New user having trouble - Help

Long story short I never new I had Sleep Apnea. About 4 months ago I came down with Atrial Fib and the doctor said I should have a sleep study as folks with AFib often have Apnea. Long story short they said I did have Sleep Apnea and send me home with a Philips machine.

Now my problem. They said I need to use a Non vented mask. In fact they sent me the normal vented mask with instructions saying I have to tape up the holes above the nose. About 30 inches down the hose there is an in line vent of some sort. They said the objective is to increase my CO2 levels during the night. Well I feel like I am suffocating (I sort of am if I am rebreathing my air). I wake up with headaches and do not feel good (I felt much better with no machine). The Drs say I need more time using it as its only been a week. I have a report from last night saying I had 3.9 AHI (16 total clear airway apneas, 3 total Obstructive Apneas, 11 total Hypopneas) can someone translate this for me?
IF the above apnea events are acceptable could I be feeling bad due to the CO2?

any advice would be appreciated.

thank you

In cases where you CO2 levels are too low (which is called hypocapnia) usually ASV is used. That is, in fact, why it was invented. And you can use a normal, vented mask with it. Perhaps your doctor would be open to trying it?

Clear airway (or central apneas) are where you technically do stop breathing for a spell, as opposed to Obstructive apneas which are caused by your airway closing off. Hypopneas are partial obstructions which are not completely closed, but closed enough to cause your oxygen to drop and/or wake you up.

It sounds like they are using deadspace treatment on you, where they use a non-vented mask and a specific length of hose to force you to rebreathe your exhaled CO2 in order to stimulate the breathing response during the central apneas (the theory being that the body has a CO2 threshold that forces us to take a breath of O2.) It works but people can and do find it uncomfortable. It also needs to be set up and monitored by a qualified technologist in order to make sure it is safe and effective.

sleeptech is correct that ASV (adaptive servo ventilation) is the general standard for treating central or complex sleep apnea. The way ASV works is it monitors your breathing for the first 20 or so minutes and calculates an algorithm which forces the air into your lungs during the times where you have a central apnea. essentially breathing for you. I have seen it work wonders in patients with Hypocapnia, Renal Failure, Congestive Heart Failure and COPD where Central Apneas are quite common in patients. However, your doctor would need to determine if your ejection fraction is above 45 before undergoing a titration in order to ensure its safety.

Hope this helps.

P.S. 3.9 is a normal AHI. so the treatment is working by most evaluations.

What are the pros and cons of the using a Cpap with the dead space vs. the ASV device? Note I did do a sleep study with the mask with the dead space so they could come up with the correct length and pressure (BI in Boston). This is a major teaching hospital in Boston and I wonder why they are messing with this dead space method to increase CO2 rather than use the ASV?

Also is a normal AHI all we are after? If increasing CO2 results in a normal AHI that's great but how healthy is it to breath normally with less O2 (and more CO2)? How do we know its not out of check and the CO2 is to high.

Thank you for the advice

You report waking with a headache, which is a classic symptom of elevated CO2 levels. I'm not sure why they are using the non-vented mask treatment. I have heard of it before, but ASV has been the industry standard in treating respiratory events due to hypocapnia for quite a few years now. It is correct that you would need to have your heart check to see if your left ejection fraction of above 45%, and would hope that your doctor would do this as a matter of course as it is part of the standard procedure. You are also correct in your suggestion that giving you a low AHI but elevated CO2 (above the healthy limit) can also be injurious to your health and so is not a great solution. If you are struggling with your current treatment then I would hope your doctor would at least discuss the idea of ASV and its possible suitability or otherwise.

its odd they did not give me a ASV in the first place. Is there a big difference in price from a Cpap and a ASV?

I agree that it is odd. I really don't know what price difference there is in the US as I am in Australia and I know that things cost a lot more here than they do there. Here an ASV is several thousand more expensive than an CPAP.

Sounds like they are trying to go cheap. Perhaps the insurance company is taking the low road due to cost. I did a quick google and a Resmed Airsense 10 shows at about $700 and an Aircurve 10 ASV at $3000-4500.