Periodic Breathing - Strategies?

[mark.apnea]

I notice Periodic Breathing represents a large portion of my night's sleep.  I do see some stretches of nice regular breathing with no events, but I'd estimate 3/4 of my night is periodic in nature.  Within these periods, I see a frequent mix of H and CA events. 

Speaking with my pulmonologist was a waste of time.  She noted my 3mo AHI ave was <5.0 and tried to send me on my way.  I responded with a question about these periodic breathing patterns and frequent CA events.  She claimed not be aware of Oscar, which seemed odd.

She reluctantly offerred the following adjustment:  

Fixed Pressure: 9.0  (was 10.0, but too many leaks)
EPR: 1 
Ramp: Off

Its been several months, and my results seem about the same, maybe a bit more variable in AHI 
 - Was - mostly <2.0, frequently <1.0
 - Now - mostly in 4.0-7.0 range, occasionally <2.0   
 
Periodic breathing is unchanged.

Any suggestions or strategies to help address and improve this breathing pattern?

Thx

Resmed11
Evora Full Face Hybrid

       

Note: I find it interesting the Pulse Rate spikes seem closely associated with Movement events. I had though these might have been associated with H & CA recovery breaths. Not sure.

[Sleeprider]

This is a breathing problem best explained as "loop gain". It is usually a fluctuation of CO2 in the blood and a latency in your respiratory response. Read our wiki article on loop gain in ventilation, and we can talk from that starting point. https://www.apneaboard.com/wiki/index.ph...entilation An effective strategy is to us some extra dead space to preserve expiratory CO2, known as Enhanced Expiratory Rebreathing Space https://www.apneaboard.com/wiki/index.php?

By preserving some expiratory CO2 in the CPAP breathing circuit, we can level out the loop gain and generally resolve periodic breathing and loop gain. There is a solution, but it is not recognized by mainstream sleep medicine, partly because it's not used in obstructive sleep apnea. Several doctors have investigated and written on this approach, and we have a handful of members that can share their experience in building and using EERS.

[mark.apnea]

Thanks Sleeprider,

That's quite a bit to digest; I'll wade thru and let you know any questions or concerns.  I am guessing my pulmonologist would not be participating in any sort of EERS approach as she's already blown me off.  The DMEs noted in the EERS wiki are actually fairly local to me.

As the primary risk here appears to be cardiovascular, it seems appropriate to get a cardiologist in the loop.  I'll raise the topic with my PCP at my upcoming annual exam (May 6) to put this on his radar.  Hypertension is already an issue for me.  There may also be some link between my CAs and TLE (Temporal Lobe Epilepsy) neurological disturbances during sleep/wake transition affecting respiratory drive.  I visit my neuro next on Mar 6.  She expressed interest when I mentioned CPAP therapy at a prior visit (but was in context of memory gaps).  I'll bring it up; who knows?

Would BiPap or ASV be considered as a treatment option?  Are these therapies even appropriate?  I presume my PCP would need to prescribe another sleep study.

I guess I was hoping for a reply like - bump your pressure to XX, set EPR to YY, etc...  Not so easy.