AHI of 52.67 on APAP (Airsense 11)

[Rubicon]

Hearing your story makes me feel better.

There is nothing that has presented here thus far that should make you feel better.

Living at altitude could be a confounder (perhaps your O2 baseline is a little low to begin with) and you have Periodic Breathing vs CSR (which given your cardiac comments might be more likely) vs CompSAS vs a combination.

My AHI reaches 130 during the early early morning so there is a lot of variability.

Kinda sends you in the direction of "short-cycle" central apnea as this is theoretically as bad as you absolutely can get.

Hoping for update and you have already seen a highly qualified professional to get this sorted out.

[Rubicon]

Last night it was at 52.67.

IMO it's a ****load more than that.

A closer look at your screenshot reveals



10 second rule be damned, that's AHI 120+.

[chunkyfrog]

The 10 second rule is indeed arbitrary.
Most of the time, it seems to work, but when it doesn't . . .
Shortcuts serve, but not everyone equally.

[dataq1]

Last night it was at 52.67.

IMO it's a ****load more than that.
10 second rule be damned, that's AHI 120+.

ummm, Obstructive and Hypos (items amenable to APAP therapy) Indexed at 3.8 during the 6 hour observation-treatment period.
Clear Airway ( generally not correctable by APAP ) Indexed at 49 during the 6 hour observation-treatment period.

Ostagoymp therapy needs to address the most exigent problem: Clear Airway Apneas.

I agree with Rubicon on the possibility of a coorelation of Cheyne-Stokes (Periodic Breathing) with AFIB that needs closer examination.

Ostagoymp: Do you monitor your heart rate while sleeping? (AFIB does not necessarily reveal itself with chest pain).

[Miss Emerita]

Ostagoymp, you haven't been back for a few days. I hope you got that doctor's appointment.

Did you try turning off EPR? If you did, was there any improvement in the CAs?

As you can see using the link below, there are several possible causes for central apnea, including "idiopathic," basically meaning "none of the above."

https://www.mayoclinic.org/diseases-con ... c-20352109

You need both medical help in understanding the kind of CA you have, and also in getting proper treatment, pronto, which will undoubtedly mean getting an ASV machine (adaptive servo-ventilator). This is like a CPAP machine in some ways, but it will "give" you a breathe if you don't breathe naturally on your own.

Your doctor may be quite knowledgeable and helpful, but I'll mention that some sleep doctors are relatively inexperienced with central apnea and the value of an ASV for CA patients. Because you live at a high altitude, which can be a cause of CA, I think your odds are pretty good of having a doctor with relevant experience. I have my fingers crossed for that.

[oystagoymp]

Ostagoymp, you haven't been back for a few days. I hope you got that doctor's appointment.

Did you try turning off EPR? If you did, was there any improvement in the CAs?

As you can see using the link below, there are several possible causes for central apnea, including "idiopathic," basically meaning "none of the above."

https://www.mayoclinic.org/diseases-con ... c-20352109

You need both medical help in understanding the kind of CA you have, and also in getting proper treatment, pronto, which will undoubtedly mean getting an ASV machine (adaptive servo-ventilator). This is like a CPAP machine in some ways, but it will "give" you a breathe if you don't breathe naturally on your own.

Your doctor may be quite knowledgeable and helpful, but I'll mention that some sleep doctors are relatively inexperienced with central apnea and the value of an ASV for CA patients. Because you live at a high altitude, which can be a cause of CA, I think your odds are pretty good of having a doctor with relevant experience. I have my fingers crossed for that.

I took the advice of everyone on this forum and others and reduced the range on my APAP to 6-11 and turned off EPR. It reduced my sleep apneas to around 6-12! They are still central sleep apneas though. I talked to a sleep doctor today and have another appointment with another in May. The sleep doctor mentioned that I could continue to play around with my Airsense and even lower it to 8 static CPAP mode and see if it reduces the central sleep apnea and try sleeping on my side to reduce the obstructive sleep apneas. She also believes if I left Colorado I wouldn't have any central sleep apnea at all.... I bought a ResMed S9 ASV off a medical depot side and I still need to get the hose but I need to titrate it according to what has been said in this forum and figure out my numbers.

The sleep doc said she could order a sleep study where they would titrate me with an ASV machine and then I would get a prescription and insurance would pay for one. I would need to send the high AHI values and not the later ones as they only pay for one if the AHI is > 15 with regular cpap therapy and it seems to have dropped to around 10 (it spikes to 20 during the early morning around 5 and I always seem to wake up at that time and then unable to fall back asleep). I also bought an oura ring and it seems my heart rate was in the 71-88 bpm range although I have a crazy low HRV of 25 and according to the ring, almost no deep sleep. All this is pretty overwhelming but the silver lining is being able to bring it down and the helpfulness and care of everyone who has answered.

