Possible CSA / Cheyne-Stokes breathing ???

[oldshoe]

Hey guys,

Would love verification I am looking at CSA and Cheyne-Stokes breathing.

I was prescribed CPAP about 7 years ago for OSA with full face mask. I have had 2 surgeries for Chiari malformation...one in Sep 2010 and another in March 2019. The do some work on and around the cerebellum. Heart check up before surgery in March 2019 was fine.

I was bothered by strap on back of head for full face mask and switched to a TAP CPAP Nasal Pillow system that inserts with mouthpiece. I love it.

I have not returned to doctor since original study. Felt I was doing well but could do better so loaded up Oscar to take a peak. I have it about a week and had some nights better than seen here and some worse, but all show multiple CA events and when I drilled down I saw what I think is Cheyne-Stokes breathing. Please confirm. Can this be caused by brainstem issue and/or heart issue ? any other possible explanations ?

Thanks for any thoughts or recommendations, JO

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[Pugsy]

Can you zoom in an give us a 5 minute segment. So a little closer look please. I suspect they are the real deal but need a bit closer look.

For tonight can you try turning off your EPR exhale relief feature on your machine? It's also a possible cause or trigger for centrals in some people. Let's see if we get lucky.

[Pugsy]

Also....you have chosen the wrong machine in your profile. Probably because you couldn't find the S9 AutoSet. Just add it manually to the comments section and leave the machine choice blank. Equipment choices are tied to current inventory of cpap.com (who hosts this forum) and if they don't sell it then it won't show up. The S9 was discontinued some time ago so of course no longer sold.
When this happens we tell people to just manually add it to the comments section.

[Julie]

I would want to see the neurologist again and ask them if e.g. the ACM could be affected by Apap regardless of what happens here.

[oldshoe]

Hear is a 5 minute view from that night....

download/file.php?mode=view&id=12022

[oldshoe]

And then here is last night...not nearly as bad....I tried sleep without a Benadryl and using some decongestant nose spray....maybe thats the ticket...will try again tonight and also turn off EPR...

download/file.php?mode=view&id=12024&si ... 5d5ba7a93b

[Pugsy]

Pretty much what I expected.

You say this is something that just started happening a week or so ago and before that you didn't have a problem with the number of central apneas? Sure makes a person wonder what changed because something did.

You really should be alerting your doctor to what is happening. I have no idea if it is related to your brain stem issue or not. I would be more worried about what changed so dramatically to cause this to happen.

I assume no change in meds or anything like that?

Do try turning EPR off though.

[oldshoe]

No idea if it just started....I just started pulling the Oscar data and noticed it.... I'll turn off EPR, discontinue Benadryl, use decongestant nose spray and contact doctor and report back

JO

[Pugsy]

That's the main failing of the S9 model machine if people don't download at least once a week. No record of the flow rate details since the machine will overwrite (on the SD card) a lot of that detail after a limited amount of time.
There's no way to really go back and see exactly when things changed. Makes it hard to isolate any changes in anything that might be a factor.

But let's see if we can at least reduce the problem now. Your doctor may or may not want to investigate further at this time but he should at least be aware of the situation and what you are trying to do to mitigate the situation.

[Julie]

Little tip - don't use Afrin - it's addictive (you need more to achieve less), but Flonase is known to work well.

[oldshoe]

Hey guys,

Thanks for all the help...I was able to a very affordable VPAP Adapt with Auto ASV ...i did a little adjustment to factory defaults after first night because I was waking up to some high pressure... here are results for second night...should I be happy with these results ( No CA events, AHI 2.47 ) or do you suggest I change or tweek anything ? Oscar readout below - Thanks, JO

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[oldshoe]

and some results from last night... min EPAP was set at 6.8 .... seems like it ramped up to 9-10 to attack the HYPOS...maybe just set min EPAP at 9-10 ???? any suggestions appreciated

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Screen Shot 2020-06-27 at 3.56.52 PM.png (252.41 KiB) Viewed 651 times

[Pugsy]

Assuming those flagged events are real asleep events (and the 2 zoomed in OAs and one hyponea look to me to be SWJ sleep/wake/junk false positives and not asleep events) then a little more EPAP might be warranted but if all your flagged events look like that....I don't think you need all that much more EPAP.