[Treatment] Cheyne-Stokes Breathing and high AHI

[jimms]

   
[attachment=32707][attachment=32707]    
Hello,    
    I am 2 months into my APAP therapy and am not getting the results I would like.   I am a healthy female, normal weight, normal blood pressure, no heart issues.  I am very active and have been running for about 10 years now.   My Garmin watch kept showing low oxygen readings at night so I finally went for a sleep study and sure enough I have moderate sleep apnea which was a total surprise to me.  

     I have started APAP therapy and use a Resmed AirSense-10 with pressures set at 8-16 with no ramp and ERA turned off right now.  I am also using a full mask F20 airtouch which works pretty good for me with minimal leaks.   My numbers have never been great with AHI averaging about a 5 most nights.   I can not seem to get this number  down at all.   My AHI has been going up over the last week and the last two nights there has been some Cheyne-Stokes breathing.   My original pressure was set at 4-20 but I really can not tolerate the higher pressures.  The machine stays at the highest pressure for most of the night no matter what it is set at.   I can tolerate pressure 16 but anything higher is difficult and I wake up a lot and my lungs hurt in the morning for a bout a hour.  

    I have two questions:
1.  Is this real Cheyne-stokes breathing or some artifact of the machine?

2.  Why is my AHI high?   I have tried EPA set  at 2 and also have turned it off with no real changes.   Is there anything else I should try.  

I would appreciate any input from the group from a very discouraged APAP user.

[OpalRose]

Hi jimms,
You don't have CSR.  The pattern for Cheyenne-Stokes just isn't there.  Usually we see the waxing and waning followed by Clear Airways.  Watch for that.

Your AHI is high due to Positional Apnea.  Look at the Obstructives and Hypopnea... where the events are clumped together.  This is due to chin tucking, where your chin drops to your chest and in turn cuts off your air supply.  This can occur whether on your back or side, but mostly on your back.  

Many here use a soft cervical collar to help with chin tucking.  

http://www.apneaboard.com/wiki/index.php...cal_Collar

I think if you can get the chin tucking under control, you will see a drop in Obstructives.  

You also have a lot of flow limitations which drive the pressure up to your maximum set.  The use of EPR can help with FLow Limitations.  Set your EPR  3.  

Once you get the chin tucking under control, and hopefully the Obstructives calm down, you may need a higher minimum pressure.

[jimms]

Thanks for the information OpalRose.   I will definetely try and get the chin tucks under control.  Is the flow limitation that you mentioned also the result of chin tuck or does something else cause that?   Hopefully I will not have to go to a higher pressure since I know that will be hard for me to tolerate.

[SarcasticDave94]

Welcome to the club. CSR isn't likely. The PAP machine is flagging CSR but it's not a correctly named event flag. In most cases that is. If you'd have the heart condition involved you'd already be discussing poor health condition with cardiac doctors.

Your flow limits, Obstructive, Hypopnea, that's another story. Those are real and need work to address.

[Geer1]

Yes flow limitation can be a result of chin tucking etc.

I am curious, have you tried a nasal mask?

[jimms]

Thanks Dave,     I will try to see if improving chin tucks will help and put EPA back to 3.

[SarcasticDave94]

Welcome, yes give a soft cervical collar a look. And when you try EPR 3 give us a nice OSCAR not zoomed and tell us how it made you feel.

[jimms]

No I am a mouth breather and always have been so I use the full face mask.

[jimms]

   

Last night I tried sleeping with a cervical collar and my numbers were better but still high flow limitation. Mostly hypopnea and also a lot of RERA events popping up.   I wore my O2 ring last night and still had some O2 drops into the mid 80's at the beginning of the night.  Anything else that I should try?

[Geer1]

It looks like you might need a machine with more capability (bilevel, Resmed Vauto preferably). This will increase air flow to help overcome the remaining restrictions (flow limitations, hypopnease and RERA's).

The only other thing I can think to try is a nasal mask as they can be more effective. A big question is why do you mouth breath and can anything else be done to fix that (mouth breathing is not as efficient as nasal breathing)? Worth seeing an ENT if you haven't already.