don't think I can do this anymore. I'm so tired.


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#19
RE: Frustrated, Cannot get AHI Down After 2 Weeks
And to add a bit more to this, as I look into the data it seems like any time the machine increases pressure, my body responds by having events. The long stretches I have no events happen at under 8 on pressure. Anything 9+ causes me to have obstructive events and central airway events in clusters. This concerns the hell out of me because it doesn't look like my body can handle the treatment.
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#20
RE: Frustrated, Cannot get AHI Down After 2 Weeks
Just to clarify a few things to try to help you...

Where were the 20 events in an hour you referenced? I'm not questioning you, just needing to see what you're saying. If you told the doc this, you'd maybe need to show him.

Increasing pressures doesn't cause Obstructive events, however for Centrals yes it could for some. You state that over 9 causes Obstructive events.

Have you tried this experiment? Go to the kitchen and get a really tall glass, fill with 8 inches water depth, insert a straw and blow bubbles like a kid. Tell us how hard that was. If I'm accurate, blowing bubbles in this experiment is equal to exhaling against CPAP on 20 cmH2O.

Your events totaled 3.22 AHI, according to the medical definition, Apnea is treated.

If a setting changes caused discomfort or worse results, change it back.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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