Another sleep apnea "victim"

[SuperDave]

no cardiologist. dreamwear nasal gel

[palerider]

no cardiologist. dreamwear nasal gel

I'd suggest having one check you out, just to be sure that the ol ticker is ticking along well.

The dreamwear opens up possibilities... Pugsy is going to talk to you about them.

[Pugsy]

I finally zoomed in on pretty much all the flow rate for the 3 nights.
We need to have a chat.
The OA flags....the machine is calling them OAs but they appear central to me...or at least the bulk of them and the machine is responding because it thinks OAs...and more pressure isn't fixing them because they are really centrals.
I don't think that we are looking at post arousal centrals caused by OAs either....I was hoping but I just don't think that is the case.
It explains why the OAs didn't reduce with more pressure like they should have.
And I am seeing a lot of breathing that looks like CSR to me...way more than I am comfortable seeing and just ignoring.

Any history of cardiac issues? What kind of heart studies have you had done in the past? Anything?

[SuperDave]

thanks for the suggestions. I will follow up with my primary doctor ro see about some cardiac tests. I had a pretty good night last night with the modified nasal cushion.

[Pugsy]

When you get a chance can you send me just the new files from last night zipped?
Or if that's too much trouble the SD card again.

I want to look at the flow rate again.
Any chance you are doing some supine sleeping?
Like 1:30 to 2:45 and 6:00 to 7:30?
You at least had some segments (though short) where things weren't horrible.

Pressures of 14 (per Dec 2018 titration) couldn't prevent the obstructives and caused centrals to increase significantly.
Classic Complex Central Apnea.
Also per the titration report....severe OSA of 80 something AHI.
Textbook situation for ASV.

[SuperDave]

Yes, there is a good chance of unintentional supine sleeping. Also I remember some dreams so Inwas probably in REM sleep just before waking up. Looking at the flow, I saw plenty instances of periodic breathing. shape of breaths look similar to cheyne-stokes respiration (csr), with nonresponsive-to-pressure OAs and CAs between breaths. I made a dr. appt with my family physician for later today to discuss getting an ekg and an echo to see if there is any evidence of cardiac congestion. (Sleep Dr. is outside the loop because I cant get an appt before April.) Thanks for your input and suggestions.

[SuperDave]

I always try to stay off my back. My preferred sleep position is to lay on either side, in a fetal position. But I am aware I may roll on my back for part of the night. Clutching and holding a spare pillow, like a teddy bear, against the chest and stomach area helps to stay on the side.

Last night I closed off the slit in the nasal pillow with a long strip of duct tape,trimmed to 1/4" wide, to increase the dead space. (The dreamwear nasal pillows have two vents, one near your lips and another at the top of the mask where the hose connects.) The duct tape doesn't want to stick to the silicone, but by using a long narrow strip, I was able to go around the mask between the pillows several times allowing the tape to stick to itself. This was very effective in closing off the vent and was undectable comfort-wise. One advantage, it stopped the loud noise at higher pressures and was less disruptive during sleep. But the added dead space didn't seem to affect the results last night.

[Pugsy]

No...didn't seem to change the centrals. It was a long shot anyway.

I don't see any alternative but ASV.

You have severe OSA...and you have complex sleep apnea most likely from the cpap pressures...and per the titration study apparently even 14 didn't prevent the obstructives and you were already having too many centrals so they bailed at 14.
Probably ran out of time.
Even if they had been able to try a regular bilevel...unlikely they would have had any better success than what we see here.
Some people just have to have ASV to get the job done.

[TropicalDiver]

I know you are going to see your PCP. There is always a possibility that your PCP may be able to get your sleep MD appointment moved sooner -- it doesn't hurt to ask. You would be surprised what a MD to MD phone call can sometimes accomplish in terms of finding a spot in the appointment book.

I might also expand my scope in searching for providers to include DFW.

Three other thoughts:
a) Many clinics have great providers but lack in office follow through. Unfortunately, in those instances, you need to work hard to avoid falling between the cracks. It seems like this happened here -- the sleep study results suggested what the doctor prescribed (even though the treatment they tried in titration did not work and you have a history as well...)
b) In rare cases I am uncomfortable with less than a full MD -- I typically find both PAs and ARNPs to be great providers. What matters the most to me is seeing the same face when I go in; and that person is committed to working towards a solution.
c) Between you and Pugsy, you have armed yourself with a great deal of data for any upcoming appointment -- I would bring that with.

[SuperDave]

Thank you for your ideas, TropicalDiver. You are correct about Doc to Doc. I saw the family doc yesterday and he thought CHF was unlikely but took an EKG, took a blood sample, and scheduled a echocardiogram. When I got home there was an email from the sleep doctors office stating there are some openings today if I want to see the provider.

More good news; last night's treatment was the best ever, with AHI down to 10! Yes, I am celebrating at 10 because It went down from 80+ to 40+ to 20+ to 10+ over the past 2 weeks.

Thanks again to everyone for their time and interest in helping me. Especially Pugsy! <kiss>

[palerider]

Thank you for your ideas, TropicalDiver. You are correct about Doc to Doc. I saw the family doc yesterday and he thought CHF was unlikely but took an EKG, took a blood sample, and scheduled a echocardiogram. When I got home there was an email from the sleep doctors office stating there are some openings today if I want to see the provider.

More good news; last night's treatment was the best ever, with AHI down to 10! Yes, I am celebrating at 10 because It went down from 80+ to 40+ to 20+ to 10+ over the past 2 weeks.

10 is still crap, but yeah, huge improvement... huge.

[SuperDave]

planning to stay with these settings a few days. If they hold true, should I slowly increase IPAP minimum to attack hypopneas and keep PS at zero?

[palerider]

planning to stay with these settings a few days. If they hold true, should I slowly increase IPAP minimum to attack hypopneas and keep PS at zero?

That is indeed the regular thing to do.

[esel]

I have been taking the same meds for years to treat high blood pressure (valsartan/HCTZ and amlodipine), depression (celexa), thyroid (levothyroxine) and gerd (aciphex). Also flonase and zyrtec for sinus allergies.

You may want to recheck your blood pressure. I know two people starting CPAP for sleep apnea and it solved their high blood pressure. Both no longer need the medicine.

levothyroxine side effects are sweating, anxiety, trouble sleeping... Are you taking it to prevent a thyroid tumors ?

So far I would not worry too much about the central events. In your polysomnography there is only one central and 4 mixed. It is possible that the CPAP treatment is inducing them. In my sleep study I had lots of OA and with CPAP they turned into centrals.

CA1.JPG

They may decrease as your body gets used to the treatment. How much time in total over night are you in apnea ?

Not sure I got this right, do you get air into your belly at the high pressure ?

Hang in and good luck

[Pugsy]

You may want to recheck your blood pressure. I know two people starting CPAP for sleep apnea and it solved their high blood pressure. Both no longer need the medicine.

Well...it doesn't always work out that way. Now you know someone who still needs BP meds even after 9 years of optimal sleep apnea treatment. Me.
Lots of causes for high blood pressure and sleep apnea just one of the many.

So far I would not worry too much about the central events. In your polysomnography there is only one central and 4 mixed. It is possible that the CPAP treatment is inducing them. In my sleep study I had lots of OA and with CPAP they turned into centrals.

They may decrease as your body gets used to the treatment.

This advice is potentially dangerous....
Nearly 2 years on cpap....the body never got used to it.
And most recently since Nov last year...hasn't changed....the body still hasn't got used to it.
Sometimes it just won't get used to it no matter how long you give it and in the mean time way too many centrals to ignore and way too much other ugly breathing to ignore.
He need proper medical care NOW...not later.