Help with High AHI of Father during Stroke Recovery

[key2thacity87]

**Updated with Sleepyhead Screenshots**
Hi,

Background
My father who is in 79 was diagnosed with severe sleep apnea about 8 years ago. Earlier this year, in March 2020, he got anew CPAP machine, a ResMed AirSense 10. In June 2020 he had a stroke and was hospitalized and in rehab until late August.

Issue
Recently I've been monitoring his sleep data on SleepyHead. Over the past month, his average AHI for nights he gets at least 7 hours of sleep is around 12 (with AHI ranging from 5 to 29!).


Somehow I also have about a month of data from before his stroke where he is averaging about a 9 AHI. However I only have the summaries of this data and no the leak rate, ect.


After seeing this I scheduled an appointment with a sleep specialist for next Wednesday 11/4. However this is a new doctor and from personal experience it's best to have a better understanding of what's happening and have some options to ask the doctor about.

Looking at his flow rate, I do notice something that looks like Cheyne-Stokes where his breathing is deeper then it gets more and more shallow leading into an apnea.


Here are two nights of Sleepyhead screenshots
October 28th

Closeup of Apnea on October 28th


October 14th

Closeup of Apnea on October 14th


Some Questions
Since many of the interruptions are obstructive, should we ask about a higher pressure?
What remedies are there for Cheyne-Stokes?
He currently does not have the Bi-Pap version of the airsense 10. Might a BiPap help?
Any other insights or suggestions would really help.
The stroke was a blood vessel burst in the brain, is there any danger for the doctor increasing the pressure?

Thanks for your time,

Matt

[Julie]

Ok, last first - as far as increasing pressure goes, I think your doctor should have the first say... not our place to guess in the circumstances.

Could you please download Oscar (top of pg) and post as indicated (in this thread) so we can see what's what overnight and get a better idea of things. Similar patterns to 'real' Cheyne=Stokes are often mistaken for it and are not necessarily as problematic. We could also suggest - if it seems necessary according to Oscar - whether or not a Bipap would be a good idea. If it seems that raising pressure would be a good idea run it by your MD before making the change.

[key2thacity87]

ok thanks I'll get the info and post it here

[palerider]

Since many of the interruptions are obstructive, should we ask about a higher pressure?
What remedies are there for Cheyne-Stokes?
He currently does not have the Bi-Pap version of the airsense 10. Might a BiPap help?
Any other insights or suggestions would really help.
The stroke was a blood vessel burst in the brain, is there any danger for the doctor increasing the pressure?

Thanks for your time,

Matt

I'll answer questions in order:
Yes.
An ASV, but let's see more data.
A *bilevel* might help, but we have no data, so that's just a guess.
Need data.
There's more danger in *not* increasing pressure.

Your dad's apnea wasn't adequately controlled before, and that might me part of the reason for the stroke, since obstructive apnea causes blood pressure spikes.

Get Oscar, and let's see what's happening now, and where improvements can be made, and don't put a lot of faith in the doc, because the "before" looks pretty terrible.

[chunkyfrog]

Don't forget:
Once the formal stroke rehab is over, actual recovery can and should continue for quite some time.
If the stroke affected speech and swallowing, it's a sure thing that muscles in his upper airway
have been affected--therapy stops once the patient is able to eat/drink safely, but damage remains.
If he has not seen his sleep doc since the stroke, he should.
As a sidebar, keep an eye on his mental health.
Depression after stroke is rather common.
Hugs to you and your dad.

[key2thacity87]

Thanks for the help and and insight pal and chunky. I've updated the post also with some sleepyhead data for your consideration

[Julie]

If I missed it, let me know, but did the doctor give a reason for him to be on straight Cpap vs Auto? Auto machines can do plain Cpap, but not the other way around, and autos give more options for treatment and using e.g. Oscar to elaborate on more features in results.

[key2thacity87]

Hi Julie, good question I'm not sure if the doctor considered auto cpap. His first machine (the machine he had before this) was a resmed c-series tango so I'm not sure if they were able to check his sleep data from there and give him something different. So for some reason when he had his original sleep study they looked at the results and gave him the tango. I'm not sure if his apneas were different back then but I'll try and do more digging

[Pugsy]

He's got an apap machine now but it's functioning in fixed cpap mode and obviously allowing clusters of Obstructive Apneas to happen.

He's also obviously having a lot of fragmented sleep with the numerous times the machine is turned off and on.
So I don't know how much of the flagged OAs are real asleep events or maybe just awake breathing irregularities getting flagged by mistake. It wouldn't be impossible for the OAs to be causing arousals as well. So there may be real asleep OAs causing wake ups and then some false positive flagging. A lot of unknowns.

Does your father have obvious residual signs of the stroke especially in the facial area where muscle tone could be impacted?

I wouldn't worry so much about the potential CSR stuff right now as I would just the OA stuff. We can't do much about CSR even if it is real with this machine and at this point I am not sure it is real CSR. I would worry first about what needs to be dealt with now that can be dealt with by use of this machine.
If he is asleep when the bulk of those OAs were flagged he needs more pressure. Does he sleep on his back a lot?

First thing I would want to try if it were my father is a change to auto adjusting pressure mode with the minimum being 12 and max being 20 and just see what happens with those OA clusters and his sleep quality. It is the only change I would make at this time.
Maybe other changes later based on what happened with this one change.

Up to you if you are comfortable making the change yourself or having a chat with the doctor about it.
Some doctors get it in their heads that auto adjusting is bad and going over 10 or 12 cm pressure is bad and just won't do it but that's kind of the old school way of thinking.

Should you want to change the mode to auto mode...and don't know how this manual explains the secret handshake or combination of button pushing to get you into the clinical menu setup area where you can change things.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

[key2thacity87]

*** 6 Year UPDATE ***

Thank you all so much for your support during this time. Though my father’s recovery is still happening his condition is much more stable. Over the past six years he regained control of the right side of his body and with the help of miracle physical therapy, speech therapy and occupational therapy workers he is able to walk again with a cane, feed and bath himself and speak enough to give sermons at church about his testimony and how God helped him.

Thank you all SO MUCH for being here with good advice for me and my family. It meant the world at the time and it took a village of support for him to get to where he is today. I though about his thread for years and put off this thank you and I’m not sure if it will be seen now, but thank you from the bottom of my heart for helping to save my fathers life as he fought to survive.

Forever grateful,
Matt

[zonker]

Forever grateful,
Matt

Matt thank you so much for giving an update. very glad that things are on the mend!

[Pugsy]

Thank you so much for taking the time to update us on your father's recovery.
We hope he continues to improve.