In Desperate Need of advice

[whatisamodel]

I've had CA for 10 years, 5 years diagnosed, and I've only been able to keep my mask on for more than an hour 4 days out of the last year despite trying everything. However, I did just get Oscar and was hoping some of yall could help me out. Im so tired everyday. Its worth noting that my oxygen when I measure it is getting 80-85% during the same times my mask is coming off. I have no idea why im taking it off, I never remember it. I've tried full face, nasal pillow, mask. I will say the 4 days I did where it more than an hour I had a chin strap and tape over my mask, however, that doesn't work typically and the low oxygen events are usually worse when I try extreme methods of keeping it on which scares me. 

I've been meaning to reach out here and download oscar for a while but its a bit daunting, I followed the instructions I think properly on how to extract some screenshots from oscar and would really appreciate any help. I'm 33 years old male 5'10 160lbs . I've had 3 sleep studies only one of which was in a lab. Despite what my ENT thinks, I don't think that lab study was great, I hardily slept, but I think just wanted me out of his hair and referred me to a dental implant after (trying different cpap masks)... for Central apnea (80% CA, little obstruction, machine never register obstruction) I'm kinda lost.  I basically sleep less than 5 hours a day and its terrible quality, I have a constant low grade headache and am basically tired all the time. 

My lab prescribed a pressure of 7 constant. I keep it at 7-12 in that apap mode (whatever its called), as im pretty sure the constant 7 chokes me. 

I really appreciate any help in advanced.

[jdougc]

Welcome to the forum, 
Can you post a copy of your sleep report with your personal info redacted?
Are you on any medications that may affect your breathing or your sleep?
Do you have any health issues that may affect your breathing.
Do you sleep on your side?

You have leaks that are compromising your therapy.
Don't tighten the mask too tight.

Also your ramp pressure is too low for an adult, set the minimum to at least 7 or 8 cm of pressure.
Consider using the cpap machine while watching TV or reading for a while to get used to the machine. 
You can uncheck this test session on the lower left of Oscar.

We need to see the device settings.

What is it that make you take off the mask after such a short time? Are you feeling airstarved? Or is it the leaks?

[whatisamodel]

Hello thank you for your response, 

I really appreciate you taking time out of your day, and sorry for the long response.  



1. Yes I will attach screenshots        

2. I have tried using it during the day the past and it didn't seem to help, something is causing me to take it off. It seems mask/apnea related as my low oxygen levels (80-85% correspond to the same time my cpap machine turns off due to me taking the mask off). I frequently compare the two times. I have oximeter, watch, and oura ring (sucks). 

3. settings:     

4. I do sleep on my side, but if I remember correctly my ahi doubles from 25-30 to 60-100. I put stuff behind my back to prevent this and usually wake up on my side.. 

5. I genuinely rarely ever remember taking it off but it usually gets ripped off, I've considered filming myself. And I  have never worn it while with a partner as its always been a lost cause for me so far. However, they do all say im just stopping breathing, not choking if that makes sense. 

6. If I go to sleep and poll my oxygen every 5 minutes with a pulse ox (probably not greatest interval, but good on batteries), my oxygen will drop into the mid to high 80s for only the first 1-3 hrs, and go back up above 90 for the rest of the night without cpap. I have a theory that their something wrong with the beginning of my "sleep architecture" I slept barely for the minimum of 4 hours (I think they padded these numbers tbh, it didn't feel like it) for insurance to cover the lab study. So the apneas they would have had data on, would have been in the early stages of my sleep. If I do the same polling with the mask on (which admittedly is for short periods) the oxygen is all over the place, but this could be those early apneas. I haven't done this in a while but its what I typically observe, I unfortunately don't save these o2 graphs.

While I have no way of knowing if the apneas are happening at later stages of sleep other than o2 indicators, which are fine, it doesn't seem like it but hard to tell with just o2. If anyone is familar with CA that only happens during the first half of sleep and knows of literature on it I would love to read it. 

7. I have no health issues that should cause me to have issues, no asthma, no smoking  and am a casual distance runner. 10-20 miles a week. No allergies.  I quit drinking pretty much entirely for the last few years. because the smallest amount would cause my nighttime oxygen levels to get very bad.  

