Help with CPAP Therapy - SleepyPrince !!!

SleepyPrince · Post by **SleepyPrince** » Thu Jul 22, 2021 1:59 pm

Hello,

I was diagnosed with severe sleep apnea (67 AHI) a month back and I have started using ResMed Auto set CPAP for couple of weeks. I noticed that my events vary from time to time and it stays between 4-8.

I started seeing clusters of events and thought its due to positional sleep apnea (chin tucking).
But what bothers me most was the CSR events (Cheyne Stokes) last night for 19 mins. I woke up after the ends of the events . Mostly I guess due to lack of breath.

Below was my Oximetry sleep study results.
Average SpO2 : 94.00%
MinSpO2 : 74%
Percent sleep time 90-100% : 93.95% (206.5 min)
Percent sleep time 80-89% : 5.23% (11.5 min)
Percent sleep time <89% : 4.6%% (10.10 min)

I have also attached my Oscar reports from last night, where I noticed the CSR events first time . I'm not really sure why i have these clusters and if this is related to central sleep apnea?

I would appreciate any insights about this .Thanks in advance.

LSAT · Post by **LSAT** » Thu Jul 22, 2021 2:56 pm

Increase your pressure to 10 min and 20 max and see if your ahi doesn't go down.

ChicagoGranny · Post by **ChicagoGranny** » Thu Jul 22, 2021 3:32 pm

Yup, min pressure is set too low. Also, no reason to limit the machine to 15 max. If you set it to 20, it still won't go any higher than it needs to.

SleepyPrince · Post by **SleepyPrince** » Fri Jul 23, 2021 1:10 pm

Thank you for the suggestion.

Last night I had set my min to 8 and max to 15 and slept for 3 hours. Then I woke up and tried min to 10 and max to 20.

In the first part of my sleep, I had 24 OSA events with CSR event too. This is my second night continuously getting CSR events.

Should I check with my Sleep doctor about these CSR events. I'm sort of paranoid seeing the OSCAR reports. Any insights are appreciated. Thanks!

Pugsy · Post by **Pugsy** » Fri Jul 23, 2021 1:45 pm

CSR Cheyne Stokes Respiration is a very specific kind of periodic breathing. There are many kinds of Periodic Breathing which by definition is just a waxing and waning of the air flow that lasts for at least 2 minutes.
Not all Periodic Breathing is CSR though.
Yours isn't CSR. Yours is most likely just plain ordinary Periodic Breathing. You have zoomed in too close to see the overall pattern the best but it doesn't look like real CSR to my eye.

Go here to the provider manual and scroll down to where you see CSR explained. Compare your breaths to the real CSR waxing and waning.
https://www.respshop.com/manuals/ResMed ... %20her.pdf
We only really worry about periodic breathing or CSR when it is accompanied by a truck load of central apneas and yours isn't.

SleepyPrince · Post by **SleepyPrince** » Fri Jul 23, 2021 2:12 pm

Thank you for your reply.

I have attached few zoomed out charts. I could not figure it out if its really CSR events or periodic breathing.

I just started my therapy 2 weeks back and these results all looks quite scary to me

thanks for clearing it out.

I'm planning to use an oximeter overnight to understand the level of my sp02 during sleep, since I had a low sp02 of 74% during my sleep.

Pugsy · Post by **Pugsy** » Fri Jul 23, 2021 4:44 pm

Doesn't look like real CSR to me and for sure no central apneas.
Any chance you were awake or half awake during that time frame?

Even if it was real CSR I don't know that the doctors would get all concerned about such a short lived segment.

This is what real CSR looks like and there is a lot of it.

palerider · Post by **palerider** » Fri Jul 23, 2021 4:54 pm

SleepyPrince wrote: ↑
Fri Jul 23, 2021 1:10 pm
This is my second night continuously getting CSR events.

You had a few minutes of something incorrectly flagged as 'CSR', but was absolutely *NOT* CSR, there was nothing 'continuous' in your night, other than minimum pressure set too low.

CSR is a very specific waxing and waning of breathing, with *CENTRAL* apneas in between the cycles. You don't have any central apneas flagged.

SleepyPrince wrote: ↑
Fri Jul 23, 2021 1:10 pm
Should I check with my Sleep doctor about these CSR events. I'm sort of paranoid seeing the OSCAR reports. Any insights are appreciated. Thanks!

I certainly wouldn't waste time or money on it, since they're clearly NOT CSR, they're the machine flagging something incorrectly and freaking you out unnecessarily.

palerider · Post by **palerider** » Fri Jul 23, 2021 4:57 pm

Pugsy wrote: ↑
Fri Jul 23, 2021 4:44 pm
Doesn't look like real CSR to me and for sure no central apneas.
Any chance you were awake or half awake during that time frame?

Even if it was real CSR I don't know that the doctors would get all concerned about such a short lived segment.

