Questions after two nights with APAP

[finitethis]

Hi everyone! I just finished my second night of APAP and I have questions.

Background: I'm a 38yo male, 6ft-1in, 200lbs. I have struggled with sleep for a long time. In 2016 I had a polysomnagram which showed roughly an AHI of 6 per hour supine and 10 per hour in REM, thus I was diagnosed with mild obstructive sleep apnea. I was encouraged to try CPAP but at the time preferred to try lifestyle changes (which I didn't do). Since then, sleep/snoring has gotten much worse. I engaged with a new sleep doctor, they did a home sleep study which came back negative (<5) but were open to a CPAP trial since I was already pre-approved by insurance. I am also working with an ENT to evaluate impact of slight deviated septum (small impact it appears), get a full allergy test (waiting), and a CT of nasal structures (waiting). I wear a night guard for grinding so I don't think an oral appliance is an option on top of that.

I currently have a 1-month trial rental of an ResMed AirSense 10. I want to make the most of this trial and be as scientific about it as possible. I immediately loaded the data from each night into OSCAR. After two nights I have a lot of questions.

First night: Pressure was set at clinic for 5-15. I barely slept at all, it was just such a strange sensation. I would estimate that out of the ~8 hours, I was asleep for maybe 3, so I don't know if this data is worth anything. I constantly felt like I wasn't getting enough oxygen and really struggled to tolerate everything, but I pushed through it. I also felt like the air was uncomfortably warm.

Second night: I increased the min pressure to 6.6 (arbitrary), turned off hose heating, turned off the ramp settings. Overall I tolerated everything a lot better, got to sleep more comfortably (also because I only slept 3 hr the previous night). I made it about 4.5 hours and then took the mask off as I felt a little claustrophic, but don't totally remember as I was pretty out of it. Slept okay the rest of the night.

Here are my questions:

1. I was surprised to see a HUGE number of Clear Airway events. Both nights, there was only 1 obstructive event and ~5 hypopnea events, but 154 and 75 clear airway events (respectively). My overnight polysomnogram three years ago did not note anything about central sleep apnea. Is this related to starting CPAP or should I be concerned? I thought maybe it was just a fluke the first night since I was basically awake all night, but then it repeated again.
2. I realized I often stop breathing as I am laying in bed trying to fall asleep. Like I'll realize I am unconsciously holding my breath. Is this indicative of central sleep apnea? I hadn't thought to bring this up with my sleep doctor yet.
3. Can anyone review my OSCAR plots and provide general feedback? Is there anything else obvious that you see? What parameters should I focus on experimenting with?

Thank you in advance.

[jaswilliams]

That’s a lot of centrals try turning off EPR off if this keeps up you need an ASV machine

[sheepless]

it's not uncommon for new cpap users to experience treatment emergent or pressure induced central apnea. because you didn't score any ca during your psg, this is most likely explanation. that plus you said you were aware of holding your breath while awake, also not uncommon. that's referred to as sleep-wake junk. I'm sure someone will be along to suggest some additional changes to your machine settings that might help. meanwhile, the treatment emergent ca usually dissipates in 30-90 days. as jaswilliams said, if they don't, you'll be looking at a different machine but that's premature at this point.

[finitethis]

I guess one of my main questions is whether you think these central events are real, considering they seem very significant and prominent in the APAP data but weren't noted in any of my sleep studies. I'm very confused over the whole matter.

[Gideon]

Not that I don't believe you but could you post a copy of your diagnostic sleep study, a Full copy with the included charts and tables, definitely more than the summary. I've seen too many cases where the user didn't understand all the terms that imply Centrals or they were buried in the back and left out of the summary.

[Gideon]

Are the centrals real?  Post a zoomed in 2 minute window.  That will show the detailed breath form and we can pretty much see if they are real.  

I believe that they are mostly real, The "false" ones will be near your sleep/wake interface.

[StevesSp]

I'm not suggesting this trial will be a waste of time, because you WILL learn a lot from it, but it took me around three months to get properly comfortable with CPAP and into the zone where I felt it wasn't compromising my sleep as much as it was helping my apnea.

[finitethis]

Not that I don't believe you but could you post a copy of your diagnostic sleep study, a Full copy with the included charts and tables, definitely more than the summary.  I've seen too many cases where the user didn't understand all the terms that imply Centrals or they were buried in the back and left out of the summary.

I don't have this. Will try to request, but I went through a long process of requesting the results and only got the summary before...

[Gideon]

Post what you have and work on getting the full study. Your DME may have it (they should)

[finitethis]

Based on the feedback in this forum, I just completed night 3 with the following modifications:

* I reduced EPR from 3 to 1 to see if it helped with CA events.
* I reduced the min pressure from 6.6 to 6.2.

AHI 5.45, 6.2-15 cmH2O, EPR 1

There were WAY fewer CA events recorded this night.

This is the first night that I felt like I actually slept somewhat. I could remember several dreams when I woke up. 

At one point I woke up with my mouth open and air blowing out. 

I was awake for awhile at 1:40 (this is obvious in the data) and there is a huge cluster of CA events when I woke up.

I still woke up MANY times overnight but I was trying to avoid checking the time whenever it happened.

I will say that the mask and pressure felt very natural from the start of lying down. I'm assuming this is because the reduced EPR was more comfortable for me?

See attached for full night OSCAR results and a two-min zoom in on a CA event. I'm not sure if I was awake when this CA event was recorded or not.

   

   

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Are the centrals real?  Post a zoomed in 2 minute window.  That will show the detailed breath form and we can pretty much see if they are real.  

I believe that they are mostly real, The "false" ones will be near your sleep/wake interface.

I wasn't sure how to tag you, but I uploaded the 2-min window in a separate post. Thanks for your help.