Time to ask for ASV Titration?

Hello all..

I started CPAP therapy in March of 2017. I asked for and received a Resmed A10 Auto.

It took a couple of months to dial in my ideal settings and then for about 7 months my average AHI was less than 1. It was great.

The past 6 weeks I have had an AHI averaging between 10 and 15 with the majority of my events being clear airway events.

I have attached a typical night for me over these past few weeks. I am now extremely tired during the day even taking Nuvigil hasn't really helped.

I am using the same pressures I have been using for months. I did try lowering my pressures for several days with no improvement at all and am now back to what used to work for me. Any suggestions would be welcome.

Any change in medications? Either it adding or dosage of something? If so, what?
Are those leaks waking you up?
There seems to be a lot of clustering of the centrals around the time of a large leak. Are you waking often during the night for any reason...leaks or whatever?

Pugsy,

The only medication change was the addition of plaquenil around the same timeframe. I have inquired with my regular doc and my pharmacist and they both tell me it should not be affecting the apnea/sleeping.

Some nights I do wake up at times, but usually only briefly and get right back to sleep. The leaks generally do not wake me up.


Thanks for your response!

You probably should be getting with your doctor about these changes you are seeing since we can't seem to blame the usual culprits...medications or awake breathing flags by mistake.

While I couldn't find where plaquenil was known to suppress respiration...it's odd that these changes seem to correspond with the addition of the medication.
You might talk with your doctor about suspending it for a period of time and just see what happens with the centrals....just to rule it out.
Sometimes these drugs cause some weird stuff.

Have you tried taping your mouth or using a FFM? I wonder how many of those "clear airways" are real.

I do have a call in for an appointment to discuss it and I'm leaning towards asking for a new sleep study.

I could suspend the new med, but without it I would have to go back on prednisone which I would hate to do as there is no evidence that it could cause these issues.

I do have a FFM and have used it a few nights with similar results. Although no matter how I adjusted it the leaks were much worse.

I know it's hard to see, but there are periods with no leaks that still have quite a few clear airway events.


How common is it for someone to develop centrals after having OSA pretty well under control for nearly a year??

JohnnyBGood wrote: ↑

Tue Feb 20, 2018 6:28 pm

I know it's hard to see, but there are periods with no leaks that still have quite a few clear airway events.

Yes, I saw that and that's why I asked about wake ups in general. Trying to blame the centrals on wake ups ...but you don't report waking a gazillion times so that culprit is unlikely the cause.

JohnnyBGood wrote: ↑

Tue Feb 20, 2018 6:28 pm

How common is it for someone to develop centrals after having OSA pretty well under control for nearly a year??

I have no idea how common or not common it might be.
Only time I have seen it has been when medications are used that can suppress respiration...pain meds in particular.
And they were taking heavy doses...not just an occasional pain pill.

Time to follow up with the doctor for sure.

Thanks Pugsy.

Sometimes the answers aren't as easy to come by as we hope.

Hopefully I can get into the office fairly quickly. I could really use a good night's sleep!