Exactly, when I discovered my brother's heart failure, he was having very long periods of classic CSR.

To the OP: this is the kind of CSR that warrants a trip to the doctor.

SleepyPrince · Post by **SleepyPrince** » Sat Jul 24, 2021 8:47 am

Thank you both !!! I really appreciate all the help & tips.

I did raise my Min pressure to 10 and MAx to 20. The results looks better than last night.
I still keep getting events, is it because I was diagnosed with Severe apnea (AHI 67). Do the events reduce in the long run usage of CPAP?

Apart from OS events, I do also get RERA events(21 last night) . I read about RERA and they are characterized as increased respiratory event for 10 or more seconds but does not fall into Hypopnea/Apnea category. Is it something to be concerned of?

Is there anything I should be trying out to avoid these events? Thanks in advance.

: screenshot-20210724-111823.png (67.89 KiB) Viewed 1186 times

Pugsy · Post by **Pugsy** » Sat Jul 24, 2021 9:02 am

Please review the posting format shown here.
viewtopic/t158560/How-to-post-images-for-review.html
You are making more work for yourself with multiple images. Just do the one basic image in the format outlined above and if someone needs something else they will just ask.

The bulk of your events happen when the machine is maxed out at 20 cm pressure....this means that the machine is giving it all it has but can't prevent the airway from collapsing.
Some parts of the night the pressure stays sort of lower and nothing happens and then something changed and caused the airway to close up and the machine couldn't stop it.
The most common reasons for when we see this happening is supine sleeping, REM stage sleep, maybe tucking of the chin or a combination of those factors.

So we wonder what changed to cause the higher pressure needs????
What position do you normally sleep? End up on your back often??
Do you know if your OSA is worse in REM sleep? Depending on the type of sleep study you had the answer to that question might be found in your sleep study records.
It is extremely common for OSA to worsen in either REM stage sleep or when we are on our backs.

The RERAs...they are a symptom of the OAs happening because the pressure of 20 cm can't do a good job preventing the airway from collapsing. So the RERAs themselves aren't so much of a problem as they are a symptom of a problem.
The OA happens and causes the arousal and then the RERA is flagged because of the arousal itself.
Reduce the OAs and the RERAs will reduce.

Unfortunately you appear to need more than 20 cm pressure at some times during the night but your machine can't go higher so we try to figure out what changes to cause the higher pressure needs and see if we can eliminate the cause if at all possible.
If it is supine sleeping...we try to stay off our backs.
If it is REM stage sleep...not much we can do because we can't control REM nor would be want to because we need REM.
If it is REM that is the culprit you likely need a different machine that will go higher.

So we do some experiments to try to figure out what is causing the OSA to worsen and the need for more pressure.
First request a copy of the sleep study results and hope it documented sleep stages and AHI in each stage.
Second...try to figure out some way to make sure you aren't ever on your back when sleeping and I know this is easier said than done but we have to figure out if supine sleeping is a major factor here or not.

To fix a problem we first have to identify the problem.

SleepyPrince · Post by **SleepyPrince** » Sat Jul 24, 2021 9:28 am

Thank you, I have edited my previous post to add a basic image with the necessary sections.

I actually sleep in all the positions, mostly lying on my back before. After I started the CPAP therapy, I have started to train to sleep in my side, but I'm not sure if I turn and lay on my back in REM sleep.

I suspected chin tucking & I have ordered a cervical collar to try and see if that helps.

Also I have to add that I have Deviated Septum, so pretty much I can't inhale through one of my nostril . I read that although this doesn't cause apnea, but treating it will improve the symptoms of apnea.

I have added my sleep reports. Please let me know if any other details are needed.

Pugsy · Post by **Pugsy** » Sat Jul 24, 2021 10:10 am

Do you have anything that shows AHI during REM itself? A comparison of AHI in each sleep stage???

Your AHI is about 50/50 supine vs non supine so I don't think staying off your back is going to be that big of an factor.
Worth trying though since we don't have a lot of options.

Cervical collar a good idea to try. Like I said...not many options to try.

SleepyPrince · Post by **SleepyPrince** » Sat Jul 24, 2021 10:53 am

Apart from what I have posted earlier, i have these in my report. Not sure if that's what you are looking for.

Sure, let me try the collar today and update. Thanks for the help !!!

Pugsy · Post by **Pugsy** » Sat Jul 24, 2021 11:01 am

Yes, that clears the REM AHI index up. Again about half and half so REM isn't a primary culprit.
Oh well, it is what it is. Not that we could have done much about it anyway.
Example...my own OSA is much worse in REM. 12 AHI in non REM but 53 AHI in REM. Marked difference. Yours isn't all that different.

Lets see what happens with the cervical collar. Crossing fingers. I might just work.

Help with CPAP Therapy - SleepyPrince !!!

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