TECSA

[ChadBSr]

My sleep test and weeks of wearing my O2 sensor showed me dropping to 89% BEFORE cpap.
Last night with CPAP EVERY time I began to fall asleep my O2 dropped. I have the monitor set to alert me and it wakes me up. I couldn't sleep. I lowered the alarm to 88. It still happened. I dropped to 84. How low would I go without the alarm waking me is unknown.
I just wanted some sleep so I dropped the alarm to 80 and turned off CPAP.
My lowest drop without CPAP the rest of the night was 92.
My only guess is this is TECSA related. The CPAP is causing me to not breathe during transition to sleep

[ChicagoGranny]

With SleepHQ, it's better to post your link instead of screenshots.

[ChadBSr]

https://sleephq.com/public/4a5737db-7b3 ... 0112893e2b

[robysue1]

ChadBSr,

Did you have a home sleep test to diagnose your sleep apnea problem? Or did you have an in-lab test? And did the results of your diagnostic test say anything about central sleep apnea and/or significant O2 desats?

How long have you been attempting to use your CPAP machine?

Did you have an in-lab titration sleep study to determine an effective pressure? Or where you just given the AirSense 11 running in Auto mode with a pressure range of 4-20 cm?

The answers to these questions are important.

First, it is not uncommon for people to have central apneas when drifting off to sleep, regardless of whether they are using a CPAP or not. These are referred to as "sleep transition centrals" and they happen because the body resets the CO2 trigger for respiration higher as it transitions into real sleep.

Next, for most people with OSA there is no real problem with sleep transition centrals becoming an issue when they start CPAPing. However, for a few patients who are new to CPAP, using the machine winds up inducing a problem with central apneas. The problem seems to be caused by the CPAP managing to encourage the start of a CO2 overshoot/undershoot cycle to develop. When this happens, the body first of all blows off too much CO2, and that suppresses the respiration until the point where the patient is not breathing well (i.e. it causes a central apnea), and at this point, there's not enough CO2 being exhaled, and so it accumulates in the blood. But that then encourages the person to start breathing too deeply and blowing off too much CO2 yet again.

Now for most of the small minority of new CPAPers who develop treatment emergent centrals, the problem will usually resolve itself in a few weeks. So often sleep docs will tell new CPAPers that the CAs (and potential O2 desats) need to be monitored, but they won't recommend doing anything in terms of changing the machine or its settings for a few weeks. For the very small minority of new CPAPers whose treatment emergent central sleep apnea does not resolve in a few weeks, the typical recommendation is to switch to a machine like the AirCurve 10 ASV that is designed to treat central sleep apnea problems.

It's also worth mentioning that significant prob

Since you have the O2 monitor, it's worth contacting the sleep doc's office and telling them that when you try to fall asleep with the CPAP on, the O2 alarm on your monitor keeps going off, but when you fall asleep without the CPAP, the alarm doesn't go off, even though you do have a record of O2 desats at times during the night. The O2 data might persuade the sleep doc to take a much closer look at your diagnostic sleep test results. It might also persuade the doctor to schedule an in-lab titration study that would document the O2 desaturations when attempting to fall asleep while using a CPAP.

[ChadBSr]

Hi, thanks for the response.
I had an at home test that said ahi 11.4 and central 1.5. I tested for mild sleep apnea by AHI, but moderate by RDI because of several RERAs.

Looking back at the results they did record a couple drops to 82 o2. I've worn my monitor for a couple weeks and usually I don't drop below 89% even without cpap.

I have been on apap for 10 days. It sounds like maybe some more time could resolve the CSA.

No in lab titration. They said set it to 4-20 but I couldn't sleep through the big jumps in pressure so I've been trying lower pressures. My insurance doesn't pay anything unless I meet an $8500 deductible so I'm doing everything on my own.

The machine has been flagging more and more CSA. Last night someone had suggested turning the pressure up but I feel like that was the opposite of what I should do. Even awake I feel like my body is confused and wants to just let the machine breathe for me.

My plan was to switch to straight CPAP with no EPR tonight at the lowest pressure that seems comfortable and look at the data and readjust tomorrow.

I guess I probably need to just turn the alarm off on my monitor for now so I can sleep. I already can't use the pulse alarm because I have a resting heart rate of 49-55 and I drop to 39 bpm occasionally during sleep. The alarm doesn't go that low

[ChadBSr]

It appears my hypothesis was correct. I set it to 5.2 continuous. I also used vcom which I think decreases inspiratory pressure by about 1.7? So I had about 3 ipap 5.2 epap. CSA basically disappeared. I kept the mask on over 6 hours. 2 AHI.

It seems like I had TECSA caused by too high of IPAP. Now I will increase in 0.2 increments and keep an eye on the csa and find the most effective pressure. I may go back to a small apap range after I settle on a pressure.

[Dog Slobber]

Why are you setting your O2 alarm to wake you up?

Occasional down spikes, even below 90, are not a problem. You're strapping on a CPAP to stop sleep disturbances, and then creating your own sleep disturbances over nonsense.

[ChadBSr]

I turned it off, but you don't think dropping to 82% every time you fall asleep is an issue? And my sleep gets disturbed during drops without the alarm. My latest settings kept me above 92 so it may not even be an issue now

[Dog Slobber]

I turned it off, but you don't think dropping to 82% every time you fall asleep is an issue? And my sleep gets disturbed during drops without the alarm. My latest settings kept me above 92 so it may not even be an issue now

Occasional
down spikes, even below 90