Are these CA events real, or misdiagnosed OAs?

[Sleeprider]

I can think of two ways to reduce the CA events you're experiencing. Either move to a bilevel machine like like the Vauto that has trigger sensitivity settings that can switch or trigger IPAP with less spontaneous effort, or use EERS https://www.apneaboard.com/wiki/index.ph...ace_(EERS) Either will work to substantially reduce your treatment emergent CA, and the EERS will increase tidal volume. Your sleep study shows prone sleeping is not particularly your friend, and I would guess this is also associated with leaks.

[JonathanBravo]

Sorry to see so many real clear airway apneas.
You may need a bilevel to treat both of your CAs and flow limitations.
You could try an experiment and lower EPR to 1 and your maximum to only 8.6, your median for a few nights to see if the CAs drop.

Hi Doug. I've been using these setting since Monday and my CAs have halved while my OAs haven't changed. Looks like this is doing the trick.

A small caveat is that my doctor told me "I know you're not supposed to be taking lunesta/zopiclone with sleep apnea, and also every night, but your sleep is so bad why don't you just try a solid 5 day weekday of taking it every night". I have previously found that lunesta/zopiclone stabilizes my breathing at night (even though it is supposed to do the opposite) and decreases my CAs, so I think it may be a mixture of both. Last night I didn't take the lunesta, and my CAs jumped up a little, but I did also admittedly stay up half the night watching Game Of Thrones, so it might be that. I'll need to spend more time on this and see how it goes, but it is promising. I feel a lot better. First morning I still felt like crap, but every morning since then has been progressively better and my memory and mood have improved over the 5 days.

I've attached a middle of a week and then last night which is slightly worse.

Thank you!

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I can think of two ways to reduce the CA events you're experiencing. Either move to a bilevel machine like like the Vauto that has trigger sensitivity settings that can switch or trigger IPAP with less spontaneous effort, or use EERS https://www.apneaboard.com/wiki/index.ph...ace_(EERS)  Either will work to substantially reduce your treatment emergent CA, and the EERS will increase tidal volume.   Your sleep study shows prone sleeping is not particularly your friend, and I would guess this is also associated with leaks.

Hi Sleeprider. Yes, I think EERS might be my next options. It makes a lot of sense and it feels like it might be the root of my problem. EERS seems like an easy thing to at least try.

[JonathanBravo]

Hi all, I tried limiting EPR and setting my Airsense 10 to CPAP mode to reduced the number of treatment emergent central sleep apnea (TECSA) events, and while it worked for about 7 days, it suddenly stopped working and i've been back up to 40+ open airway events per night, most of them clustered in 2-3 clusters.

At this point my options are BiPAP, ASV, EERS, and trying a different mask.

I find my F40 mask is the best compromise of allowing mouth breathing while also being light/small enough to be comfortable. I'm trying to get my head around how they do the EERS modification on my F40 using the example of the F30 modification in the link Sleeprider provided, but I should be trying that soon.

I'm also considering trying the DreamWear Full Face CPAP Mask as one last chance before I go in heavy with a new machine or the EERS modifications.

Does anyone have any stories with treating their TECSA? Anyone tried both the F40 and the DreamWear full face?

[SarcasticDave94]

I think you'll find the mask is the least of the issues if leaks are controlled and comfortable. I can't think of a scenario where the mask added CA.

EERS can be tried, and it'll have a place in both CPAP and bilevel. The VAuto, a no backup breath rate machine, can be of some help with CA. If it helps your case, is not guaranteed.

Treatment emergent Central Apnea should be addressed before there's a need to get ASV. And the treatment emergent aspect would be relatively hard to get insurance to cover ASV.

Any OSCAR charts to go with your current state?

[jdougc]

Glad you felt better for a while. 
Any changes to your routine or medications?
A recent chart of the whole night would be helpful and any zoomed 3 minute charts of the clusters that you mentioned.

[JonathanBravo]

I think you'll find the mask is the least of the issues if leaks are controlled and comfortable. I can't think of a scenario where the mask added CA.

EERS can be tried, and it'll have a place in both CPAP and bilevel. The VAuto, a no backup breath rate machine, can be of some help with CA. If it helps your case, is not guaranteed.

