Long term cPap user with suddenly high AHI

[DreamLady]

Hello there everyone,

I have been absent for a few years. My apnea has been very well treated for at least 10 years now, and all has been good until recently. I was recently diagnosed with A-fib. After an initial period where it was successfully treated with Metropolol, the A-fib suddenly became more frequent. I check my AHI regularly, and it's been 2 or 3 until now. Increasing Metoprolol did help some, but I'm still having rather frequent evening episodes of A-fib. I requested a new sleep study to see if I can get this sorted because I'm seeing a correlation between nights when episodes of A-fib seem to lead a bad night on cPap. I have been seeing an AHI of anywhere from 8 to 26 the last few weeks, most of the time in double digits. Unfortunately, I can't see the sleep doctor until late May! I have no leaks, and mask fit seems great. My equipment is about two years old; ResMed Autosense 10, with pillows. Weight is about the same, but I'm actively working at weight loss to see if that helps. My machine is set for 8-15. I thought I'd ask here if anyone has seen a similar scenario. I have a couple of things I'm going to try in the next little while to see if I can sort this out. None of the physicians treating me seem to know if the two are related. But I believe they are.

1. Get out my spare machine and use it to see if there is a difference. If there is, then maybe it's the machine not delivering correct pressure or responding adequately. If so, then what? I don't want to buy a new machine with an upcoming sleep study!

2. Buy (or borrow) a computer (other than my Chromebook) so I can download my data to OSCAR and see if that will tall me anything, such as increased central apnea. I had'nt realized until this popped up that OSCAR won't run on my Chromebook.

Any input is welcome.

[lazarus]

No input. Just questions:

Was your original diagnosis purely OSA?

Why is the upper pressure presently clamped down to 15? Does your treatment pressure ever approach that max?

Until OSCAR is in the picture, is your machine reporting mostly obstructives or centrals?

[Respirator99]

The latest version of Oscar will run on Chromebooks, but not all Chromebooks: http://www.apneaboard.com/wiki/index.ph ... _Chrome_OS

Are your increased apneas obstructive or central? That's an important consideration in what to do next.

[chunkyfrog]

See your cardiologist.

[DreamLady]

Chunky: I have seen my cardiologist; just on Friday, to be exact. Unfortunately, he doesn't seem to take this issue (my sleep apnea) that seriously. I had to insist on a pulmonology consult for a sleep study. He says there is no concern about my A-fib because I take a blood thinner and Metropolol (even though it doesn't totally control my heart rate now). Although he has stellar credentials, I'm beginning to have second thoughts about the choice.

I will try downloading the latest software. If that doesn't work, I will try my old lap top.

[DreamLady]

OK. I downloaded the software and turned on and set up Linux. Problem is, I know nothing about Linux, so what do I do now? If I click on the software, it tells me it is not supported. I double-checked that I had the correct file.

Do I need to type a command in Linux?

I'm now at a loss.

[Miss Emerita]

Time for a new cardiologist! Try googling "a fib apnea" and you'll see a lot about the correlation, including the recommendation that patients with A-fib be screened for sleep apnea. Example:

https://consultqd.clevelandclinic.org/s ... eep-apnea/

If you have an old laptop, by all means dust if off and use it for Oscar. It may be possible to adjust your settings to bring your AHI back down, but no one can advise you about this without more information.

[DreamLady]

I created a post and attached an OSKAR file from last night, and of course cpaptalk was down and lost the entire thing. Trying again. I think this chart demonstrates that I do indeed have treatment-emergent central apnea. Other nights showing the CA's do not have the large leaks, but I couldn't seem to get those to display....[/size[attachment=0]screenshot-20220318-105436 (1).png[/attachment]]

[Pugsy]

When posting screenshot images please follow the format explained here.
viewtopic/t158560/How-to-post-images-for-review.html

Actually apap mode might not be the greatest mode for someone with potential treatment emergent central apnea.

What medications are you on?
The centrals started with the onset of the AFib???

Your options for trying to do anything about this new problem are very limited.

1....try fixed mode or at least a really, really tight apap mode for pressures...like 8 cm minimum and 9 cm maximum or 8 and 8.
2....try turning off EPR

Can you make changes to your machine yourself? Do you know how and are you comfortable???

Do those leaks wake you up?

[DreamLady]

Thanks, Pugsy,

I am going to start tightening up to see if that helps.

It appears that these aberrant readings began after diagnosis of Afib, but I actually had Afib for a long time prior to diagnosis just didn't realize that's what it was!
The medication that I've taken since that diagnosis: Eliquis and Metoprolol.

After 8 months or so on those medications I started noticing more fatigue and necessity of taking naps during the day. Metoprolol was increased due to increasing runs of Afib. I think that's when the increase in central apnea began, and the large leaks, which I think are a result of cpap chasing rapidly rising AHI. (But I'm no expert).

I have read the organization page and did the best I could. I've since learned how to turn on the left side panel and how to select the day (or days) I want. I'll be refining it more as I learn more.

I do know how to access the clinical men and I have managed my own therapy for quite a few years. I have no problems trying different approaches, especially since no professional is as concerned about my health as I am. I understand how important appropriate therapy is for my heart and that given these central events I'm more at risk for sudden death, so I'm motivated to do my best to reduce events.

I appreciate your help, and I will post more charts as I tighten my settings. I did find the reference to Apap not perhaps being the best for this problem. I might do a trial on regular pap and see if that improves things.

[Pugsy]

For what it is worth when you use auto mode but have the minimum set to equal the maximum that is effectively making the machine work as cpap mode would work.
Sometimes some machines (and I forget wish at the moment) don't record flow limitations when in cpap mode.
I don't remember if your machine does that or not...I don't think it does but the work around just to make sure is just use auto mode but set minimum to equal maximum.

Your machine will NOT try to increase the pressure in an effort to reduce the central apneas.
Now you might have seen an increase in pressure at about the same time as you saw some centrals get flagged but that increase would have been because the machine sensed....snores, flow limitations, OAs or hyponeas.
It will never increase the pressure just because of centrals. It just won't do it because more pressure won't fix centrals and in fact could potentially make things worse.

To be honest I have my doubts as to whether the 2 ideas I have will help or not but they are really the only things you can do in an effort to reduce the centrals so might as well give them a try.
The reason I do suggest them though....sometimes they work. "Sometimes" is a good enough reason to give something a try IMHO. Never know...might get lucky. A couple of months ago (on a different forum) I offered those same options to someone with a similar problem as yours (minus the AFib complication though) and fixed cpap mode worked wonders.
I really didn't think we stood a chance of having any success but to my amazement it was a miracle. I had thought for sure that she was going to need an ASV machine to deal with those centrals. That's the high dollar machine that might have been mentioned to you. There are lots of hurdles involved with getting insurance to pay for that high dollar machine so we try anything and everything to avoid going down that road.

Quit talking to your DME about things. They can't do anything without a doctors order anyway.
You need to be talking to your doctor and if your doctor won't listen.....find another doctor who will listen should trying these 2 things not help your situation.