Looking for help to lower my REM AHI

[wadz34]

Hi, I am one month in to my therapy. I had an at home sleep study that found an AHI of 19.7. I was given and Autosense 10 with the usual 4 to 20 pressure. I had been trying to narrow in on what my pressure range should be with mixed results. Some ranges I felt that they were working then I would have multiple rough nights in a row and I would changes the pressures slightly and try again.

The main thing I've noticed is that with every setting my AHI skyrockets late morning during REM sleep. I have an Oura ring that is fairly accurate at sleep stages so I'm confident I am in REM sleep during these spikes.

I also seem to have a lot of centrals during these spikes. The last few nights I tried turning on EPR at varying levels and so far small to no success controlling the centrals.

I sleep on my back because side or stomach is too uncomfortable. I use a SSC that definitely helps my overall AHI but I still have trouble during REM

I am 30 5'10" 400lbs.

I have attached last nights chart in 3 screenshots.

Any help would be greatly appreciated

Thanks

[wadz34]

       

[DeepBreathing]

G'day wadz34. Welcome to Apnea Board.

I'm pretty sure we can fix your apnea fairly easily. See how the events are all clustered together? That's usually a sign of positional apnea - your sleeping position is compromising your airway. In the great majority of cases it's caused by the chin tucking down to the chest and compressing the windpipe. You need to sleep in a position so that the head is tilted slightly back and the neck is slightly extended. This usually involves two things: 1) pillow, and 2) collar.

Your pillow should support your head without pushing your chin down. You may need to experiment. And only use one pillow to sleep on.

The collar is the real trick here - a soft cervical collar will support your head and neck and prevent your chin dropping down. This will pretty much eliminate those apnea clusters.

I should mention that the central apneas are possibly mis-diagnosed obstructives. When they cluster so tightly it's hard for the machine to diagnose them properly. If you zoom right in on a cluster so we can see he detail of the waveform, we'll be able to confirm or deny this.

Read about positional apnea here -> http://www.apneaboard.com/wiki/index.php...onal_Apnea

Read about the collar here -> http://www.apneaboard.com/wiki/index.php...cal_Collar

[wadz34]

Thanks for the reply. I already use a collar because I was suspicious that my chin was dropping. I will post the zoomed in view when I get off work. I started off the night pretty much clear and didn't notice any change in my position over night but I will definitely focus on that.

Thanks

[wadz34]

Here are two separate clusters. One with OAs and one without.

       

[jaswilliams]

Your airsense 10 Autoset will not do anything for your CA’s in REM I have exactly the same thing

Here is a typical night for me the issue was only solved by a Resmed ASV the cluster of events don’t look positional to me.



Similar graph with an ASV doing its thing

[70sSanO]

Adding EPR generally results in a higher number of centrals on an APAP machine. I would go to 0 EPR.

As already noted, an Airsense 10 won’t treat centrals. I fought a much lower level of them for years and then they started to spike and I ended up with an ASV machine.

The typical insurance protocol is to try an APAP and if that fails, sometimes try a BiPAP, and when that fails, go to an ASV. I think that in some ways the insurance companies are hoping the patient gives up before the ASV.

Based on your high level of centrals you may be able to get your doctor to make an ASV medically necessary. Resmed does state it is their only machine for centrals. It would be good to collect your data to show it is not just one night. I also have Resmed Rescan 5.9 software that I use when I go to see my doctor as I think it has greater acceptance.

John

[wadz34]

Thanks for the info. Just to clarify I don't always have them this bad. I've had nights that were really good, below 1. Then I'll have a couple clusters the next day. Seems very random but I have had clusters with every pressure setting I have tried. I can post screenshots of other nights that weren't as bad if that info could help.

Thanks

[70sSanO]

Central, or complex with obstructive, sleep apnea can be like that. When it suddenly got bad it went from an AHI of 2.5 to 12 and then fell back down to under 4. Then 3 months later it started moving up again. All of this drive by central apneas.

On ASV, I’m running around .7 AHI, all hypopneas.

John

[SarcasticDave94]

Central apnea by nature are random or in other words consistently inconsistent. And yes the ASV is the only one that will squash these CA events. The best ASV is going to be the ResMed AirCurve 10 for most people. Show the doc whichever format he/she will look at to get the idea you are having CA. Enter into the mix a healthy dose of all that you can learn while in Complaining 101, because the things you complain about will likely sway the doc the most.