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Hi there. I was diagnosed with obstructive sleep apnea in 2018 and have been compliant with CPAP since. I recently started using OSCAR to analyze my data as over the past 3 months I've noticed higher AHIs. It is very rare for me to have an AHI under 5, but recently they've been averaging around 15. I met with a CPAP expert who suggested high loop gain may be an issue. I'm going to copy and paste some charts here to see if anyone can point me in the right direction. I am definitely ramping up on the anxious thoughts about all of this, and as a clinician in the mental health space, it's creating a whole new kind of burnout! The CPAP expert suggested that my central apneas were caused by awakenings, deep breaths, and then falling into central/CSR.
I have tried sleeping with a soft cervical collar but as I fall asleep, I jolt myself awake, gasping for air. I'm wondering if that's obstructive or a central, I'm not sure but I could give it another shot. Any recommendations or advice would be very, very helpful.
Medical history:
31 y/o white male
HTN
OSA (likely complex?)- original sleep study AHI was in 60s with both obstructives and centrals.
ADHD
Migraine
tonsillectomy age 19 for VERY large tonsils (uvula was also removed)
Most recent labs were all WNL, but getting another panel next week.
05-06-2025, 09:59 AM (This post was last modified: 05-06-2025, 10:05 AM by SarcasticDave94.)
RE: Help Needed with Central Apneas and Hypopneas
Are any of these charts the diagnostic sleep study? This would be a base study without CPAP. Or are all these from the Titration?
Asking because what's shown tells me you have a tendency for Central and some mixed Apnea. If the diagnostic shows this, you may be better on the ASV.
Your OSCAR showed a few issues as well. Leaks occasionally high. Frequent Central Apnea, sometimes frequent Hypopnea. Sounds like it reflects your test results, and that the CPAP doesn't change much, if anything.
The frequent event flags may also be Positional Apnea patterns, where you're chin tucking and kinking the airway.
So circling back, do you have the diagnostic study event table with the type and count? It either is image 3 or much like it, that you posted above.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(05-06-2025, 09:59 AM)SarcasticDave94 Wrote: Are any of these charts the diagnostic sleep study? This would be a base study without CPAP. Or are all these from the Titration?
Asking because what's shown tells me you have a tendency for Central and some mixed Apnea. If the diagnostic shows this, you may be better on the ASV.
Your OSCAR showed a few issues as well. Leaks occasionally high. Frequent Central Apnea, sometimes frequent Hypopnea. Sounds like it reflects your test results, and that the CPAP doesn't change much, if anything.
The frequent event flags may also be Positional Apnea patterns, where you're chin tucking and kinking the airway.
So circling back, do you have the diagnostic study event table with the type and count? It either is image 3 or much like it, that you posted above.
Hi Dave. I'm going to try to get a copy of my original sleep study without PAP. If I remember correctly, they did start me on CPAP that night.
Leaks seem to be high following an arousal.
I'll try to get more information. Thanks so much!!!
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-06-2025, 08:37 PM (This post was last modified: 05-06-2025, 08:40 PM by sleepybai.)
RE: Help Needed with Central Apneas and Hypopneas
Dave, here are the results from the 2018 sleep study.
I had to delete some of my Oscar charts to make room for this. Let me know if there's anything missing!
This test shows 40 Central Apnea to 4 Obstructive Apnea, ten X more CA than OA.
You're likely going to get best therapy with the ResMed AirCurve 10 or 11 ASV as the CA were present at 10X the Obstructive Apnea. The ASV is a specialized bilevel with backup breath rate, and specifically treats Central Apnea. It will treat the other events also.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Dave, if I’m not mistaken, I think the chart you referred to is the titration results, not baseline. The baseline results are attached above as well which shows more obstructive than central. With the titration it appears the obstructions went way down and centrals way up.
The 40 CA to 4 OA did not have pressures listed in the table. It is very much setup as a baseline look.
The Titration table shows 11 CA & 51.5 OA on zero pressure.
Central Apnea can very much change that amount at any time. Even so, the change over for the split study to CPAP and include wearing the mask would have you woken up. How far in that zero pressure is, I'm not sure, but they recorded 103 minutes.
I still say with CA acting that way, you at least need the ResMed AirCurve VAuto to have a Trigger setting that helps avoid some CA. It can't treat them. ASV actually treats CA.
Are you at higher elevation? That can enhance the possibility of CA events. Still the same treatment though.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I'm thinking the two charts are for the two separate portions of the study- the baseline and then titration analysis, where it switched from more OA than CA and then to much more CA than OA. Of course, they basically told me they fixed the OAs and sent me on my way w/ CPAP.
I do not live at elevation. I had an echo done in 2018 which my provider told me was normal. It's probably time for another echo. I'm obviously worried about heart failure or some other unknown cardiopulmonary cause (COPD, stenosis, etc) being the the cause of all of this. My sleep provider told me last year that's very unlikely, but since then I had the Bi-pap titration study which wasn't particularly successful, either!
I meet w/ sleep medicine today and I'm going to advocate for bipap. Do you have any other advice as to what I should speak to them about?
