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AHI ticking upwards
#1
AHI ticking upwards
Hello, and thanks to everyone on this forum; very thankful to have found this community.

I've been on CPAP for almost two months.  DX'd severe OSA with AHI 44.3.  Resmed Autoset 10 seems to have controlled the OSA events, with the OSA events per hour on CPAP pretty much always < 1.

My question/ concern is around the central events.  When I first started CPAP I started getting some blocks of central events per hour hovering around 3 - 5 for a week or so.  Then they dropped down to < 1, but seem to be coming back, increasing every night for the last few nights.  Total AHI was 5.9 last night. I've also noticed hypopneas increasing, but obstructives are still low.

Don't know if this is related but I'm a shallow breather/ breath holder during the day, due to stress/ anxiety.  Often when trying to fall asleep I notice that I just stop breathing during the transition from wake to sleep, which of course wakes me all the way back up, and the vicious cycle begins.  I'm pretty anxious about my sleep in general so I'm sure I carry that to bed.

I'm also now waking frequently thru the night; not sure if that is due to anxiety about the whole thing or possibly due to these central events simply waking me up to breathe, since from what I understand the CPAP doesn't control the centrals.

So with all of that as background, would anyone have any insights on these questions:

  1. Wondering if my shallow breathing "habit" during the day could be causing the stoppage while falling asleep, like I've trained my brain to instruct my lungs not to breathe due to the feeling of stress surrounding getting to sleep
  2. I've read that treatment emergent central apnea usually happens right after starting treatment (which it did), and usually resolves (which it did), but can it show up again two months into treatment?  No other health or medical changes that I am aware of.
Very much appreciate any insights or thoughts from the CPAP pros here.
Thank you
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#2
RE: AHI ticking upwards
Welcome to the board. There are a lot of knowledgeable people that will help but everything we do is driven by data. That data is from OSCAR, downloaded from the top of the site (free). 

You need a SD card in the machine while you sleep. Please see the link on charts at the bottom of the post. It tells you the charts we need and help with Oscar.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: AHI ticking upwards
Welcome

As Stacey said, we really need some data so definitely get an SD card into your machine so we can take a look.

I think it is more likely that your anxiety is going to disturb your sleep than your daytime breathing... though it's not impossible. That said, it sounds as though you're potentially hyperventilating during the day (the quick shallow breaths) which is a whole different thing. It's actually fairly normal for things to get a bit erratic around the point you're falling asleep - in fact, so common that we refer to apneas that happen during that time as "sleep-wake junk". I know it's really hard when you're anxious, but try not to worry too much about that.

Re: Treatment-emergent centrals. It's not necessarily that they magically appear after two months, usually. More often it's someone who had them earlier on in their treatment and they never really resolved. The easy way to see is to check your data. Though you can check on an S10 what proportion of what events make up your AHI, too (though you may have to go into the clinical menu and turn on Essentials to Plus). If you go into your sleep report and use the knob to scroll down, it will tell you a little more detail, at least until you get the full data ongoing into OSCAR.
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