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[Symptoms] Worried about sudden spike in CA events
#1
Worried about sudden spike in CA events
Hi Folks,

I am a 33 year old male, recently diagnosed with severe OSA(AHI 35.1) . I had my inlab ( level 1 sleep lab) PSG in March.  The test revealed obstructive sleep apnea and no central apnea. It was a split night study with 3 hours for the diagnostic and 3 hrs for the titration with the CPAP. I was hardly able to get any sleep for the titration study but managed 25 minutes of REM sleep. The sleep study indicated treatment of OSA with APAP varying pressure between 4-13.

I started therapy the same week using a Resmed Airsense 10 and an F20 ffm. Struggled quite a bit initially due to multiple issues- mask fit, pressure intolerance etc, but I managed to make progress each day. Finally after a couple of weeks I got a point where I was able to tolerate it for 4 hrs at night. AHI ranged around 3-4 most days. I also noticed a few central apneas but I ascribed it to TESCA. I was also able to fall asleep without the mask if I wanted to.

In order to increase my compliance with the cpap I decided to try a nasal mask. Started using the N20 on April 7th and my compliance went up. The nasal mask was a lot more comfortable for me as a stomach sleeper and it felt less obstructive on my face.  I was able to go up to 7+ hours each night with it. AHI went down further, now it ranged between 1-2 most days( central were still there but mostly seemed to be sleep wake junk).

Last week I had to travel overnight, I carried the CPAP along. As I was setting it up in the hotel I noticed that the mask settings were wrong. Instead of the Pillows setting for the N20 it was set as FFM. I changed the setting and went to bed. I was struggling to fall asleep. Initially I thought it was because of the hotel and being away from the bed I was used to but I  happened to check the machine and noticed a very high AHI( most of them were revealed to be centrals and hypopneas later when I checked Oscar.).

Ever since that week my AHI has gone up significantly sometimes as high as 7-9. I tried changing masks, pressure settings but still the central and hypopneas persist. I also struggle to fall asleep and have multiple awakenings through the night >5. before last week I did wake up but not more than 3 times in a night. Im surprised that I'm having centrals despite it not being reported in the sleep test. I did a cardio consult not too long ago and heart is fine. Could it be a neurological condition. Im super anxious especially since my grandmom had ALS. 

Im attaching my sleep report here in this post. I'll also share a few oscar reports from different dates for reference. Request fellow CPAPers to share their thoughts

           
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#2
RE: Worried about sudden spike in CA events
Attaching the OSCAR reports from the beginning of the month when the AHI was under control

           

OSCAR snapshots from this week after sudden spike in CA events.

           


Attached Files Thumbnail(s)
   
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#3
RE: Worried about sudden spike in CA events
You look like you may have positional apnea. April 17 for sure but many times the central are not real centrals. The machine pushes small bursts of air and tries to determine if there is blockage and if the air is not returned it is classified as a central. So sometimes it is not accurate.

You also have grouped H events and that is almost always positional. Have you been sleeping on a new pillow or added pillows?" have you raised the head of the bed?" Sleeping on your back? These may be real centrals but I would first rule out any positional apnea.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Worried about sudden spike in CA events
maybe try measuring your position (somnopose app). i have a very strong correlation with position changes and the machine marking CA events. no idea if they are real CAs but my doctors were not concerned because the CA AHI was < 5. for me, usually 3 or below.
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#5
RE: Worried about sudden spike in CA events
Thank you so much for your responses. I don't know about positional apnea. I am mostly a stomach sleeper. What I have noticed is i experience significant CA clusters at the transition stage between wakefulness and sleep.  if I stay awake at this state for a long time the ahi is significantly higher. if I manage to fall asleep I don't experience too many CA events when I am asleep. Yesterday was a.great example for this. I'll share the oscar chart for last night shortly
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#6
RE: Worried about sudden spike in CA events
Thank you so much for your responses. I don't know about positional apnea. I am mostly a stomach sleeper. What I have noticed is i experience significant CA clusters at the transition stage between wakefulness and sleep.  if I stay awake at this state for a long time the ahi is significantly higher. if I manage to fall asleep I don't experience too many CA events when I am asleep. Yesterday was a.great example for this. I'll share the oscar chart for last night shortly
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#7
RE: Worried about sudden spike in CA events
Here is the Oscar summary from last night. 
   

Im also sharing the zoomed in view of the transitional events and the rest of the events from the night.

Transitional CAs
   

Sleep time CAs
   
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#8
RE: Worried about sudden spike in CA events
I see that you have EPR off.  Your flow limits are high so you need to turn EPR on full-time, set at 3.  That should help you feel better. Smile   If you are using ramp turn it off or at least set it for only 5 minutes.  You get negligible therapy with ramp.  As to your CAs, if you have only been using your machine for a month or two they are no doubt treatment-emergent and will go away or lessen as time passes.  You don't need to worry about them at all.  I have been using my machine for several years and still have CAs most days.
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution
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#9
RE: Worried about sudden spike in CA events
Thank you so much Deborah. You just put my mind at ease.  Let me give EPR 2 an attempt tonight.
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