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Advice Needed
#1
Advice Needed
Hi all

this my first post here and looking for your advise. I have been diagnosed with Moderate Obstructive Sleep Apnea in 2017. 
I decided to go with oral appliance for the past two years but it didn't work with me. I switched to Resemed airsense 10  last December with some struggle in beginning but I think I am progressing now. I started with low pressure and keep progressing my minimum is 4 and maximum 9. 

my average AHI for the past three night was below 5 with 5-7 hours of sleep. However, my AHI spikes to reach 12 sometimes. Is this normal and it will be reduced by time or should I increase my pressure. 

I attached my data for last night and overview analysis for your feedback


thank you


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#2
RE: Advise Needed
Welcome! I hope an expert will come along and advise you, but in case that doesn't happen today, I want to make some recommendations.

From what we can see in the chart segments you have posted, your pressure goes up to the maximum of 9 and stays there. For that reason, I would recommend that you increase the maximum to 20, to see where the pressure "wants" to go.

Next, it looks as though you don't have EPR turned on. Expiratory Pressure Relief drops your pressure down when you exhale. It produces greater comfort for many people, and it can help with hypopneas, of which you have an abundance. It can also help with flow limitations, which you apparently have with some frequency. I would recommend that you start with EPR of 2.

I would also recommend raising your minimum. I would suggest that you raise it to 10 for now, given that you would also be introducing EPR.

To change your settings, see the link at the top of the page for Setup Manuals.

Finally, before you post your next chart, I would suggest that you make the following changes. Close the pie chart (File, Preferences, Appearance). Stack the following graphs:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

You can squeeze all of those into one screenshot by grabbing the grey bars that separates them and moving them up a bit.

Please also show the chart for the entire night.
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#3
RE: Advise Needed
Generally, I agree with Dormeo, but I would add that your low pressure setting of "4" is much too low.  Your low setting should probably be at least at 6.0, you should start with an EPR of 2, not 3, and I would consider raising your high limit to at least 15 for now.  All of this will probably change before too long, but perhaps not.  Let's see where you are in a week after trying our suggestions.
Serial Tapist
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#4
RE: Advise Needed
Raed87 you have positional apnea that may be aided by use of a soft cervical collar. A couple of changes are needed in your settings as well. Your Resmed Airsense 10 Autoset is currently set to a minimum pressure of 4.0, maximum pressure of 9.0 with Ramp on for 20 minutes. EPR is on Ramp Only at a setting of 1. My recommendations are:

Mode: Autoset
Minimum pressure: 7.0
Maximum pressure : 12.0
EPR: Full Time
EPR Setting 2
Ramp: On (only if needed, off if you can tolerate starting pressure)
Ramp Minimum pressure: 6.0
Ramp Time: Auto

Make those changes and you will see a significant improvement. Your events are clustered in to several episodes and this suggests there may be chin-tucking that obstructs your airway. Your flow limitation is relatively high, and I'd like to see that graph included in the future. I think the use of EPR will help with flow limitation and hypopnea, and you clearly need the higher maximum pressure. If those do not resolve the events, then the use of a soft cervical collar may be needed. Please read our wikis on positional apnea and the soft cervical collar.
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...cal_Collar
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Advise Needed
thank you all for beneficial feedback. I will Increase the minimum and maximum pressure and turn on EPR. 
I will take It gradually as i had difficulty in the beginning with the maximum was 20 especially stomach gases. 

one last question, last night it was my first time seeing CSR in my sleep and not sure what is the cause of it.

I will give it a try for one week and see the result. 


I attached a combined data to show all the information in one screenshot if that would give more insight.


thank you again for your help


Attached Files Thumbnail(s)
   
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#6
RE: Advise Needed
Raed87, I recommend that you use the settings suggested by Sleeprider, as he has amazing expertise.

Your charts are organized beautifully; if you can turn off the pie chart before you post a new chart, that will be great.

ResMed reports any kind of periodic breathing as "Cheyne-Stokes Respiration," which is a shame, because CSR is a very specific kind of periodic breathing. If you see this marked frequently and for extended periods of time, you can post a 2-minute zoomed-in view for review. But otherwise don't worry about it.

And do try the soft cervical collar. A number of people see very good results, so it's a worthwhile experiment.
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#7
RE: Advice Needed
Just want to reassure you that Resmed flags all periodic breathing as CSR. In your case the events are obstructive and has absolutely nothing to do with Cheyne-Stokes Respiration. The variable flow rate is the result of an obstructive cycle that is pretty common with positional apnea where the "victim" repeatedly obstructs and arouses. CSR is a comorbidity of congenstive heart failure and a central apnea condition that has nothing to do with what we are seeing here. Your pattern of "CSR" is nothing new to us on the forum, and it will resolve with the suggestions made above.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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