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+--- Thread: One year in, still can't use PAP all night, tired even with it, now showing CAs (/Thread-One-year-in-still-can-t-use-PAP-all-night-tired-even-with-it-now-showing-CAs)
One year in, still can't use PAP all night, tired even with it, now showing CAs - LongJumpingEnergy - 11-23-2020
Hi all, first post here but I've been on Reddit for a while and other places, researching. Finally got a new data-capable machine, a BiPAP even (Aircurve 10 VAuto). Not getting very consistent results other than still very tired. Worse the last couple of weeks too :-(.
At some point when I'm less foggy, hopefully I can post more coherent questions, but I wanted to put something out now in case anyone can see anything obvious from my OSCAR data.
Biggest problem at night is falling asleep with PAP going, or falling back asleep after waking up. Second biggest is waking up, sometimes with obvious SDB symptoms (chest, short of breath, etc), even with the machine (less than without it though).
I don't think I've had any Centrals to speak of on any study (home, lab, watchPAT), but now Clear Airway events are usually dominating my AHI - according to the machine's / OSCAR's analysis, anyway. Are Central Apneas and Clear Airway events the same???
Hopefully these screenshots are good enough for now. Do you have any advice? Or links to good reading material while I learn?
Thanks!!
LJE
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RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - OpalRose - 11-23-2020
HI LJE,
Start by turning your Pressure Support down from 5 to 4. This should help bring down the CA's. And yes, Central and Clear Airway is the same.
Also, check to see what the Trigger setting is. Default is Medium. Try setting it to High. This has also been shown to lessen CA events.
The Obstructives showing on your graph look positional. You may be tucking your chin into your chest which in turn cuts off air supply. Try supporting your chin by using a soft cervical collar. Also, your bed pillow may be too high. This can throw you head forward and into your chest. Note: this can happen on your side or back.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - Sleeprider - 11-23-2020
I see a couple possibilities for you. Your OA events are clustered which is the signature for positional apnea. I'll link a couple of our wiki articles for your consideration:
Positional apnea: http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea
Soft Cervical collar: http://www.apneaboard.com/wiki/index.php/Soft_Cervical_Collar
The emergence of central apnea is a common problem with increasing pressure support due to the drop in CO2 (hypocapnea) which is responsible for respiratory drive. The solution is to reduce to reduce pressure support until CA events resolve. Your pressure range on the Vauto is quite constrained at EPAP min 4.2, Max pressure 11.0 and PS 5.0. You start at 9.2/4.2 and only have 1.8 cm left to move before you hit the maximum pressure. As a result, the machine does not have the range to address the obstructive events. You seem to do pretty well with that low EPAP until you hit the OA clusters. I think your first step needs to be to reduce pressure support to 4.0, and try a soft cervical collar, then we can take a look at the EPAP min.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - staceyburke - 11-23-2020
A question why are you on VPAP MODE and not on VAUTO? If you have not tried VAUTO that is the first suggestion. 2nd I would raise my min 6 - that was where you were almost all night. The trigger setting is on medium and should go to high or very high... that may help with the CA. Keep everything else where it is. Last thing is your obstructive apnea looks to be positional - probably chin tucking. Try not to get into a position where your chin tucks to your chest. You are cutting off your own airway and pressure will not do anything to fix that. If you continue like that you may need a collar to stop the chin tucking. And to answer your question yes the CA are central apnea.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - OpalRose - 11-23-2020
(11-23-2020, 09:30 AM)staceyburke Wrote: A question why are you on VPAP MODE and not on VAUTO?
Stacy, LJE is using VAuto mode.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - SarcasticDave94 - 11-23-2020
Unless I'm mistaken, VPAPauto is equal to VAuto when it comes to mode.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - staceyburke - 11-23-2020
Opal you are correct - sorry I missed it
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - LongJumpingEnergy - 11-23-2020
WOW, thanks so much all! 3 replies with detailed advice, so quickly, how great this community is. As a bonus, you all pretty much agree :-D.
And it makes extra sense because I think it's been worse the last couple weeks since the last doc visit....I thought there was something else changed besides a pressure tweak. Now I remember, he turned PS up from 4 to 5! So I'll try turning that back, and the other stuff as well.
Positional makes sense also, I have a collar and will try that. I also have poor posture due in part to vetebral problems (which I am seeing if I can address), so between that and chin tucking.....
Here's my history on this machine so far. You can see how broken my sessions are, sometimes I am awake in the middle of the night, most of it is due to having a hard time using the machine then falling asleep without it. No wonder I'm tired.
Thanks again, and I'll report back with results!!
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - Sleeprider - 11-23-2020
You need to make the suggested improvements to therapy, but the frequent breaks in therapy are a habit you need to break, and it is a habit. The fact you wake up or have a momentary discomfort should not be an excuse to break therapy. The act of removing the mask fragmentation of sleep and therapy is incredibly disruptive to your sleep and simply reinforces this problem. Somehow, you need to deal with the issues and keep powering through. No one can properly sleep with fragmented therapy, and the resolution to stop doing that is a matter of you recognizing the problem and dealing with it as a bad habit.
RE: One year in, still can't use PAP all night, tired even with it, now showing CAs - Shadowpup - 11-24-2020
LJEnergy,
Perhaps consider Cognitive Behavioral Therapy - Insomnia. There are free resources for CBT-I on line. The US Veterans Administration is a good place to search. I have better sleep from improving my sleep hygiene following CBT-I. Best wishes.