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[CPAP] First Night on AirSense 10 - New Member
#1
First Night on AirSense 10 - New Member
Good Evening Everyone

First and foremost, I wanted to say thank you to all that keep this forum going strong, with the consistent and selfless work on providing valuable information to those in need.  It is greatly appreciated.  I've been reading this forum for the past few weeks, attempting to acquire as much information as possible.  I've learned a tremendous amount and will continue to do so.  

Background:  I'm a 42 year old male living in Denver (218 lbs. / 5'10.5")  I always suspected, due to snoring and the ever present "tired" feeling when waking, that I had some type of sleep disorder/concern.  Since I returned to Denver in Oct. from a 2 year stint on the east coast, I noticed that I felt increasingly awful in the morning. Maybe it is slow altitude adjustment again, especially after gaining some weight in D.C.  I've been breathing a little heavier upon my return to altitude (around 6K at my house).   After visiting my primary care physician, I learned I had a severe Vitamin D deficiency. That's currently being rectified.  I was squirreled away in a building with no windows for 2 years! She also recommended a sleep study, which was something I was going to request during the visit. Shortly thereafter, I completed my sleep study (report attached).

I found a board certified sleep & ENT Dr. and provided him my sleep study results.  Last night, after my initial visit with the DME provider, I had my first session with the ResMed AirSense 10 AutoSet.  No Ramp, EPR set at 3, pressure set at 6-16. I didn't sleep well at all.  I don't think I had that many hours where I actually slept. Hard to really know at times how many hours i'm actually asleep! I'll keep at it and hopefully get used to it soon.  With all that being said, I figured i'd post my first night's results.  Not sure it's worth that much, being that it was the first night, I was uncomfortable, and didn't sleep a full night, but why not I guess!

What has me concerned is the CSA.  Been reading some horror stories about causes of CSA, although I know it can be Idiopathic. Not sure it would be treatment emergent as CSA showed in my sleep study.  I don't have any currently known medical issues other than what I've posted here.  

If anyone has any suggestions, thoughts, comments, etc., please feel free to share.  Thanks in advance!

P.S. I have additional attachments that show the remaining data points if anyone would like to see those.  


.pdf   At Home Sleep Report.pdf (Size: 167.59 KB / Downloads: 2)
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#2
RE: First Night on AirSense 10 - New Member
Welcome to the forum.

Let's find out if these centrals are CO2 induced which is common for Treatment-Emergent Central Apnea.

The CAs in the zoomed view (thanks)  are short and definitely Central but not enough waxing and waning to call it CO2 induced but hints of it are there.

Drop your EPR to 1 (EPR = 1, full time) and see what happens.  You have no obstructive events to mention, your flow limits are somewhat high in a couple of places but not enough to chase without symptoms.  Reduction of EPR reduces the efficiency of your AutoSet and if your centrals are treatment-emergent this should reduce them, if not it means you could need another machine to treat them.  It is possible that obstructive events will rise, that's ok, we need too see what happens.

Note that no CPAP, APAP, BiLevel without backup can treat central apnea, they can only avoid it.  These machines treat obstructive events.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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New to Apnea? Helpful tips to ensure success
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#3
RE: First Night on AirSense 10 - New Member
Thanks Bonjour! I’ll give that a shot and will post back tomorrow. 

Quick Question: Any initial thoughts about the existence of CSA in my at home sleep study, which had no associated treatment (PAP) at the time of the test? Could the ones present on my OSCAR report be different (treatment related) than the ones that showed in my study? 

Thanks again!
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#4
RE: First Night on AirSense 10 - New Member
Welcome, Denver APAP, and congratulations on beginning therapy for your apnea. Just think, you'll never have to have a first night with the machine again! Seriously, it's an adjustment, and now you're on your way toward improvement as you continue to adapt, solve problems, and tune your settings. I'm impressed, actually, that you kept the mask on over a nearly 8-hour period and that you had zero leaks. How did you do that??

On my computer, the sleep study wasn't an actual attachment. You might try scanning it and posting the scan, instead of trying to post it as a pdf. That way the experts can take a look at your CAs during the study, which should help them help you. And just to be completely sure we have the right picture, you had the sleep study at your renewed high altitude, right?
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#5
RE: First Night on AirSense 10 - New Member
(02-18-2020, 11:16 PM)Dormeo Wrote: Thanks! Yeah, I was just straight lucky with the mask! That’s strange the attachment is not showing. I was able to pull it up on a laptop and iPhone. Hmm. Maybe, I’ll try to add it in a new format tomorrow. 

Yes, I had the study at the new, higher altitude. I read about altitude induced CSA. I wonder if it’s connected in some fashion? However, 6K isn’t that high, but it’s much higher than Northern VA!  Wink
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#6
RE: First Night on AirSense 10 - New Member
Oh, my bad. I now see the link. I was just looking at this bit:

.pdf At Home Sleep Report.pdf (Size: 167.59 KB / Downloads: 2)

I'll be curious what Bonjour thinks about the centrals that were showing up in the sleep study.

I hope you have a good night tonight.
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#7
RE: First Night on AirSense 10 - New Member
Possible, but Altitude Induced Central Apnea (typically over 10,000 ft) I just noticed Denver, is similar to Treatment-Emergent. Note that this altitude may be important to your apnea.

What altitude was your sleep study performed at and was it different than your home altitude? Just saw your Sleep Study. Of further significance, 67% Oxygen DeSat as a low, don't care about a low, but du when I see significant time under 90% approaching 80%. I miss the time under part of the desat report You may want to buy a pulse oximeter to be able to monitor your oxygen levels, without CPAP you may qualify for supplemental oxygen.

