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[Treatment] Starting to lose it.
#1
Gross 
have been on CPAP since last November and it has been a roller coaster ride. My prescription settings are a straight pressure of 7 and an apap setting of 5-10. I had these after the usual two sleep studies. I have had some nights of low AHI under .75 on average, however on a few nights my AHI is up quite a bit, for me anyway, and I am starting to get very concerned. I have a follow up appointment with my sleep doctor this coming Monday and I will be putting my concerns to him. Mainly I am worried about the nights of high CA's. I have always had some CA's, however my testing didn't reveal any. I picked up a replacement Airsense 10 Auto yesterday, the first one was quite noisy and the new one is just as bad after one night, and trialed a Mirage FX mask last night. My Eson is not my best friend, with some leak issues. I seem to have a lot going on Unsure I have attached some overview graphs. I would be keen for a few thoughts about where I am and how to proceed.

James
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#2
Do you follow a routine? My AHI"s are always <0.3 unless I stay up late or eat late or drink alcohol or drink caffeine after lunchtime etc. Sometimes these factors play a big part in quality of sleep.
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#3
Hi James. Your data show a small increase in CA events, but really it's very very low both in the aggregate AHI and CA. This is not a concern for your health. Clear apnea can be central events as in complex apnea, but I'd guess the few events you're having may be clustered around periods when you are awake or semi-awake. Some of us refer to this as sleep-wake-junk, and it's more common than you think. It is simply holding your breath as you turn in your sleep, or while you're semi-awake before the autonomic breathing reflex kicks in. The modern CPAPs with data do a pretty good job of interpreting events, but they can't tell when you're asleep, and the only tool they have for determining a CA is a pressure pulse or the Resmed Forced Oscillation Technique (FOT) with pressure sensor to determine if the airway is clear or obstructed. This is NOT a diagnostic of central apnea.

It would be more revealing if you could post a Daily graph of the events, rather than a long-term trend. I just want to emphasize this is common, and not at a level of concern.

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#4
I very much doubt that your doctor will share your concerns. In fact, quite the opposite. The data shows that the machine is doing a stellar job of treating your condition.

Many people confuse the diagnosis of "sleep apnea" with the occurrence of apneas. Apneas will occur in almost every person. They are defined as a certain percentage drop in the flow of air for a time of 10 seconds. You could have a higher percentage drop for only 9 seconds and it wouldn't count as an apnea. The diagnosis of sleep apnea is based on statistical criteria. Therefore so is the treatment. The purpose of CPAP therapy is not to eliminate all apneas (although in some cases it does appear to do that for some people) but to lower their occurrence from an unhealthy level to a healthy one.

The same medical criteria used to diagnose your condition will now declare it treated.
Sleepster
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
So my question is are you concerned about the centrals just because they are there or are you not sleeping as well as you would like and are looking for the cause?
Personally I have up to 40 or 50 centrals a night and am sleeping just fine. I kept questioning the Doctor about the number because I was not sleeping as well as I wanted, even with a low AHI, and my Doctor kept telling me that the centrals I was having was nothing to worry about. I went to a pulmonologist and discovered the reason I was not sleeping well, fixed that and the centrals remain while I am speeling quite well.
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#6
        I sound a little paranoid, my wife seems to think so Dielaughing but I do over think my health issues. Apart from sleep apnea I have a chronic lung infection that is very difficult to cure, the simple way to describe it is non tuberculosis bacteria (NTM) and I am mildly bi polar. I have attached a couple of screen shots from a good night and a not so good night. I am very grateful for the support that this forum gives me like

James
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#7
(01-29-2016, 05:30 PM)PoolQ Wrote: So my question is are you concerned about the centrals just because they are there or are you not sleeping as well as you would like and are looking for the cause?
Personally I have up to 40 or 50 centrals a night and am sleeping just fine. I kept questioning the Doctor about the number because I was not sleeping as well as I wanted, even with a low AHI, and my Doctor kept telling me that the centrals I was having was nothing to worry about. I went to a pulmonologist and discovered the reason I was not sleeping well, fixed that and the centrals remain while I am speeling quite well.

I guess that the CA events worry me a fair bit, insert paranoia figure Smile I am sleeping OK and waking up pretty well rested. Far more now then before I started on CPAP.

James

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#8
JamesW,
I don't see anything in your numbers to worry about. You don't have that many CA's, and normally they will settle down after awhile.

What I do see is that your start pressure of 5 is too low, and your max pressure should be raised.
If you look at your pressure graph, you zoom right up to 9 pretty fast and stay there.

A good start pressure for you would be 7, which is what you were titrated at.
Also, since your bumping against your max pressure of 9, you could raise it to 10.

APAP setting 7-10, and watch for a couple weeks to see how you feel.
OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.




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#9
I have been on since July of last year. I found that it took quite some time for me to "trust" the machine and process. I do not give control of my breathing over to a machine easily. I also had to recover from waking every 30-60 minutes all night, every night before CPAP. I was always scared that this would come back. Each month I trusted the machine a little more and got the machine a little more dialed in.
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#10
(01-29-2016, 05:47 PM)JamesW Wrote: I sound a little paranoid, my wife seems to think so Dielaughing but I do over think my health issues. Apart from sleep apnea I have a chronic lung infection that is very difficult to cure, the simple way to describe it is non tuberculosis bacteria (NTM) and I am mildly bi polar. I have attached a couple of screen shots from a good night and a not so good night. I am very grateful for the support that this forum gives me like

James

Both nights look Ace to me.
Many people would love to have graphs that good.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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