Looking for Ideas to Help Central Apneas

[IronScaggs]

Greetings and thanks in advance for any suggestions you all may have.  I am open minded and willing to try anything to improve.

I have had my Airsense 10 for 5 years, but never knew about the clinical settings.  My sleep doctor is impossible to get to, and never returns emails, so I found out about Oscar.  My machine did not have a card so I installed one this week, and have started playing with the settings.  But my initial results are worse than before, so I created an account to ask for some experienced eyes to look at my limited data and see what you may find.

Initial sleep study was home based, 15 AHI, 9 of which were central.  I got my machine and the basic N20 mask, and have used at those settings for 5 years.  Very faithful user, only missing a few days a year.  

Sleep is not restful.  Best I can describe, my mind races and doesnt shut off.  When I wake up, I feel like I just got out of an 8 hour office meeting.  Mentally exhausted.  I upgraded to a heated hose a few years ago, clean my machine daily, and use distilled water.

Now here are the complications...  

1.  My regular doctor has had me on 1mg Clonazepam for 3 years, to try to calm my overactive brain.  Helps me fall asleep, but little improvement in restfulness and AHI does not change much.

2.  When I started 5 years ago, I was 330 pounds.  Have been on tirzepatide for 2+ years, and have lost 170 pounds.  Visceral fat went from 30 to 7.  Loose skin in places but waist went from pants size 50 to size 30 now.  I still take tirzepatide injection weekly at a low dose to maintain the weight loss and keep my sugar numbers low.

My interpretation of the OSCAR data is that my problems all relate to central events, not obstructive.  I wear a mouthguard on my lower teeth to prevent grinding, and have for many years.  Total nose breather, no dry mouth ever, no issues with claustrophobia or mask adoption.  I wear it every night like clockwork.

Ideas?  Thoughts?  any direction on what to do?  I heard that the newer Servo machines are better for central apnea, but they are $$$ and the wait time to see a sleep specialist in my network is 9-10 months.  But I am willing to try any suggestions.  I will attach OSCAR screen grabs, last one is representative of settings from sleep doctor 5 years ago.  Thanks!

[SarcasticDave94]

Welcome to Apnea Board,

Both the CA and leak rates are wanting attention. With the leaks, I think there's mostly a mask leak issue signified by the spikey look in the chart. There's possibly some mouth leaks too.

As for the CA, you might need to try reducing EPR to 2. See if that helps reduce CA. Also get with any doctor if yours and ask for a Titration focusing on ASV to treat CA.

[Deborah K.]

In the meantime, set your pressure range to 8 to 17. This will provide better therapy until you can get the machine you need.

If it were me, I'd leave the EPR at 3. I think you'd feel better, and I don't think a slightly higher AHI matters right now.

[Jay51]

Here are some tips from our Wiki to help lower mask leaks as well:

• 1Mask Primer
  

[IronScaggs]

Ok, Thanks for the advice thus far.

I have been using N20 nasal mask, but this past week I have switched to the F20 full face mask.  The benefits have been no dry mouth issues and leak rates have seemed to drop, and when donning the mask and getting ready for bed it seems easier to get the mask to fit correctly with no noticeable leaks.

Then the wheels fall off the train!

Attached are two OSCAR reports.  One was done with APAP, the other as an experiment with CPAP.

What am I looking at here?  My layman interpretation is that I am doing great until "something happens" then my AHI goes through the roof.  Is this positional apnea? Am I having night terrors?  its crazy how it goes from OK to awful so fast!

I try to go to sleep laying on my back, but I switch positions often during the night.  I use a memory foam pillow (just one pillow) which seems a "normal height".  My best guess interpretation is that I am moving into a position where I am creating my own problems.  

Looking for suggestions to try over the next few nights?  I have a chin strap available which I wore occasionally with the nasal mask.  I tolerate it well but it did not improve my numbers or res with the nasal mask.  The results I got between CPAP and APAP did not seem to differ much, but it looks like I am pushing max pressure on the APAP graph and maybe my CPAP pressure was too low.  I started making changes to reduce CSA events, so I have been trying to keep the pressures lower per suggestions from others on the board.  I could order a soft Ccollar if that might help?

As always, thanks and props for any suggestions the community has.  This Board is doing Gods work!

[staceyburke]

The charts you have up now show that you have positional apnea and very little central apnea. Positional apnea cannot be helped with pressure changes.  The only way to stop position app now is to get out of the position you’re laying in.  It’s called chin, tucking with chin drops to your sternum and stops the air from coming in. To fix that we usually use a cervical collar. I have a link to cervical collar in my signature at the bottom of this post  

In the post, it shows many people that had position apnea with the collar and without a collar, a huge difference.

[IronScaggs]

Thanks!  Will order one today and report back next week how it works out.

[IronScaggs]

Thank you!!!

Got my soft collar yesterday, used it for the first time.  AHI for the night at 1.4.  Perfect seal with the full face mask. Best numbers i have ever had in 5 years of CPAP therapy!

I don't feel more rested, but I am patient and know it will take time to make up the sleep deficit.  

Only drawback was my dog, who thought I was an intruder when she saw me with the collar and face mask.  

Again, many thanks for your evaluation and recommendations.  Your efforts are appreciated!