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TOTAL MAYHEM - need help - slimjim - 02-19-2021

A little background:

Young male, normal body weight.  

CPAP user for over 3 years now.  Started on Dreamstation AutoPap at pressure of 4, doctor gradually moved me up to the top of the range around 16-20 over 1 year.  I noticed significant improvement in energy and mood, and a general decrease in AHI, but apneas still persisted and AHI still bounces around from about 2 to 6.  Most of the time it is "clinically treated", but I still feel like it should be lower.  Doctor said it is treated.

3 months ago, I saw a new doctor.  I asked about BIPAP and if it might help to further reduce AHI.  She asked if I was gassy -- YES, very much, I replied.  She started me on Bipap at pressure of 10-20 with PS 2-8.   This did not work so well, it caused high AHI, so she quickly adjusted min pressure slightly to 12-20 with same PS 2-8.  Gassiness was mostly resolved, and overall this worked alright for a couple of months.  Apnea numbers were similar to pre-BIPAP: not perfect, but generally "clinically treated".

Several weeks ago my numbers started trending a bit higher and I developed a daily eye twitch (indicative of poor quality sleep).  Doctor increased my min PS from 2-8 to 4-8.  TOTAL MAYHEM.  Clear Airway (Central?) apneas are off the charts all of a sudden, I mean 50, 70, 100 or more Clear Airways PER NIGHT!  AHI is radically higher, anywhere from 10 to 18.  I gave it 4 days and the numbers were not improving, nor was my eye twitch, tiredness and headaches.  I reverted back to the original BIPAP setting (PS 2-8) but still got bad numbers and still don't feel well.  My sleep has become more fragmented than usual, with multiple awakenings each night. I am scared that I have developed some kind of "treatment emergent central apnea".
I have now dropped my machine treatment altogether and have gone cold turkey for the time being because I am so desperate to get a "decent" night's sleep.  Now I am quickly returning to my old self pre-CPAP: lethargic, bed-ridden, tired, daily headaches, etc but my eye twitch is improving.

What is going on?  What should I do now??

Happy to provide snapshots of my SleepyHead data.  Just let me know what you need to see, if anything.

RE: TOTAL MAYHEM - need help - SarcasticDave94 - 02-19-2021

Welcome to Apnea Board,

You need to get your sleep study results for your personal file and to post detailed, redacted results here. And the sleepyhead nightly chart of the Daily tab. We need to see what's going on, it's very preliminary without data though this sounds like pre-existing untreated CA. If that's the case, you need a different machine. Regardless, I think you'd get better therapy via a ResMed 10 series. Also consider upgrading sleepyhead to OSCAR.

Get the data regarding this and we'll quickly help.

RE: TOTAL MAYHEM - need help - slimjim - 02-19-2021

Here are some screenshots of OSCAR.  Thank you. I also want to add that I have been on low doses of Vraylar and Seroquel medication for about the past 6 months. Would these medications affect anything apnea-related? Also, what would the Resmed 10 Series do that my current Dreamstation BIPAP does not do?

RE: TOTAL MAYHEM - need help - Sleeprider - 02-19-2021

When we see obstructive apnea, and sometimes centrals clustered, we immediately suspect positional apnea or chin-tucking may be the root cause. It's so common we have written a couple wiki articles that explain the problem and how to approach solving it with a soft cervical collar. Let's start by reading these, and then get into the details of your results. I think you will notice some similarity in the charts we used for examples in the wikis. We want to try resolving this first, then see if the centrals remain or are resolved. I expect that if you treat the positional apnea, your pressure will be much lower on average, and the centrals will no longer be an issue.

The second thing we need to do is to stabilize the pressure support settings on your BiPAP. With a range of 2 to 8 they can be a direct cause of the centrals and we need to go to a fixed PS setting to learn where you need to be. For now, I want you to set your PS min and PS max both to 3.0. This may resolve much of the problem. Once we see how that works out, we may increase or decrease PS to optimize.

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

RE: TOTAL MAYHEM - need help - slimjim - 02-19-2021

Thanks, I'll get a cervical collar and also set the PS to a fixed 3 tonight and report back tomorrow.  Thank you

RE: TOTAL MAYHEM - need help - SarcasticDave94 - 02-19-2021

That chart almost made the purple ink tank run out. Yes, get better settings with a collar and see how it's changed.

My personal reason for stressing ResMed over Respironics is the fatal flaw in the algorithm Philips uses. It responds slow forcing users to higher pressure sets to squash events, where the similar ResMed can respond faster and prevent events. This faster response gives both better therapy while enhancing comfort. 2 wins in my book.

RE: TOTAL MAYHEM - need help - slimjim - 02-20-2021

Here is last night's summary.  I used a cervical collar and set the PS to a fixed 3.  I don't know if I had the cervical collar perfectly fitted or not, but I gave it my best shot.  I did not use a pillow (I normally do not use a pillow most nights anyways). I laid on my back as I normally do.

After about 3 hours I woke up and looked at the data.  It looked bad, but I went back to sleep to try again.  When I woke up a second time, I saw the data had worsened at which point I gave up on the "therapy" for the night and went sans-machine for the rest of the night  Sad

RE: TOTAL MAYHEM - need help - slimjim - 02-21-2021

Last night I went WITHOUT the cervical collar, but kept the PS fixed at 3.  I slept on my side, and with a pillow.  Here is the result. I feel a little tired and foggy, but the data looks better than I've seen in a while. Still a lot of Clear Airway apneas throughout the night.

RE: TOTAL MAYHEM - need help - Hydrangea - 02-21-2021

As for eye twitching... I agree with you that the root cause could be poor sleep. BUT another cause can be a need for more magnesium.

I'm not a doctor. It's not medical advice.

When I'm stressed, my eye gets twitchy. Magnesium glycinate does a great job of getting rid of that for me! I take it every day.

And since you mentioned meds... I wonder if the meds affect magnesium levels. Who knows? But magnesium is cheap, and usually helpful for the body, so it could be worth a try, addressing the twitching.

RE: TOTAL MAYHEM - need help - SarcasticDave94 - 02-21-2021

Maybe ask pharmacist about meds and possible side effects on sleep and eye twitches.