CPAP making very little difference in AHI. Taking big/hard exam soon and looking for advice.

[Maybedoc1]

Hello All,

I'm a 25 year old guy with no medical issues besides asthma who was recently diagnosed with mild to moderate obstructive and central sleep apnea. I'm 5'10" 165 lbs and workout regularly (4-5 times a week). I'm not as cut as I'd like to be, but I wouldn't consider myself overweight in the slightest. I started CPAP therapy about a month ago and so far its been fine except for the fact that it doesn't seem to be doing much for my AHI. I've gotten down to ~3 one night, but other than that I sway between 7-11 events per hour usually. I had 11 during my study so I would like to see a lot more improvement.

I am mostly seeing central apneas in OSCAR with the occasional hypopnea/obstructive event. This would mirror my sleep study (unless I'm reading it wrong), which showed mostly centrals with no obstructive apneas during the study. I've read that CPAP usually doesn't affect centrals so I am left wondering why I have a CPAP. I know some centrals can be junk data, I'll attach what some of them look like as well.

Could anyone offer advice? I recently had a tech visit after 3 weeks of use and she recommended that I turn off the EPR setting, and discussed the possibility of narrowing the pressure range in another month. I'm actually taking the MCAT in 10 days so bad sleep is not my friend right now and I can't afford to wait.

When I did the study I was living at ~5,000 feet above sea level. I've recently moved to around ~10,000. The first night after I moved to a higher elevation I had 20 events, but they've gone down to about 10-11 after I switched off EPR. I also changed the pressure range to 6.6-10 recently as it felt like I couldn't breathe at the lower pressure.

I'm using the Resmed Airsense 10 Autoset with a Small Dreamwear full face.


Here is a copy of the three pages from my sleep study:
https://imgur.com/30obBBZ
https://imgur.com/ngLzpXb
https://imgur.com/A00qBWD

Here's some data at ~5,000 feet: (EPR was at 3, and the pressure range was 5-10)
https://imgur.com/9qxIzdw
https://imgur.com/p7sYnss
https://imgur.com/FZ3KGCb

Here's some data at ~10,000 feet: (the first night I had EPR on and had 20 events, afterwards I turned it off and had fewer)
https://imgur.com/YmnfAP9
https://imgur.com/5jZQv4t
https://imgur.com/DTDTmjV


Thank you in advanced for any help given.

[TropicalDiver]

Sorry about the timing -- that is harsh.

I think you ultimately have three paths available (whether short term or long term):
a) For centrals, getting a machine that better focuses on treating complex apnea (such as an ASV type).
b) Take steps to mitigate some of the centrals (although at the potential expense of increased obstructives)
c) Focus on subjective measures of sleep during the short term.

People will be along shortly who are better suited to talk about each of these options.

[TropicalDiver]

Given the diagnosis in the sleep study (mixed) and the significant number of centrals, I am curious how ended up on a regular APAP. What was the conversation with your doc like?

[Miss Emerita]

Do you think your sleep is worse with the machine? If so, then if I were you I’d stop for now, given the looming MCAT.

You’ll get expert advice here soon, I’m sure, but one quick question: any chance you tuck your chin at night? I ask because you have clusters of events, which sometimes indicate that the position of your head is affecting your breathing. The easy experiment is to buy a soft cervical collar at the drug store and wear it at night to see if it helps.

Break a leg on the MCAT!

[palerider]

Step 1, turn *OFF* EPR... see what that does.

[Pugsy]

Can you post the most recent night you have had?

Was this a home sleep study? Did you sleep decently with it? It appears to be a report from a home sleep study of the type 3 variety ...they measured movement of the body and flow (and used a chest belt to measure effort) but no measurement as to actual sleep status or at least I didn't see any reference to sleep stages in the reports.

Turning off EPR helped a little but not enough because essentially you had central apnea prior to ever starting cpap.
While EPR can make centrals worse in a few people...turning it off will help reduce the centrals in those people when EPR makes it worse but isn't going to do much for people who had central apnea prior to even starting cpap.

How did they come up with these settings? Just picked them out of the sky or any special reason?
Your machine wants to go higher because of the flow limitations....are those flow limitations causing arousals and maybe some false positive central flags?? It's possible.
Are you spending much time awake with the mask and machine on?
Have you looked at the flagged centrals to see if you were really asleep or not?
http://freecpapadvice.com/sleepyhead-free-software
watch all the videos with special attention to the last one.

Finally as to why people with central apnea are sometimes put on straight cpap and don't go directly to one of the other machines...because sometimes plain cpap will fix centrals. It's a maybe but a maybe nonetheless and insurance companies will often require it to be done before they fork over the big bucks for a machine that is specially designed to fight centrals.

And second finally....altitude does seem to cause more centrals in some people...the going to higher altitudes will do it in some people.
With time the body might adjust and the centrals no longer be a problem....another maybe.
A big maybe in my book when centrals were already a problem at lower altitudes.
Would stand a better chance if there weren't centrals at lower altitudes and they just popped up with the move to higher elevations.

So the first thing to do is evaluate the flagged centrals up close and determine if you were really asleep when the bulk of the centrals were flagged.
If you weren't asleep when they were flagged then we work on how to fix your sleep issues if at all possible.
If you were asleep...not much we can do except give it time and see if they reduce in numbers on their own.
I don't know if allowing the machine to go higher to fight the FLs is going to help or hurt the situation. Might be worth trying to see.

[slowriter]

I dunno; based on my own newbie experience, my biggest frustration has been how much time this is taking, between finding right treatment settings (and machine), and dealing with doctors and insurance company. I basically threw out two months before I got confirmation I needed a bilevel machine.

I'd assume a Plan B this won't be resolved before your test, certainly if you ultimately need an ASV machine.

[Chapalauser]

I have central sleep apnea and winter at 5000 feet. I found Acetazolamide quickly reduced my ahi. But what helped the most was switching to an asv.