Seb-Sanfilippo wrote: ↑Sun Jan 22, 2023 2:57 am
I've been using CPAP for another 4 days.
I changed from a nasal to a pillow mask which is more comfortable
I notice that my stats are getting worse by the day. I get more CA everyday.
The number and distribution of the CAs scored on the data that you link to is not statistically significant. In other words, even the "worst" nights for CAs (Jan 20 and Jan 21) could simply be nights where you were a bit more restless durning the night for reasons that have nothing to do with your sleep disordered breathing problem or your CPAP therapy: We don't sleep exactly the same every single night and most of us see natural variation in the AHI numbers from night to night. But there's nothing to be worried about when you have a night with an AHI = 0.9 instead of an AHI = 0.2.
Can CA be caused by the leaks?
While there does seem to be a
correlation between periods of higher leaks and CAs in your data, it's not as simple as "leaks cause CAs".
Real CAs of the sort that are scored on a proper (in-lab) sleep study are the result of the brain forgetting to send an "inhale now" message to the diaphragm when a person is genuinely asleep. But a lot of people will experience perfectly normal sleep transition "central apneas" during the transition from wake to sleep as the CO2 trigger for breathing is reset somewhat higher for sleep breathing. These sleep transition CAs are not considered part of sleep disordered breathing and they are not scored on proper in-lab sleep studies. Our CPAPs cannot definitively know whether we're asleep or not, and it's not unusual for them to score CAs during periods where we are transitioning to sleep or back to sleep after a brief wake during the night.
So anything that causes you to be restless and wakeful while using your CPAP can increase the probability that the machine will score some normal sleep transition central apneas. And in your case, I think what's going on is that the leaks are causing very short
wakes and that the CAs that are scored are
normal sleep transition wakes that occur as you are just about to fall back to real sleep.
If we zoom in on some of the centrals in your data, it's easy to see that you were already restless well before the CA is scored, and in the presence of the leak, it's reasonable to assume that you were just awake enough to be trying to fix the leak. Here's a particularly clear example of one of your CAs that is most likely a normal sleep transition central caused by your being half-wake, half-asleep fighting a leak and trying to get back to sleep all at the same time:
All that ragged breathing during the period when the leak is at its worst looks like
wake breathing, which is no where near as regular as normal sleep breathing is. The CA occurs right after you (temporarily) have the leak fixed and you're drifting back off to sleep. That points to this particular CA being a normal sleep transition CA that is nothing to worry about.
Or is it the other way around, as in when I have a CA event the CPAP increases the pressure and it leads to a leak?
There are a couple of misconnections here.
1) Auto adjusting CPAP machines do not increase pressure response to CAs being scored. And the reason why is simple: More air pressure is not going to prevent additional CAs because the problem is not a collapsing airway. In fact, for a small subset of CPAP users, additional air pressure can increase the number of CAs because more air pressure can encourage too much CO2 to be blown off during exhalation. When too much CO2 is blown off, that reduces the urge to inhale.
2) While increased pressure can lead to a mask springing a leak, CPAP machines do not increase pressure just because there is a leak. In fact if the leak is large enough, an auto adjusting CPAP is programmed to reduce the pressure in an effort to see if the seal can reestablish itself. CPAPs and APAPs do increase air flow into the mask during a leak in order to maintain the current set pressure: The larger the leak, the more air the machine must add to the leaky, "semi-closed" system comprising the machine, the hose, the mask, and your upper airway just to maintain the desired pressure.
For brand new PAPers, the emergence of a few CAs here and there is not considered a serious problem, and they usually resolve all by themselves after a few weeks of therapy. For a very small number of new PAPers, the number of CAs is both significant and does not resolve with time. These unlucky folks are the ones who wind up with a diagnosis of either Complex Sleep Apnea (CompSA) or machine-induced centrals. But there is nothing in your posted data to suggest that you are dealing with a potential CompSA: Your CAs are far too few in number and they appear to be associated with restless periods where you are likely awake or semi-awake from fighting leaks.
Don't know what the data is telling me, I only know that I fully wake up 3 to 4 times per night and I have a hunch that I have a lot of micro awakening that I half remember.
Yep. That does not surprise me at all. When scrolling through your data there is plenty of evidence that you are arousing or awaking briefly a lot of times during the night. The thing is, we don't typically remember wakes if they are shorter than about 5 minutes in length. But it's a very bad idea to try to keep yourself awake long enough to remember the wake when you find yourself awake in the middle of the night. (Lots of insomniacs do that, however, by staring at the clock worrying about how little sleep they've gotten since the last time they woke up.)
If you want to investigate more carefully how many times you are actually waking up during the night, there are a couple of things you can do.
First, if your machine is easy to turn off and back on from bed, just get into the habit of turning the machine off and then immediately back on whenever you are conscious you are awake in the middle of the night. Don't try to figure out when or how many times you've turned the machine off and back on when you're in bed: Looking at the data in SleepHQ or Oscar will definitively answer those questions. If you've got a FitBit, AppleWatch, or some other wearable that claims it can measure sleep, it can also be useful to go through that data and compare it to the data gathered by your CPAP machine. In other words, see if there is a strong correlation between restless breathing patterns in the CPAP data and "wake" periods flagged by the wearable device. Don't expect the correlation to be perfect: None of the wearables can definitively track mini-wakes and arousals because they don't have the EEG data needed to properly track sleep cycles. Still, they're better than nothing at trying to figure out how many times you might be arousing during the night.
Second, don't worry excessively about brief wakes that are at roughly 90 minute intervals: It's not uncommon and not particularly destructive of the sleep architecture to have a very brief wake at the end of each full sleep cycle.
Third, look for correlations in your data between restless periods in the flow rate graph and largish leaks in the leak graph. When you have a lot of restless periods in the flow rate graph that correspond to noticeable leaks, that's a sure sign that the
leaks are what's triggering the restlessness and the arousals and micro-wakes. Fix the leaks, and your sleep should improve.
Also I still wake up unrefreshed and feeling like trash the whole day although I feel like the fatigue is marginally less severe then before using the CPAP. I've been using antidepressant for 3 weeks, I might feel a bit better because of the meds and not the CPAP. I don't want to stress too much about that but it might be a possibility.
Both antidepressants and CPAP therapy are
processes.
In other words, it takes a while for both of them to work.
If you've been fighting both clinical depression and obstructive sleep apnea for a long time, then it's going to take getting both the depression and the sleep apnea under control before you will feel substantially better.
It sounds to me like you are on the right track: The antidepressant is starting to lightening the fatigue and mental fog caused by the depression now that you've been on it for 3 weeks. And your CPAP data indicates that your obstructive sleep apnea is being well controlled by the CPAP. The remaining piece of the puzzle is giving your body the
time it needs to learn how to sleep
well with the CPAP. Right now, you're still dealing with fractured sleep and a lot of wakes & mini-wakes/arousals, which are most likely being caused by fighting with leaks for large stretches of the night.
My advice is to work on fixing the leaks and see if that helps to fix the fractured sleep. And once the fractured sleep is less fractured, then my guess is you will start feeling better in the daytime than you currently are feeling.
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