ittiandro

Sierra Thank yo so much for your feedback. It is a mine of info that I’ll keep in mind while trying to sort it out with my respirologist

To put thing into perspective, though, overall these CSR episodes don’t affect me as much. I usually sleep well and feel well at wake-up.

If I wrote this post it is because I am a bit concerned that these CSR’s, albeit rare, may be a precursor of something more serious to come, given the fact that I am 81 ( still running and windsurfing, though)

My betablocker is metoprolol. It was prescribed after two occasional tachycardia episodes at rest, two years ago, which led to an atrial fibrillation diagnosis.

My GP increased the dose to 2X50 mg/day after the 2nd tachycardia/ Afb episode 2 years ago. I am also on Metformin for borderline A1C and I read that metformin can be a factor in sleep disturbances.

By reading extensively about CSR and CA, I have come to realize that perhaps the CO2 dynamics may be involved. I asked myself whether there was some degree of CO2 retention( hypercapnia, as they call it) and I wondered whether the EPAP setting needed to be adjusted . Perhaps it was too high and impeded the full CO2 evacuation

. Currently, my pressure setting was 12.4-15.8. I thought that lowering the EPAP to 10.5 , with 15.8 IPAP could facilitate the CO2 evacuation. I’ll see how it works. If I still have CSR’s I’ll try the EPR adjustment you suggested , as a 2nd venue.

Another association I made is about the Tidal Volume. I noticed that when the AHI ‘s are on the rise ( above 1, which is rather rare) , particularly when I have CSR events, the minimum tidal volume drops to 0. AS I understand it, perhaps wrongly, if the TV is 0, there is no air exchange in the lungs and the blood CO2 then may increase.

Last night, with the new adjustment, I had an almost perfect AHI score of 0.59 ( 0.23 OA’s, 0.35 H). What is interesting is that the TV reached a peak of 1500 ( 99.5), which happened only once before with an even lower AHI score of 0.25. Usually, the TV is 1200-1300 at 99.5. Perhaps the lower EPAP setting has contributed to a higher TV.

Thanks again

Ittiandro

I’m 81, I’ve been on CPAP for almost 3 years. My nightly AHI count is fine, at around 1. I rarely, if ever, had CSR events, but lately the OSCAR read-outs report CSR events more than usually Last night I had two of them, with a duration of 506 and 1067 ( seconds, I suppose)., respectively almost 18 minutes. It seems to me a hell of a lot, even though, I feel well, as usual.

I spoke to my respirologist. I had my annual apnea check-up about two months ago and everything was normal. He finds it strange that I should have CSR’s all of a sudden. I have requested an appointment, but the system is overloaded and it will take some time. I’m in very good health, generally. I’m on betablocker for occasional atrial fibrillation in the past, but I am exercising ( running) regularly.

I’m a bit intrigued, ( to say the least !) because medical literature associates CSR’s with congestive heart failure( of which I have no sign) and dying events.

Awaiting to hear from my doctor, I’d like to understand a little better about CSR.

There seems to be a connection with CO2 levels . If there is too much CO2, the system reacts with hyperventilation in order to remove the excess CO2, which depresses or slows s down breathing and this goes in a loop, sort of vicious circle. . Beyond this, if CO2 retention is the cause, I cannot understand what causes it, to the point of triggering the stop-and-go breathing pattern underlying the CSR. Perhaps the mask pressure ( too much or two little IPAP-EPAP ) needs to be adjusted?

I wonder if somebody is familiar with this issue.

Thanks

Ittiandro

Thanks Perfect, I've already adjusted it to 14 effective tonight.
On another note, I had noticed that after setting the max to 20, the machine automatic max tends to get close to 20. It never got up as much in the past. Maybe in the past the automatic upper pressure needed to go up close to 20, too, but it couldn't because I had manually set the upper limit to 18 or below and perhaps this was not enough pressure to clear the airways.

Franco

Thanks Sierra By increasing the minimum pressure I suppose you mean changing the current setting 12-20 to something like 14-20 ? As to the EPR how much above 3 cm? 4, 5? Also I'm in the dark as to where to spot the Flow limitation issue on the graph. It would help, but I have to proceed heuristically for the moment, as I don't have the technical know-how of the CPAP machine.

Thanks

Franco

This thread pretty much resumes my experience as summarized below.

1. .I'm 80 and have been diagnosed with severe Sleep apnea 3 years ago, after seeing a doctor

2..It never bothered me before and my sleep had always been good, but I decided to see a doctor only because it bothered me to wake up frequently to go pee .

3..The doctor said this was due to Sleep Apnea and prescribed a full-face CPAP mask. The pee problem disappeared and my AHI's went dramatically down to under 1, but I never felt a tangible improvement in the quality of my sleep, except for the numbers on the Oscar graphics. and for not waking up several times to go tp the bathroom. A big relief( in all senses..) .

1. . I adjusted the pressure settings a few times myself, looking for an optimal range ( 10-15, 12-18, 12-20..) The latest current setting is 12-20. On the paper, it seems to be the best because my AHI's have been now consistently around 0.60 for 2 weeks, with mostly H's and occasional O.A's The doctor said I'm doing well. The snoring, too, has practically gone down to 0.00. Regretfully, however, the machine positive feedback, does not correspond to what I feel, because for the last month or so I have been waking up somewhat more tired and sleepy than before.. May be the pressure is too high and it troubles my sleep , but I don't feel it because I don't wake up. I don't know what to make of this ..

Thanks

Franco

I was wondering if there is a safe level for RERA's, if any, Usually mine keep at around 0.15. Thanks Franco

Basically, all the high frequency RERA readings (i.e. every other day instead of occasional) occurred when the pressure settings were around 12-18.6, as compared to when they were 10-15, which is what they are as of yesterday. I'll check over the coming days-weeks if this new adjustment decreases the RERA frequency

Thanks

Franco

I looked at the Events tab. Yes there are three RERA’s events recorded at 00:23:11, 00:34:16 and 04:54:55. You may look at their timeline of the previous screenshot to see if the pressure is a factor.

Regarding previous RERA’s, yes, I was aware I already had them in the past, but they were occasional, as they never occurred every 2nd day as they do lately with the higher pressure settings. Also, when they occurred in September 2020, as you mentioned, I had just started the therapy in July and may be this was a factor.

Best way is to keep an eye on the Oscar records to see if the settings adjustment makes a difference. Bottom line, if this is the case, my body will tell me as I’ll be less sleepy.

Thanks

Franco

Thanks By clicking the CSR box the RE flag line pops up in the AHI events graph, but no RE marker appears. Looks like there have been none, contrary to what the summary shows.
The 10( min)-15(max) value to which I reverted today was the one originally prescribed by my doctor. and there never were RERA's associated with this setting. This is why I thought I would go back to it, but if you have an alternate suggestion, I am open to it, bearing in mind that the settings historically showing a possible correlation with RERA events were those comprised within the ranges 13(min) -18( max) or even 18.6 ( max) .

Franco

Thanks Here is the screenshot . I cannot see any RERA on the event flag graph, only H and OA events. Ref. the min/max pressure settings, I now understand . The AUTOSET feature will work only within these manually set limits.