Treatment emergent Central Apnea should be addressed before there's a need to get ASV. And the treatment emergent aspect would be relatively hard to get insurance to cover ASV.

Any OSCAR charts to go with your current state?

Glad you felt better for a while. 
Any changes to your routine or medications?
A recent chart of the whole night would be helpful and any zoomed 3 minute charts of the clusters that you mentioned.

Good morning all.

I've attached recent charts to this message. There's a whole night and a zoomed chart of a recent bad CA night, and also an overview. The last 4 nights i've been messing with settings putting it back to APAP and increasing EPR, and it made things worse. I haven't included those charts because they are clearly in the wrong direction. I'm going to go back to 8.6 pressure with EPR 1. I can't tolerate EPR 0, but maybe I should try harder.

Looking now, the pattern I see is that lunesta (zopiclone) definitely cuts my central events in half. I've marked nights I took lunesta with a red star, and also the day of the week (So Sun night to Thurs night, with a break on Fri and Sat nights). In week 3 my events went up and stayed up. I don't know if this is me getting a tolerance to the medication. It also may have just been bad luck and maybe I shouldn't have given up so quickly. I've been off lunesta completely for a few days and i've been moody and irritable, and last night was an awful night sleep. Between potential tolerance and withdrawal, and long term effects, i'm not sure it's a great idea to take long term. But as my doctor says, neither is apnea and insomnia, and it might be the better of two evils. Another pattern I see is that nights which have more number and more severe leaks early in the night tend to lead to more CAs later (like 4-5 hours later) in the night. Might be conincidence, might be a sign that something is wrong with how i'm sleeping.

I will consult with my medication doctor and also my sleep doctor. My sleep doctor doesn't believe that Oscar is real and says that the CPAPs don't collect this level of detail. I'm not even convinced he knows what BiPAP and ASV are. There may have to be some arm twisting to get a prescription for ASV.

In the meantime, I would gladly accept any suggestions and advice. I really appreciate how helpful and supportive this community has been.

A quick edit - those days when my AHI was around 2 were great days. I felt alert, energized, and focused for the first time in months/years.

[Dormeo]

Your sleep doctor is an idiot. What a shame.

Have you tried lowering your pressure to, say, a fixed 7 and turning off EPR?

[JonathanBravo]

Hi Dormeo,

I can't really go below 8.6. That seems to be my basal minimum required pressure. Any lower and I feel like I'm not getting enough air and that's confirmed by if I set APAP with a range below 8.6 - the moment I fall asleep it ramps up to 8.6ish and never goes below it.

[SarcasticDave94]

Vote 2, doctor sounds like the idiot quack variant. This sleep doctor probably got the medical license at Wally World. If they don't know what a bilevel is or ASV, maybe you should be asking "are they qualified to keep me as a patient?". Sounds like no to me. I guess your primary doctor can't support your CPAP needs?

There's no rule that says CPAP can only be ordered by a sleep specialist.

[JonathanBravo]

Vote 2, doctor sounds like the idiot quack variant. This sleep doctor probably got the medical license at Wally World. If they don't know what a bilevel is or ASV, maybe you should be asking "are they qualified to keep me as a patient?". Sounds like no to me. I guess your primary doctor can't support your CPAP needs?

There's no rule that says CPAP can only be ordered by a sleep specialist.

It seems that around me (and I guess in many places) the sleep doctors are specialists in something else, such as ENT or allergies, and then claim to be sleep doctors cause they know they can just prescribe a CPAP and set it to auto, and that will fix 90% of cases with little effort.

I got a prescription for CPAP after an at-home study and then just used that to order my own CPAP from a website rather than paying a premium to do it through the doctor. However, it doesn't say anything about BiPAP or ASV, so I hope the vendor will still accept my prescription. Even then, i'm not sure what machine to buy, there are so many variations.

Is there anyone out there who had a similar profile to me - youngish, 'normal' BMI, obstructive apneas cleared by CPAP but resistant treatment-emergent central apneas? And if you are one of these folks, what steps and instrument worked for you?