Caffeine. CSA and Cheyne-Stokes

[JDS74]

Gone

[robysue]

I'm not a doctor---just a patient who is good a math related stuff.

I have no idea if caffeine is aggravating things or not, but I have noticed some interesting things in the two days of data that you showed.

1) Your APAP is running a wide open range of 4--20. That's a bit unusual as a prescribed pressure range. Are you currently doing a week or two of auto-titration? If not, do you have any idea why your prescription is for such a wide range? I ask because that might be part of what's causing those rather high AHIs while using APAP therapy. The point of xPAP therapy is to try to get your treated AHI under 5.0 if possible.

2) The wide open range on the APAP may be making the machine have a harder time responding to the OAs, Hypopneas, snoring, and RERAs, all of which should be making it increase the pressure. The minimum pressure setting probably needs to be adjusted. I'd personally talk to a doctor about these numbers before arbitrarily increasing the pressure though. Part of my caution is based on the fact that you are experiencing a large number of CAs---events the PR System One APAP you are using thinks might be central apneas because there is evidence that these non-breathing episodes occur with an open airway instead of a collapsed airway. Higher pressures can trigger CAs to emerge in some OSA patients when they are using CPAP/APAP therapy.

3) On the bad night in particular, you appear to have some significant periodic breathing episodes. Have you got any cardiac problems? Again, if this is a typical bad night and bad nights are occuring on a pretty regular basis, there's enough periodic breathing here to be a concern. Again I think you need to bring this issue up with your doctor.

4) There's a subtle difference in how the leak line looks on the two nights. On the bad night, the leak line is bumpier and a bit higher than on the good night. The good night's leak line is what a leak line should look like---provided that it is at the expected leak rate for the mask. Since you are using a nasal pillows mask, my guess is that it's in the right place. On the bad night, there may be some problem with leaks, but I don't think that by itself is enough to explain why the bad night is so bad.

In the end, I'd strongly recommend that you talk to the sleep doctor and show him these graphs. It really looks like your therapy needs some serious adjustment and that there may be issues with either central sleep apnea (CSA) or complex sleep apnea (CompSA) as well as OSA. Have you had a proper titration study done in a sleep lab? If so, what was your titrated pressure at?

[JDS74]

Robysue:
Thanks so much for the thoughtful comments.
I've been diagnosed with OSA, CSA, and Cheyne-Stokes ( I have them while awake sometimes.)
Multiple cardiac exams and no indication of any cardiac problems.
My mask is an oral mask - not a nasal one which I can't use.
The range of 4-20 is less than my doc wants. He wants 5-25 but I cut it back to 20 to see if I did better and I think I am.
Reduced the 5 to 4 a few nights ago after noticing that I have periods of no OSAs and no CSAs and the pressure was at the minimum of 5. I'll probably move it back up to 5 tomorrow.

Never had a titration at all. I'm scheduled for an ASV titration to see if switching to an ASV machine will help in supressing the CAs and the PBs. Switching docs 'cause my current one only says continue and isn't particularly interested in the data.
"If I feel better, that's good enough." I don't feel that much better.

Thanks again

[robysue]

Never had a titration at all. I'm scheduled for an ASV titration to see if switching to an ASV machine will help in supressing the CAs and the PBs. Switching docs 'cause my current one only says continue and isn't particularly interested in the data.
"If I feel better, that's good enough." I don't feel that much better.

I think switching docs is an excellent idea since the current one has nothing to say but "continue to try".

I also think given the OSA, CSA, and Cheyne-Stokes, the ASV titration is an excellent step in the right direction for getting effective therapy for your conditions. Best of luck on that sleep study.

There are folks here who use ASV machines. And have CSA. And have Cheyne-Stokes. You'll find plenty of help if you need it---just put ASV, CSA, or Cheyne-Stokes in the subject line if you want to catch their eye. You might in fact want to edit the title of this thread to contain CSA or Cheyne-Stokes instead of "caffeine"