For what its worth I do live above 6k feet, but the CA still occurs after being at sea level for months. 

Thank you for sparing time out of your day! I hope you're having a great weekend!

[Expat31]

Hello, 

I see you are on CPAP mode. Do you know how to change to APAP mode and change your pressure settings?

To do this you need to access to clinical menu Airsense 11, just check out this video link. 

Currently you have a long ramp time of 45 minutes, then straight up to 11. This may be too agressive. 

To ease this situation, using the clinical settings above, adjust mimimum pressure to 7, and maximum pressure to 11.  Ramp time to say 10 minutes, hopefully tolerable. 

We will then be able to see how the algorithm moves the pressure automatically, to get an initial overview of your therapy, and adjust these settings as necessary. 

It would be useful to read through the mask primer, which gives tips on mask fitting, and general leaking  issues.

Finally to get your graphs, statistics, and settings together, have a look at attached screen shot.

[SarcasticDave94]

I'm familiar with Central Apnea, just not events that only happen in the first half of the night. Agreed with the Ramp, either it needs to go off or be higher pressure and much shorter. The 50 to 61 minute charts means you had 5-16 minutes treatment as the Ramp time voids attempts at treatment.

If the static CPAP is used to avoid CA, Ramp also adds a variable CA may not like.

What did your detailed sleep study report look like? If you don't have your copy, you need it ASAP. You must know what is going on with the CA.

And if you're only dealing with Central Apnea treatment, you'll need the ResMed AirCurve 10 or 11 ASV. This one is designed to treat CA not avoid them.

[Dormeo]

To avoid taking your mask off, you could try putting long strips of tape over the straps that cross your face. That way you'll wake yourself up with a tug on your skin when you try to take it off. And some people wear a cap at night that ties under the chin, making mask-removal difficult.

There is such a thing as sleep-wake central apnea, which occurs as people fall asleep or (sometimes) start to wake up. But your charts aren't showing apnea events as you fall asleep. What we do see on your charts is a lot of irregular breathing during the times when your O2 levels drop.

Like others, I strong recommend that you make a change to your ramp settings. The simplest thing would be to turn the ramp off and set your minimum to 7. I'm not seeing a need for you to have a pressure range, since you don't seem to be experiencing obstructive events. So maybe min = max = 7.

Give that a try and see whether that makes a difference to your O2 levels. And do experiment with ways to avoid taking off your mask.

Keep us posted, would you?

[Deborah K.]

Since your median pressure is 8.58, and you rise to the 11 you have set, I suggest you set your pressure range at 8.4 to 15.  That way, we can learn what your pressure needs are.

You don't need ramp anymore since you've been at this for at least a year, so turn it off.

Best wishes for great therapy and comfort!

[whatisamodel]

Thank you for this response, I do know how to change the settings, I've since changed it to APAP, and I will make those other changes too. 

I will also reach out to my ENT to get a copy of the sleep study, and see if I can dig deeper into that. All I can remember is that supine made it way worse, and that it was cheynes stokes (however you spell it) breathing patterns. I was told by the doctor that, because I responded well to cpap in the lab my insurance wouldn't provide bipap/cpap. 

Is there anything I should be looking for in particular in the sleep study to help me better adjust my treatment of CA? I appreciate the time! Thanks again!

---

Thanks for the advice, everyone seems to say take of the ramp, I will do that!

[whatisamodel]

Thanks for this advice! The consensus sees to be to remove the ramp, and my prescription is technically supposed to be a constant 7 I'll see if that changes things. 

I've tried some of these methods in the past, but will keep trying (I admittedly don't always put the most effort into it), but its gets over whelming having so much stuff on your face. With the chin strap and the mask I feel like I'm about to climb into an f16 cockpit lol!

I appreciate you taking the time to respond!

[SarcasticDave94]

IF the doctor prescribed BPAP you'd get BPAP. Same for other machines, in part yes you want data to back up the machine choice if it's beyond simple Apnea treatment. What I mean is if there's Central Apnea on the test, you'd need to press the doctor to script ASV. If this doctor won't, try another of your doctors with the script data in hand.

First thing is get the script copy. Yes I repeat this. Get it and find the table that says what events type and count you had. Post that table here. Looking to see how many Central Apnea were involved vs the other events.