[Treatment] Newly diagnosed and using APAP

[cummings66]

       
Hello, my name is Matt. Although I have suspected sleep apnea for over a decade, I did nothing until I had a cardiac event and my doctor suspected sleep apnea based upon the lab results. My heart is OK, there is no damage, but I want to improve my health and I did the  suggested sleep study. Here I am.

That study diagnosed me as having sleep apnea, and in my research I have found this site and Oscar. I have been reading the advice given based upon posted images, and looking at them and mine I decided to read up on positional apnea, coming to the conclusion that it's part of my problem.  My sleep study did show I was much worse on my back, and I do tend to roll over on it after I fall asleep.

Consequently, I'm trying to lower my AHI and get better rest. Last night was probably the best night of rest I've had, and I did it by buying a memory foam neck brace you use in a car and using it backwards. It's not optimum, but all I could find on short notice. I'd appreciate suggestions of respected brand names that would be useful, assuming there is an agreement that it will help. Other ideas are of course more than welcome, anything I can do to get better rest I'm game for. My AHI is still high. It was near 30 at the start, but I and seem to have hit a limit.

To that end, I'll include 2 screenshots from Oscar for the last 2 nights.

I'd like to see what thoughts members may have of them, and things I can do to help get better rest.

Thanks,

[SarcasticDave94]

Welcome to the Apnea Board,

Do you have your detailed diagnosic sleep test results? It will help a lot to have that and post a redacted version here. My concern is the high amount of Central Apnea. You may need to lower EPR from 3 to see if there's any positive effects to lowering the CA. The negative is that Obstructive, Hypopnea, and flow limit events may increase as a result. This can create what I call the teeter-totter dilemma. Central is on the opposite side of Obstructive on this teeter-totter, actions to help lower Centrals tend to increase Obstructive and vice versa.

If you need to request your test results from the doc, be aware HIPAA law permits you to request and receive it. No isn't an acceptable answer. Just be certain to request the detailed report.

[CapeCodder]

Welcome, Matt.  I’m also new here.
I am sure you fill find lots of help and guidance from members far more expert than I.
Regarding the cervical collar, I am using a “Caldera Releaf Neck Rest” (available on Amazon). My AHI has fallen considerably since I started using it.
Best of luck!

[cummings66]

This is what I have. It's a home sleep study, they're not taking in the lab people right now due to COVID-19 concerns.

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Last 2 pages

[SarcasticDave94]

That's what I'm looking for, the chart with event breakdown of count and type. You're equal in Central and Obstructive events at 6, then a higher count of 64 Hypopnea which night be a combo of both since it doesn't split these out. What this tells us is you are showing susceptible to pre-dominant Central Apnea. It also means the CA will be a problem for you, and that ASV is likely the best machine to treat. Right now on any other PAP, the best you can do for CA is try to avoid by editing settings.

OK given this info, your choice how extreme you want to try, but let's edit EPR and see what CA does. You can go easy and reduce EPR to 2 or more extreme and go EPR off. EPR off is the most drastic and yet might be most telling.

Whichever you choose, follow-up with telling us how you felt reflecting changes and overall therapy. Then post OSCAR as well.

Begin a sleep diary so you mention how's therapy feels, mention symptom and complaints about PAP, about CA, what you think is wrong.

And please note that Central Apnea has the consistently inconsistent attribute, up and down.

[cummings66]

I've noticed my CA's will be high some days and lower others. I've thought it may be related to how I sleep, i.e. supine or not. I tend to end up supine and that's the worst position for me. I'm trying to sleep on my side, but it's not easy because I just roll right on over.

I'll make a small change, there's a monitor company and they call me when they notice things... EPR 2 and I'll see. I'll post back the results. They did tell my doctor about the Centrals Monday, there was a lot of them on Sunday and maybe that will help get things changed. Insurance is a pain because they have this path you must follow. So, to them, we are all the same until we prove we are not, over time...

Thanks,

[SarcasticDave94]

Ok best piece of advice and I've done it myself regarding CA, keep complaining about them. The up and down is normal CA trait, that's the consistently inconsistent thing.

The normal path is 3 months to fail each machine, CPAP, BPAP, and ST, then up to an ASV. At BPAP you'll likely get Trainwreck CA. Don't let them treat you badly like this. If your CA are disrupting sleep, call them every single day to complain. Tell them ResMed states CA is treated with ASV. That's why ASV exists is to treat CA.

We'll likely need to trial some CPAP to prove CA aren't going anywhere. But realize that BPAP without backup rate, the next step is where it gets much worse, not better. Start squeaking now.

[cummings66]

Best numbers so far, I think it's moving the right way at this point. The suggestions you made did improve things, thank you. Here's the new data.

[SarcasticDave94]

OK it helped a bit. Since this was just a single night, you choose if you want to hold steady or drop EPR again and see what changes.

And let's be clear, it's not so much about your numbers, it's about your comfort and ability to get rest. Both objective (OSCAR data) and subjective (your feeling how things are) count. But your comfort is first. You decide if, when, what gets adjusted based on how you feel.

[cummings66]

I’ll drop it again Christmas night. I did rest better and I think I might do better again. I’ll see what it’s like tomorrow. 

Thanks and merry Christmas