What is going on here?

[Round2]

Greetings - I started PAP therapy about a month ago for the second time. The first time was many years ago and I stopped due to severe aerophagia. Sleep was getting noticibly worse recently, so decided to give it another go. Overall, I think it's been going quite well! AHI has been in the 2-4 range most nights, but every so often, it jumps for a night or so. Looking at OSCAR data from the nights where it jumps, I often see a cluster of CA's. So, I'm wondering what is going on here! Could this be positional? They are marked as CA, so I don't think that's it. Any thoughts or advice on this would be appreciated!

I didn't have the insight that OSCAR provides last time I used CPAP, so I don't know if this kind of thing was happening before.

Thanks!

[SarcasticDave94]

Welcome,

A couple of things are needing attention. CA stands for Central Apnea, the PAP calls them clear airway. Can you remember if you were waking up at the time of that cluster of CA?

Are you using EPR? If so, you may want to decrease the setting in light of the CA.

Next, your pressures are machine defaults at 4-20. You may want to try Min pressure of 6.

Last, your leak rate is about high enough to interfere with good therapy. Either leaks will be a sleep disturbance or hinder PAP therapy from doing the work it needs to. You'll want to pay attention to mask fit to make sure it's the right sized cushion. You'll need to give attention also to adjusting the straps better. In most cases, too tight of mask tension can increase leaks instead of controlling them. Also, if you don't have a full face type, you may be mouth leaking.

PS I did forget, did you have a sleep study? Yes, then request your report and post a redacted detailed version. HIPAA law permits you to request and receive it.

[Round2]

Thanks for your response and suggestions!

I don't recall waking up at the time of the CA cluster, but it is about the time I normally wake up, so maybe?

My EPR is set to 3, so maybe I'll try reducing that. The default setting was just something to get started with. I have an appointment with my pulmonologist coming up, so I'm sure we'll discuss that then. I'm hesitant to increase the minimum pressure since I had such bad aerophagia last time, but maybe that will be necessary. But, like I said, most nights are better than this.

I noticed that leak rate as well. It was higher last night than normal. So, I will try to address that.

I had an at-home sleep study. Some of the results are attached here. There are also some plots, but the quality of the scan I got is not great. But, it it would help, I can post those too.

Thanks again!

[clownbell]

I wonder whether your max pressure setting of 20 could contribute to your aerophagia? Perhaps one of the experts will opine on that.

[SarcasticDave94]

OK that helps on the Central Apnea. It's still going to be, at this time, a treatment emergent type as you did have some CA recorded at 11, it is far less than the Obstructive at 167. It is worth noting you did have some, not in regards to needing ASV, a specialized Central Apnea machine, but it may come to that if the CA become worse or aren't under control with the Avoidance moves like lowering EPR. The continuing existence of CA would need to be included with a symptom and complaint list from you on subjective issues. For now, this is just an if CA were to continue.