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Sleep Onset Issues
#11
RE: Sleep Onset Issues
Hey  Smile

The symptoms appear the same, but the cause seeminlgy quite different in your case.  Your spo2 plunges do seem to be caused directly by apneas (as every time you stop breathing and it's marked as an 'oa').  But the question is whether the DreamStation APAP you're using is falsely detecting centrals as obstructives (if, like you say, you feel you've ruled out obstructives as being likely) - it sends a test pulse to see if your airway is clear to establish this but I've always been a bit dubious about the validity of that result.  My spo2 levels fall as a result of my flow rate going right down over a period of time, and that's while on ASV.  I do have apneas without the ASV, but it kicks in to deliver breaths which is the main difference between ASV (or Bilevel ST) and standard CPAP/APAP/'Vanilla' Bilevel.

I'm not an expert and I'm sure others might disagree or have their own opinion, but if it were me the first thing I'd try doing is dropping your Min EPAP to something like 6 and ensuring you're running in Auto (not CPAP) mode - this should hopefully answer whether a higher pressure is causing the apneas.   If this still doesn't work, exhaust any possible positional apnea solutions as advised by sleeprider.  Any change you make, give it a few nights to see how your body responds.

If all else fails and you're stopping breathing as a result of centrals which are not induced by the high CPAP pressure itself, you might be a candidate for ASV.  But, I'd definitely consult with an RPSGT about that first as they may decide you're a better candidate for ST therapy (usually more applicable where there are conditions like COPD existent).  Here in the UK I'm left waiting up to a year before I can even speak to a sleep tech due to the mess covid has caused our NHS, so I'm doing this alone and very gradually / with a lot of research and monitoring my data.  I use hospital grade equipment where I can and have arrived at a therapy that seems to safely 'do the job' for me for now, but I will still want a full polysomnographic study - I can however go into that appointment with a catalogue of data I've collected myself.

This is a pretty good video about ASV settings / indications imo: https://www.youtube.com/watch?v=JmCJjDOjYQQ

If you do try and purchase a machine, I recommend any of the resmed adapt SV machines (S9 or above if you want OSCAR/SLEEPYHEAD, S7/S8 are just as effective in terms of the therapy if you can live with only having Resscan to analyse your data).  I picked up a refurbed ~200 hours S9 VPAP AdaptSV for $600 and a low hours S7 VPAP Adapt SV for just $200 - both came with humidifiers and they're both awesome machines.  But, do as I say and not as I do - get advice first if you can Smile   Again, do bare in mind what sleeprider has said - there is a good chance they could be positional apneas looking at the charts... know though that if that's not the case and your problems are central, there are more effective therapy options out there.   I decided to try ASV on the basis my DreamStation was flagging the vast majority of my events as central apneas and hypopneas, and my flow rate graphs were all over the place - the therapy is a significant improvement for me over stadard CPAP/BiLevel (which I've also tried), but still not perfect.  It's just keeping me out of the danger zone for now. 

Chris
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#12
RE: Sleep Onset Issues
Thank you! I don’t know how this could be positional knowing it only happens as I’m drifting off to sleep - and happens in every position and even sitting up.

This problem has really been the only problem and the one that caused me
To get a c-pap etc. So can’t be pressure induced.

Got prescribed diamox and took that last night. Average night but much better than the last two.

I see my Dr next month. Absolutely will be talking to him about ASV. Thank you.
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#13
RE: Sleep Onset Issues
(03-14-2021, 08:18 AM)NewToSleepApnea Wrote: Thank you!  I don’t know how this could be positional knowing it only happens as I’m drifting off to sleep - and happens in every position and even sitting up.  

This problem has really been the only problem and the one that caused me
To get a c-pap etc. So can’t be pressure induced.

Got prescribed diamox and took that last night.  Average night but much better than the last two.  

I see my Dr next month.  Absolutely will be talking to him about ASV.  Thank you.

CPAP can cause apneas if the pressure is too high - so yeah it can be pressure induced too... it's a balancing act for some.  Might not be what's happening here, but if it was, you want the pressure low enough to eliminate the obstructive apneas, but not too high that it introduces central apneas (and you've said it always happens, so there's a chance they could indeed be central but are obstructive without the CPAP therapy).

Again, I'm not a sleep tech but I'd have thought if nothing else is controlling your onset desats the next step would be almost certainly to trial Bilevel ST (Spontaneous/Timed) or ASV, both of which deliver breaths if you stop breathing for a short period.  Your apneas are lasting almost a minute at times according to your graphs(!)  As an example, on the resmed ASV the default backup rate is 15 breaths per minute - so if you stop breathing for 4 seconds it'll force breaths at increasing pressures until you're back to breathing normally, then back off until it thinks it's needed again.   Bilevel ST is more strict - it has a fixed EPAP and IPAP (vs automatically varied on ASV), and you specify the backup rate and inspitory time etc which it stays at all night (a bit more like a ventilator in behavior).  Definately ask about both these things when you see your doctor.
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#14
RE: Sleep Onset Issues
Thank you so much. Extremely helpful. I am going to ask my Dr this for sure. So odd. Came out of no where one day. All on sleep onset, in any position and apneas lasting for a min at times. Wake up with chest tightness and O2 drops. Hopefully I'll be able to try an ASV machine.
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