Looking for assistance interpreting information

[JDMnc1103]

Hello,
My husband has a CPAP and I am attempting to learn more regarding his sleep apnea. His AHI typically stays under 3, and most often is under 1.5. On Tuesday of this week, he had surgery and was put on Percocet for the pain. Starting Tuesday night, his AHI jumped to 53 and then was 75.8 on Thursday night. Last night I elevated the head of our bed and I have included his OSCAR chart from last night. I can't attach previous nights because I just installed the SD card for the first time last night. I was not aware that there wasn't one installed previously. I must also admit that I wasn't paying much attention to his AHI because there were no problems that I knew of. Now, I will certainly be keeping a closer eye on it. I believe that his levels are so high due to the narcotics and we are changing his meds because of it. However, I am hoping that someone could give me a little insight on what I am reading in these charts and what to look out for in the future. I tried to follow all instructions regarding this upload. Thank you for any help you can offer and please be patient with me as I do not know what information you need or what the correct questions are.
https://imgur.com/tUdNkQf

[Dog Slobber]

When I see clustered Centrals like that *on a relatively* new CPAP user, often it is an EPR sensitivity and reducing/removing EPR stops all the Centrals.

Same thing is true with higher pressure sensitivity inducing centrals.

But, I haven't seen an experienced CPAP user suddenly develop EPR/pressure sensitively because of surgery or medication. But there's a first for everything.

I would start by reducing EPR by 1, and looking for improvement, if nothing try again. If that doesn't help try no EPR.

You can than try capping the max pressure, but don't try capping pressure and reducing EPR as should it help we won't know which helped.

[Miss Emerita]

Welcome! You are right that Percocet and other opioid drugs can cause central apnea. (A central apnea is a pause in breathing of 10 seconds or more that does not result from an obstruction.) Now that your husband is on a new medication, you'll want to see whether the CAs go down.

The SD card and Oscar will be a big help to you in monitoring his sleep. Please keep an eye on his daily charts and let us know how it goes.

And when things get back to normal, I'll be curious to see a chart in case there's a little fine-tuning of his settings that might make his treatment as good as possible.

[JDMnc1103]

When I see clustered Centrals like that *on a relatively* new CPAP user, often it is an EPR sensitivity and reducing/removing EPR stops all the Centrals.

Same thing is true with higher pressure sensitivity inducing centrals.

But, I haven't seen an experienced CPAP user suddenly develop EPR/pressure sensitively because of surgery or medication. But there's a first for everything.

I would start by reducing EPR by 1, and looking for improvement, if nothing try again. If that doesn't help try no EPR.

You can than try capping the max pressure, but don't try capping pressure and reducing EPR as should it help we won't know which helped.

Okay what is an EPR and how do I adjust it? I guess I should have included that his machine is regulated by the VA and I don't know what I am allowed to adjust or not. I also don't have any idea HOW to adjust anything. I had a woman on a Facebook sleep apnea group help me learn how to enter a "clinical mode" on the machine itself so that I could see his CAs from last night only AND get a weekly view. I think they (the VA) kinda had us locked out of that view, but I'm not sure why. I'm sorry that I don't know what any of the terms are. Also, he has been using the machine for almost 4 full years on a regular basis. He didn't take any Percocet at all today so I look forward to seeing the charts after tonight.

[JDMnc1103]

Welcome! You are right that Percocet and other opioid drugs can cause central apnea. (A central apnea is a pause in breathing of 10 seconds or more that does not result from an obstruction.) Now that your husband is on a new medication, you'll want to see whether the CAs go down.

The SD card and Oscar will be a big help to you in monitoring his sleep. Please keep an eye on his daily charts and let us know how it goes.

And when things get back to normal, I'll be curious to see a chart in case there's a little fine-tuning of his settings that might make his treatment as good as possible.

Thank you! I intended to share another set of charts with you once his AHI drops back to normal, which I hope doesn't take more than a couple days. I appreciate your assistance.

[Pugsy]

I wouldn't do anything until he is no longer on the pain medication.
It is quite common for opioid types of pain medications to mess with the respiration and have centrals pop up.

1...he's post surgery and anesthesia for one thing
2...he's on pain meds that can suppress respiration.
Both are well known to cause increased central apneas....and not to mention that some of the flags could very well be arousal/awake related flags simply from not sleeping well because of pain.

Until the drugs are out of the system you will be chasing your tail.

[clownbell]

Not to hide head in the sand, but won't the problem go away once he is off the pain med?

[Miss Emerita]

Clownbell, the problem probably will go away. But it's good to check once he's off the meds that may be causing the problem.

[Pugsy]

Not to hide head in the sand, but won't the problem go away once he is off the pain med?

Very likely the problem will go away once the drugs are out of the system.
If not...then further detective work is needed.

[JDMnc1103]

Okay thank you everyone. It seems like most agree that ceasing the opiates will remedy the problem. Should I stay on this post when I get clean charts in a few days or should I start a new topic/post?

[Pugsy]

Keep further posts here if you don't mind.
Just in case someone wants to see the "before and after"....

I suspect that the difference will be rather remarkable and people can see and learn for themselves.

What kind of surgery did he have?

[palerider]

I wouldn't do anything until he is no longer on the pain medication.

I have to disagree on this one, this level of centrals can be depressing SpO2 levels, I'd definitely try lowering the AHI and see what that does.

[Pugsy]

I wouldn't do anything until he is no longer on the pain medication.

I have to disagree on this one, this level of centrals can be depressing SpO2 levels, I'd definitely try lowering the AHI and see what that does.

Then the first thing I would do is look at the flagged events up close and see if they were real asleep events or SWJ arousal events secondary to maybe pain.
Then call the doctor and alert the doctor.

[palerider]

Hello,

Hi.

You can post the "overview" page, because that data will be written from the machine to the card when you pop in a new card. it won't have the juicy breath by breath data that I'm about to ask for from last night, but it still will show us trends.

Now, would you please bring up the 16th in Oscar, then highlight a small section where it looks like a solid block of purple, (click and drag with your mouse, or use the up arrow to zoom in, and left/right arrow keys to move to the side) and give us about a 5 minute section say around 3:45-3:50... I want to see what's happening in those solid blocks.

Thank you,

[palerider]

I wouldn't do anything until he is no longer on the pain medication.

I have to disagree on this one, this level of centrals can be depressing SpO2 levels, I'd definitely try lowering the AHI and see what that does.

Then the first thing I would do is look at the flagged events up close and see if they were real asleep events or SWJ arousal events secondary to maybe pain.
Then call the doctor and alert the doctor.

That was what I was asking for when you were replying to me

We don't know how long he'll need to be on the percocet, and low SpO2 won't help healing.