[CPAP] 1st time APAP user. Lots of Clear Airway events? Anyway to improve without ASV?

[wwsleep]

From the oscar charts attached, it seems like most of my events are Clear Airway (CA), (aka Central Sleep Apneas, right?).  I'd like to see if there is anything I should try to improve those numbers.

I mainly went for a sleep study to see if I could figure out why my sleep is usually interrupted.  

After the sleep study, they told me I had an AHI of 39.  I need to request the full report for the breakdown details.

I’ve been using the Resmed autoset 10 w/humidifier  for a week.  Average AHI has been around 8 and I do feel somewhat better.   I’m still waking up ; some nights are better than others. 

Mask is full face Resmed F20, leak test seems good. It feels comfortable, but I’ve only tried full face mask during the sleep study and now.  

My follow-up appointment isn’t until mid-May, which seems far out, so I'd like to optimize my results on this machine.

Please let me know if other screenshots or data would be helpful.

Thanks! I really appreciate all the info on this board!  lots to learn


WW

[OpalRose]

It would have been nice to know if the sleep study breakdown included clear airways, but until you get that report, the one thing I would do is lower the EPR setting to 1 and see if that has any effect on lowering the clear airways.

You may also need a higher minimum pressure, but first try the lower EPR setting.

[SarcasticDave94]

Agreed. For now, as in context that CA are elevated, lower EPR to help reduce pressure swings that have reduced CA in some members on AB that do not have an ASV. I am not saying a need for ASV, just distinguishing that the ASV varies pressure in manners that do not increase CA while other machines do typically.

We do need that breakdown of event type and count from the sleep study, as you knew that already. Optimization will need to be done either by way of adjusting the current machine or by a different machine, depending on how you respond to therapy on the current device.

[Gideon]

We need to understand the nature of your centrals to best 'treat' them.  
To be clear, we cannot treat them with an AutoSet, but we may be able to minimize them.  

The use of EPR on an AutoSet or Pressure Support on a BiLevel (the next machine up) increases the efficiency of your breathing.  In some people this efficiency increase in cludes the increased washout of CO2 from your system to below your apneic threshold.  When this happens a Central Apnea occurs.  A 3-minute view of your central events may also provide clues about if this is occurring. Lowering of EPR is the first action to see if lowering your efficiency will raise the CO2 level consistently above your apneic threshold.

Action: Lower EPR to 1 and keep on full time.

ASV is the machine for treating Centrals with or without Obstructive apnea.

Note that lowering of EPR is the opposite of what you want to do to treat obstructive events so those may go up, that's ok, we will then understand your apnea better.
Your treatment with an AutoSet will be a balancing act between obstructive and central events.  There will very likely be additional changes recommended.

[wwsleep]

Excellent!  I appreciate the speedy replies.  I'll change that epr setting to 1 tonight.  

attached are some 3 minute duration of a few of the CA events.

thanks!

[wwsleep]

with EPR=1 last night

still a lot of CAs.    But one night isn't enough to tell.   I'll keep monitoring it.


thanks,

WW

[SarcasticDave94]

I know it's only a short amount of time, but you, the machine, and therapy combo seem to not be responding well in regards to CA events. I don't know how much time we should invest before deciding that an ASV is best. There are many CPAP users that suffer from treatment emergent CA, but IMO your CA pattern doesn't appear yet to fit that mold.

I will state again, that it would be helpful to at least have the info on the event count from the sleep study to know this aspect historically. I think we can extrapolate what it says you had in event type but not event counts.

Include with charts comments on "How do you feel?" especially during this early phase. The how you feel answers should focus on sleep complaints, problems, etc. I'm specifically looking for things like I changed EPR from x to y, when I did that I slept better/worse, I felt more/less rested, it was easier/harder to breathe, etc.

[wwsleep]

Thanks for the feedback all.  It's very helpful.   

In general, I definitely feel better than 'pre cpap' where I'd have burning eyes and was really foggy in the afternoon.  Right now I'm feeling pretty good.

I still woke up twice last night, but I did manage to get back to sleep, which is difficult sometimes for me.   


Also, while I don't have a lot of OAs compared to CAs, they seem to come before I wake up at night.  Or a series of OAs followed by CAs.

I did go ahead and order a neck collar ('the eliminator'), wondering if it would help.   It just got here.  I think I'll go a few more nights without it, to gather more EPR=1 data.

does that sound like a reasonable approach?   

thanks,

WW

[SarcasticDave94]

OK keep us posted on progress.

[wwsleep]

My doctor just posted my sleep study that I requested. (attached)

Looks like they did a text dump out of their system, so no fancy graphs, but the numbers are there.  I see some odd line wrapping, but hopefully it makes sense.

More of 'mixed' apneas than Centrals.  Is that the same as 'unclassified' apneas in oscar graphs?  I usually don't see those from the resmed data, maybe it leans towards CAs (or the treatment makes it clear it's a CA).

thanks!

ww