Sierra

I was more asking about drugs which could cause central apnea, rather than ones that could help reduce it. I believe the Vilafinil is a brand name of the modafinil generic. I have a vague recollection of someone posting that they were taking this type of drug to address the side effects (daytime sleepiness) of apnea, but it in turn was preventing them from getting a deep sleep.

First off, your more recent nights with the nasal mask seem to be a big improvement over the one with the full face on Jan 7. On the Leak Rate graph, DreamStation chooses to report the total mask leakage which includes the intentional leak from the mask vent plus the unintended leaks from the mask seal. The top green trace is this total, while the bottom one has the intentional venting subtracted out. Ignore the top trace and just look at the bottom one. Your net reading is very low, even with the full face mask. But, if the leak is disturbing you, then that is a problem. In any case you seem to be doing much better with the nasal mask.

If it was me, the first thing I would change would be to turn the Flex off or set it to zero. It reduces the pressure on exhale and is estimated by the green trace in the pressure chart. So while you are getting the higher pressure (red) on inhale, on each breath it is being reduced on the exhale. Events can occur on exhale as well as inhale. By turning flex off your machine may not need to raise pressure as much to control obstructive apnea and hypopnea. You also have some clear airway or central apnea events. They tend to increase as pressure goes up. So, a lower pressure would be a good thing for them too.

If you have decided to adjust your own machine, first I would turn Flex off and see what that does. After that you may be able to gain some more by increasing the minimum a bit, and reducing the maximum. But I would hold off on that until you see what turning off the Flex does.

A few days ago you reported that you had a RDI of 18 and AHI of 4.7. Do you know what the breakdown of events that made up the AHI? If there were no central apnea events in the diagnosis, then it would seem unlikely you are suffering from central apnea.

An APAP is most likely to bring the RDI and AHI down, but you don't have a lot to come down on the AHI. Most of your potential improvement would come from reducing RDI. The APAP is most likely to do that too. The real issue is that there certainly will be some disruption of your sleep at least initially when using an APAP and mask. Will the RDI reduction be enough to offset the effects of having to wear the mask? Hard to predict. You most likely will not need a lot of pressure and mask leaks should not be a big issue. It is unfortunate there is not some way to do a trial to see if it works. The proof is always in the pudding.

That is a new one for me. Welcome to the forum though. I recall there has been some recent research that found 7 to 8 hours of sleep is the optimum amount for adults. It certainly would be worth talking to your doctor about it.

I think what I would try next is a tighter range. You are still getting quite a few events where the machine seems to be getting caught with not enough pressure. At the maximum pressure end it is not even going up to full pressure, and you would not lose much by restricting the max pressure. It is always a bit of a guess, but I think I would try 14.5 min and 16 max. Your minimum pressure is getting up there, so you may want to use the DreamStation SmartRamp feature. You should be able to select it and then choose a ramp start pressure. I would suggest a ramp start of 7-8 cm, whatever feels comfortable to you. It should hold the pressure at that value until it detects you are sleeping, thus making it easier to go to sleep. When you go to sleep it should then ramp up to your minimum treatment pressure.

On the mask farts issue, some people report getting a better seal and better comfort by using a layer of old cotton T-shirt material as a liner. You would have to cut it out in the shape of your mask seal plus a bit extra. Remzzzs is one commercial brand. I have no personal experience though.

That is a good article. You are right in that the big things we are kind of forced to deal with, but the little things are easy to put aside until they become a big pile. I will put a link to your blog below. It is fairly easy. First go to your article, and copy the URL at the top of the screen. Here, type in the text you want for the title of the link. Highlight it with the mouse. Then click on the chain symbol at the top of the post (for a link). It will assign an example URL. Replace that with your actual URL. Or, you can just put [] brackets around the title, and regular () brackets around the URL.

Sometimes it's the little things

Welcome to the forum Mike! If you have questions just post as a new topic/thread.

You may find this study abstract of interest:

Acetazolamide reduces blood pressure and sleep disordered breathing in hypertensive obstructive sleep apnoea patients – a randomized controlled trial

Yes, in my non medical professional opinion, that looks to me like Cheyne-Stokes Respiration. I have experienced events that look quite similar. Certainly the 5000 foot elevation is not helping. I was taking a minimal dose of a beta blocker, bisoprolol, and I convinced my GP doctor to cut the dose in half. I think he was a bit skeptical about it, but said my blood pressure was fine with the lower dose, and went along with it. With central apnea it is hard to attribute cause and effect, but I think it has reduced my frequency of CSR. Beta blockers not only reduce blood pressure but they mainly do it by reducing the pulse rate. I think in turn that reduces blood flow which can aggravate central apnea. The literature reports an association of CRS with atrial fibrillation to.

There is a good blog here by an MD, Robert Thomas, on Complex Sleep Apnea that you may be interested in reading. He mentions that there is some indication a drug intended to treat elevation sickness, acetazolamide, can reduce central sleep apnea. Perhaps something to have a discussion with your doctor about. I believe it is basically a diuretic which is considered a safe drug to treat blood pressure long term.

No problem, I often do the dyslexic thing. However in this case did mean a higher maximum pressure. The machine was bumping into the max of 14 cm, and events were still occurring at 14 cm. This is most often a sign the pressure max is too low. The OP has done that and increased the max to 18, and got an improvement. The remaining issue is that AHI is still a bit high with a pressure of 18 cm, and the machine is not even trying to go higher. I would hope things improve by shutting off Flex. The next step may be to reduce the maximum some to see if there is a "happy spot" in there somewhere that will minimize OA events while limiting CA events. The other tool still left in the toolbox is the cervical collar trick suggested by bonjour in another thread.