Increasing AHI despite fewer leaks

[Aife]

Hi again,

first, thanks so much for your help, Deborah!

Two nights ago I switched to a nasal pillow mask, the N20, and I tried to sleep on the side more, but that wasn't a great night, huge mouth leaks.

However last night, since I received my cervical collar yesterday I wore it during the night. Unfortunately I had some mouth leaks, I didn't want to add two new things at once (collar plus mouth tape), but the report looks OK to me, except for the large number of central apneas. My two sleep tests before starting treatment showed I barely had any central apneas (1 per hour, if I remember correctly), so I'm guessing these are treatment emergent sleep apneas.

I'll try using mouth tape tonight, although I am a bit worried; what if my nose is blocked for some reason?

Anyway, does it look like my positional apneas are fixed, at least?

[Deborah K.]

You did a great job in solving your positional apnea!  Good for you!  The N20 is a nasal mask, not a nasal pillows mask, but would still require that you use mouth tape.  I thought mouth taping would be horrible and claustrophobic but found that I'm really comfortable with it.  Once I have it on, I barely notice that it's there.  I wore mine straight through a bad case of Covid with no problems.  But, if it's too much for you, you can always return to a full-face mask.

If you do use mouth tape, make sure you buy good stiff.  Lots on here like Cover Roll Stretch tape or Hypafix tape, both of which work very well.  I use Theraband Kinesiology tape because I find it more comfortable, but it does cost more.

People are different, and I leaked a lot more than you do, but for me, I need to use 2-inch wide tape cut to about 5-1/2 inches long or I still leak.

[Aife]

Thanks!

Oh you're right, I got my vocabulary confused there, it is a nasal mask. My therapist told me to set the Resmed to the Pillow setting rather than the Nasal one, however, is that OK?

I'll definitely try the mouth tape tonight, thanks for the reassurance.

Is there anything I can do about those central apneas other than fix my leaks and/or be patient?

[Deborah K.]

If you had only a few in your sleep study the CAs will lessen on their own as time passes.  You can decrease your EPR setting to 1 or 2.  That should lessen the number of CAs, but will increase your flow limits.  Flow limits are short apneas that are not reported as apneas, but which do lessen the effectiveness of therapy.  It's up to you what you want to do.  If it were me I'd leave the EPR as is.

[Aife]

The last two nights were a bit of a mixed bag. August 29 went quite well, leaks were low with the mouth tape, and central apneas seemed to be on a downward trend. However, last night (August 30) I had more leaks, and central apneas are now around 8 her hour, with one huge cluster of them from 3am to 4am.

First, I'm really confused as to where the leaks are coming from, I wore the mouth tape all night both nights, it covers the entire mouth, and I feel it's almost completely blocking the air that I try to push through my mouth. If I try to blow really strongly through the mouth then yes it leaks a little bit. Does it look like my body is trying to exhale through the mouth most of the night, against the big resistance of the tape? I'm worried that's not healthy.

Second and more importantly, I'm scared about the increasing number of central apneas and that big cluster I mentioned. Might they be related to the mostly blocked mouth exhalations I mentioned?

I attached both reports to this reply. What do you recommend I do?

[Jay51]

Here are some tips to help prevent mask leaks.  I hope these help:                Mask leaks)            Mask Primer

[Aife]

Hi again,

The number of central sleep apneas seems to be going down, slowly. These last two nights I tried sleeping on the side with my sleep noodle. Unfortunately, the first night sleeping on the side I forgot to put back the memory card inside the machine, so all I know is that I had 5.3 total AHI, of which 5.1 were central apneas, 0.1 obsctructive apneas, and 0.1 hypoapneas.

Last night the central apneas went down again, but the obstructive ones went slightly up and, this is what's worrying me, I had my first occurence of Cheyne Stokes Respirations for 15 minutes towards the end of the night. Any idea what could have caused that, and what I could do to prevent it?

Thanks again for your help.

[Aife]

Looking at other threads with people suffering from CSR, they were sometimes asked for a zoom-in on the CSR, so here it is for me:

[Jay51]

The vast majority of CSR flagged by Resmed machines are false.  Your CSR flag here shows it happening just before you wake up.  This is not typical of true CSR.  Real CSR is most commonly associated with heart failure.  Also, real CSR tend to occur over the entire night, not just in one brief span of time.  Because of the transition from awake to sleep and from sleep to awake that occurs at the start of sleep and at the very end, CSR can falsely appear also.  

Here is some reading from our wiki on CSR, too:    

• Cheyne-Stokes respiration
  

[Aife]

Thanks for your help, Jay. Last night I had no CSRs so you were right!

However, it looks like my obstructive apneas are back. After sleeping on the side with a nasal mask three nights in a row, last night I went back to my full face mask and sleeping on my back.  I wore my cervical collar all night. Are these positional apneas again, or 'normal' obstructive apneas?