CPAP after Rhinoplasty

[Gunny]

I had a Rhinoplasty/Septoplasty over a month ago. Everything went well, and I can breathe through my nose (finally). I am currently using the P10 and taping my mouth to eliminate mouth leaks. Also using the V-COM. My OSA seems to be fine, but CSA has increased significantly. See attached OSCAR screenshot from last night, which is a little worse than normal, but illustrates my problem. FYI, the 2 big leaks are when I removed my mask briefly.

I think my breathing patterns are consistent with cheyne-stokes. From the research I have done, traditional CPAP will have little effect treating CSA.

My question to the group is twofold; would you consider going ASV, or would you advise giving it more time? I have an appointment later this month with my primary care provider, but she has shown little interest in the OSCAR data or referring me to sleep specialist. I'll press the issue but wanted to get the group's opinion as well.

[mlmollenkamp]

You should see a sleep specialist. The machine will show your doctor the basic statistics without any other software, take it to the doctor. No doctor should ignore an AHI of 16, it would be malpractice.
It would be interesting to know how many clear airway apneas and CSR events prior to the surgery, I would find it surprising if the surgery alone triggered this level of central apnea, but it could make it worse. Its possible that your improved breathing efficiency has decreased the blood CO2 triggering high loop gain instability, where your body over reacts to low blood CO2. If it persists you will likely need an ASV machine, but sleep study and titration would be the usual next step.

[Nocibur]

Not enough information to even make a WAG. There's a ton of variables and you just changed a ton of variables. Start from scratch and get a new sleep study.

That said, some arbitrary thoughts:

Load all the data into SleepHQ to try to determine what changed.

Post initial sleep study results to try to determine what you were trying to fix and since

I can breathe through my nose (finally).

maybe it's fixed.

I am currently using the P10

If you couldn't breathe through your nose what were you using before.

Also using the V-COM.

Their propaganda claims it's benign but try getting rid of it or setting the machine to Antibacterial Filter On. Specifically, what happens to the FLs.

I think my breathing patterns are consistent with cheyne-stokes.

Probably more like periodic breathing or TECSA (which could disappear with time).

referring me to sleep specialist.

I have surprise that the guy who fixed your nose didn't order a new sleep study to see if whatever he did, did something.

[Gunny]

Nocibur,

Thanks for your thoughts!

I was previously using the F40. I had a 90% nasal blockage, so I split breathing between mouth and nose.

The V-COM did seem to improve the AHI. I went from 25.29 to .3 the night I added it. I'll take it off and see what the numbers do, though.

You are correct, I am pretty much starting over. My original sleep study had an AHI of 69.5, which was controlled well (single digits), prior to surgery. I did have some CA events, but nothing like now. I am toying with the idea of purchasing an O2 Ring to add to the mix. That would give me almost the same data as a home sleep test whenever I want it. My original sleep test also had O2 levels as low as 74%, so I am curious to see what they are now.

The attached screenshot is what was leading me to think cheyne-stokes. I am getting similar patterns at least 1/3 of the night (sometimes more).

[Nocibur]

The attached screenshot is what was leading me to think cheyne-stokes.

IMO cycle time too short to be CSR.

[Nocibur]

And anyway to get CSR you need some sort of catastrophic event like stroke, heart failure, pending dead, etc.

[Gunny]

And anyway to get CSR you need some sort of catastrophic event like stroke, heart failure, pending dead, etc.

Or high altitude. I'm at 8,500 feet.

[Nocibur]

And anyway to get CSR you need some sort of catastrophic event like stroke, heart failure, pending dead, etc.

Or high altitude. I'm at 8,500 feet.

Yeah that's an important little tidbit.

But still not CSR, that's High Altitude Periodic Breathing.

Pop a couple acetazolamide.

[Nocibur]

Could also be some leaks associated with pillows and all you need is a trigger to upset the apple cart.

Now you're thinking "My leaks be -0- according to Oscar" but you don't need a lot of leakage to create CO2 stability, and calculating leaks is by no means precise, as the accuracy is

Leak ±12 L/min or 20% of reading, whichever is greater, 0 to 60 L/min

[Gunny]

Could also be some leaks associated with pillows and all you need is a trigger to upset the apple cart.

I have been wondering about that as well. I previously used the F40 and had no issues with it. I switch to the P10 because I thought it a little less obtrusive (and it is) and I can actually breathe through my nose, but now I am taping (which is a pain).

Is there any value to nasal pillows vs. full-face mask or purely user preference?