[Miss Emerita]

I'm relieved that you're seeing improvement! Could you clarify: is the 6-12 the number of events during the night, or the AHI?

It'd be interesting if you could spend a night or two close to sea level and see what happens. Easier said than done, I know.

Instead of setting your machine to CPAP mode, try setting max = min = 8. Some machines don't provide the full range of data in CPAP mode that you might want to see.

Keep us posted, would you?

[palerider]

I took the advice of everyone on this forum and others and reduced the range on my APAP to 6-11 and turned off EPR. It reduced my sleep apneas to around 6-12! They are still central sleep apneas though. I talked to a sleep doctor today and have another appointment with another in May. The sleep doctor mentioned that I could continue to play around with my Airsense and even lower it to 8 static CPAP mode and see if it reduces the central sleep apnea and try sleeping on my side to reduce the obstructive sleep apneas. She also believes if I left Colorado I wouldn't have any central sleep apnea at all.... I bought a ResMed S9 ASV off a medical depot side and I still need to get the hose but I need to titrate it according to what has been said in this forum and figure out my numbers.

The sleep doc said she could order a sleep study where they would titrate me with an ASV machine and then I would get a prescription and insurance would pay for one. I would need to send the high AHI values and not the later ones as they only pay for one if the AHI is > 15 with regular cpap therapy and it seems to have dropped to around 10 (it spikes to 20 during the early morning around 5 and I always seem to wake up at that time and then unable to fall back asleep). I also bought an oura ring and it seems my heart rate was in the 71-88 bpm range although I have a crazy low HRV of 25 and according to the ring, almost no deep sleep. All this is pretty overwhelming but the silver lining is being able to bring it down and the helpfulness and care of everyone who has answered.

reducing the pressure further *may* exacerbate the obstructive apnea, and all things considered, obstructive apneas are *much worse* than central apneas are, because the centrals are not stressful, (bp, heart rate, stress hormones) whereas obstructive apneas *are* stressful to your body.

The only time to really be concerned about central apneas is when you're having boatloads of them, like you were.

Post another chart of an example night. You may need to increase your pressures to overcome the obstructive apneas, now that the extra ventilation caused by EPR is out of the picture.

[dataq1]

Citation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227706/

A series of studies indicate that central apnea responds to treatment with supplemental oxygen. For mountaineers at very high altitudes, a primary beneficial effect obtained from the use of supplemental oxygen is an observed decline in apneic events during sleep.11 In the sleep laboratory, supplemental oxygen has been shown to markedly reduced the incidence of central apneas.12,13 Low-flow oxygen has been shown to decrease the rate of sleep disordered breathing during sleep, having particular effects on reported central and mixed apneas, and increasing the percentage of events described as obstructive.14,15

The partial pressure of (atmospheric) oxygen at Denver is 14 kPa, while at sea level the partial pressure of (atmospheric) oxygen is 21 kPa.

Consult your physician.

[clownbell]

Agree with Deborah K's remark above. Know your sources.

[dataq1]

Yes, be very wary of anyone who would suggest that you consult your physician

[oystagoymp]

I'm relieved that you're seeing improvement! Could you clarify: is the 6-12 the number of events during the night, or the AHI?

It'd be interesting if you could spend a night or two close to sea level and see what happens. Easier said than done, I know.

Instead of setting your machine to CPAP mode, try setting max = min = 8. Some machines don't provide the full range of data in CPAP mode that you might want to see.

Keep us posted, would you?

It's the AHI recorded when I wake up and check my APAP. I will be going to Florida in about a month to see how I do in sea level.

I will try to set the machine to max, min of 8 and screenshot the data. It has consistently been around 5-15 after reducing the pressure but yesterday I tried the nasal pillows instead of the nasal mask and kept waking up gasping for air. I checked my CPAP and had reached 60+ AHI. I think the nasal pillows cause a higher AHI but I'm not exactly sure why.

[Miss Emerita]

Ooof -- 60+. I don't know why a change in mask would make a difference either. Maybe causing your sleep to be more choppy, with CAs after every little arousal? I'll be curious whether the AHI settles back down if you switch back to the nasal mask. I'll also be very curious about how it goes in Florida.

Keep us posted, would you?

[chunkyfrog]

Ooof -- 60+. I don't know why a change in mask would make a difference either. Maybe causing your sleep to be more choppy, with CAs after every little arousal? I'll be curious whether the AHI settles back down if you switch back to the nasal mask. I'll also be very curious about how it goes in Florida.

Keep us posted, would you?

Not everybody get "fitted" with the right size of nasal pillows.
Too small--I don't get enough air.