Sierra

Apnea is when you stop breathing when you are sleeping. Any stop in the breathing of more than 10 seconds is considered an incident. Over a night of sleeping the total number of incidents is added up and divided by the hours of sleep. The apnea index represents the number of incidents per hour of sleep. 5 to 15 incidents per hour is considered mild apnea, and in most countries treatment is recommended. From 15-30 incidents is moderate apnea. And 30 or more is severe apnea. The objective of treatment with a CPAP is to reduce the incidence frequency to less than 5 per hour.

About all you can do is try lower pressures to see if that helps with CA events. The ideal pressure may be when OA and CA event frequencies are about the same. OA events tend to go up when you lower pressure, while CA events tend to go down with lower pressure. The trick is to find the happy median.

Quite some time ago I reduced my beta blocker, bisoprolol, from 5 mg to 2.5 mg as a test, and I think it reduced my CA frequency. My doctor was a bit skeptical, but agreed with it, as my blood pressure remains good. My wife uses Ozempic, but I have stuck with insulin and metformin. I also use a Libre 2 sensor to monitor things. My A1c is usually right about 6.0 or a bit less...

I am not sure it is fair to blame the CPAP. My wife uses the same machine as I do, and her AHI averages about half of what mine is, and she has hardly any CA events. See graph below. My theory is that CA events are caused by a slow response to the need to breath faster or slower to keep blood oxygen and CO2 levels constant, and a little faster heart rage might help. I also take the bisoprolol in the morning so it has more effect during the day, and less at night.

I also suffer from CA events, which form the large % of my AHI. However my AHI on average is around 0.85, and not that high. I get the occasional flags for CSR, with a long term average duration of 0.1%. See the graph below. The magenta part of the bar graph are CA events. I almost never go over 3.0 however.

I recall we have discussed this issue before, but I can't remember where you are at for machine settings. I have found that using a fixed pressure and keeping pressure as low as possible limits the frequency of my CA events. The only direct way of controlling CA events with a PAP device is to the ASV version. However, it is highly recommended that you get heart function tests before going down that road. The ASV may be just covering up a potential heart issue that needs treatment. It would be worth seeing a heart specialist in any case to see if there are any issues requiring treatment.

CSR can also be caused by altitude and there are medication treatments used for elevation sickness that may work, if you live at a high elevation, or you could use an ASV.

I am not that familiar with asthma and what impact it may have on sleeping. I use OSCAR to track my CPAP data, and I see that I have a respiration rate of about 18. My wife also uses a CPAP and runs a little lower at about 15. I am not sure what is considered normal.

I am not sure if an ASV would help or not. As best I understand it, it tracks each breath and assists in breathing if you are not breathing on your own. What do you have for a CPAP and how is it set up. With a ResMed it may be helpful to set the Expiry Pressure Relief (EPR) at the maximum setting of 3 cm. Reducing pressure on exhale and increasing it on inhale may help you breath a little deeper and cause your respiration rate to be a bit lower.

What may be of more help is a BiPAP or BiLevel machine like the ResMed AirCurve VAuto. Instead of boosting inhale pressure by 3 cm compared to exhale, it can be set up to 10 cm, and may be more helpful in assisting breathing.

What you may want to do is track your CPAP data with OSCAR and then see your sleep specialist and ask about doing a trial with a BiLevel machine to see if it provides any benefit.

If you have a CPAP and use OSCAR to look at the results in detail you can determine if what one imagines is really happening or not.

There is a website started by a pharmacist that was concerned about the use of sleeping pills especially in the elderly. It apparently significantly increases the risk of falling and breaking a hip etc... There are a lot of good tips there including the use of the CBTi process.

https://mysleepwell.ca/

Good advice!

David. thank you for that account of your experience. Mine is not totally different but diabetes got me first and along with that came high blood pressure and cholesterol. Fortunately I got good treatment and brought those issues back into control, as well as my weight. My apnea came later and I have to admit that I was really not having any sleep issues, but I was annoying my wife with snoring. She had gotten a CPAP much earlier than me, and was on my case to get one. She tested at about 73 or so for AHI and the CPAP did amazing things for her. She now averages less than 0.5 for AHI. When I broke down and got tested I came in at 37 or so. I did not take well to the CPAP and the first or second night I was considering opening the window (second story house) and throwing the whole thing out the window. I did not fortunately as at that point it was a loaner machine... In any case I finally worked things out and made friends with the CPAP. I don't do as well as my wife as I have central apnea issues, but I am still managing to stay under 1.0 for AHI.

Your message is a valuable one. When I think about it now I was ignoring the symptoms of diabetes and had it for a long time before diagnosis. It was kind of strange how I figured it out. I was out of town with my son who was in a hockey tournament. One of the kids on the team got hurt and I ended up taking them to a rural hospital. They had to call a doctor in to check him out (it turned out he had a ruptured spleen), and while I was waiting I read a pamphlet that was on the rack. It was about symptoms of diabetes. I realized at that point I checked all the boxes. I saw a doctor when we got back to the city and sure enough my BG was off the chart.

That was 23 years ago now, and thanks to insulin and a few drugs my BG, BP, cholesterol are well under control. The CPAP is still probably the most invasive treatment, but it works! We should be thankful for technology. Many others before us did not have it...

If the Dreamstation is like the ResMed you will have lost all the detailed data. ResMed machines only send high level summary data over the air to the cloud. However, you can start collecting data now by inserting a SD card. If it is like a ResMed all you need is a 4 GB or up to 32 GB SDHC. The machine should format it when you insert it. You may have a old SD card around from a camera or GPS.

"The following machines have been tested and are supported by OSCAR v1.4.0: DreamStation 2

DreamStation 2 CPAP (410X150C, 410H11C, 410T11C) - see note 3 below DreamStation 2 Advanced CPAP (420X150C, 420H11C, 420T11C) DreamStation 2 Auto CPAP (510H11C, 510T11C) DreamStation 2 Auto CPAP Advanced (520X110C, 520X130C, 520X150C, 520H11C, 520T11C) DreamStation 2 Auto CPAP Advanced with P-Flex (521X120C, 521X140C)"

Here is a video on where it is located if it is a supported model.

https://www.youtube.com/watch?v=VkBkhGYZSHk

It is also possible that the supplier of the CPAP has removed the card. It is a dirty trick, but some do it.