All this said I expect this to NOT be Treatment-Emergent and not Altitude-Induced, but dropping EPR is a good way of testing this.

You had 30 minutes of CSR and that is significant enough to discuss with your doctor even if you do not see it again. Note ResMeds CSR reported by it's CPAP machines is NOT CSR, but periodic breathing with Centrals but needs to be validated as not actually CSR. The fact that your sleep study called it out is significant. CSR is closely associated with heart issues, especially Congestive Heart Failure. Your heart health needs to be verified. You should be fine but be sure. CSR is also CO2 induced the same as is typical for Treatment Emergent and Altitude induced Central Apnea.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#8
RE: First Night on AirSense 10 - New Member
(02-18-2020, 11:35 PM)bonjour Wrote: Possible, but Altitude Induced Central Apnea (typically over 10,000 ft) I just noticed Denver, is similar to Treatment-Emergent.  Note that this altitude may be important to your apnea.  

What altitude was your sleep study performed at and was it different than your home altitude? Just saw your Sleep Study.  Of further significance, 67% Oxygen DeSat as a low, don't care about a low, but du when I see significant time under 90% approaching 80%.  I miss the time under part of the desat report    You may want to buy a pulse oximeter to be able to monitor your oxygen levels,  without CPAP you may qualify for supplemental oxygen.

All this said I expect this to NOT be Treatment-Emergent and not Altitude-Induced,  but dropping EPR is a good way of testing this.  

You had 30 minutes of CSR and that is significant enough to discuss with your doctor even if you do not see it again.  Note ResMeds CSR reported by it's CPAP machines is NOT CSR, but periodic breathing with Centrals but needs to be validated as not actually CSR.  The fact that your sleep study called it out is significant.  CSR is closely associated with heart issues, especially Congestive Heart Failure.  Your heart health needs to be verified.  You should be fine but be sure.  CSR is also CO2 induced the same as is typical for Treatment Emergent and Altitude induced Central Apnea.

Thanks again Bonjour for the information. I'll speak to my Sleep Dr. and get his thoughts.  I can only assume he was waiting to see how my APAP therapy worked out.  Here are the charts from last night.  I actually slept much more, which I can guess is the reason for the increase AHI.  Looks like it's all Centrals again.  EPR was at 1.  And yes, the sleep study was completed in Denver after I returned from 2 years in Northern Virginia.  I only noticed how terrible I felt when waking after returning to Denver, so I wonder if somehow it's affecting me.  Granted, i've always been pretty tired in the morning, but it was noticeably different upon return.  

[attachment=20093]

[attachment=20094]
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#9
RE: First Night on AirSense 10 - New Member
OK, you failed that test.  While some of your Centrals may be CO2 based, most of them clearly are not.  

Set EPR for comfort!  your choice.

Check the other causes for CSA.  You should know if any of these apply to you.  Above we eliminated the CSR, Treatment Emergent and Altitude, do any of these apply to you? (from webMD)

Central Sleep Apnea Causes and Types
There are several types of central sleep apnea, each with a different cause.

  • Cheyne-Stokes breathing. This is when your breathing speeds up, slows down, stops, and then starts again. Each of these cycles can last 30 seconds to 2 minutes. Cheyne-Stokes breathing is common in people who’ve had heart failure or a stroke. It happens in about half of central sleep apnea cases.

  • Narcotic-induced central sleep apnea. Opioid medications like morphineoxycodone, and codeine can affect your breathing patterns.

  • High-altitude periodic breathing. Many people have trouble breathing when they go up to a high elevation, usually 2,500 meters (8,000 feet) or more.

  • Treatment-emergent apnea. About 5% to 15% of people who have positive airway pressure treatment for obstructive sleep apnea get CSA.

  • Medical condition-induced apnea. Health problems like heart failure, Parkinson’s disease, stroke, and kidney failure can cause CSA.

  • Idiopathic (primary) central sleep apnea. This is when there’s no clear cause.
I expect you to fall in the unknow category, Idiopathic.

Ask your doctor about an ASV machine.  You have OSA (from your Sleep Study) and it is well managed, and CSA from both your Sleep Study and your nightly charts.  

CPAP, APAP and BiLevel without a Backup rate (machine forced timed breathing), will not treat the Central Apnea, they simply are programmed to literally ignore Central Apneas. 'Treatment' with them is to AVOID Central Apnea and we tried that above and failed.  
ASV is a BiLevel with backup designed to treat OSA, Mixed or Complex Apnea and Central Apnea.  It is also expensive and as such often difficult to get.  

Central Apnea is 'consistently inconsistent' as you see.  In other words it varies all around the place.  AHI is an index, while the lehgth of your sleep is important it has little to do with your AHI.

Approach your doctor as a knowledgeable but cooperative patient.  You want to be a partner with him.  Ask him how "WE" should proceed. Acknowledge that your understanding is that ASV is the most likely solution, but you understand that the path there is not necessarily a straight one.

An important item for your doctor are your symptoms.  It is extremely important that your doc realizes frequently and often your symptoms.  Tell him on every visit.  How are you feeling? is not a greeting, it is an open ended probe for your symptoms.  I can't stress this enough.  Make a list and read it to him.  Offer him your copy of it, and repeat during each and every communication with him.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
Grin 
RE: First Night on AirSense 10 - New Member
Evening All

It's been quite some time since I posted within this thread. Thanks to all who originally replied.  It's greatly appreciated. I have adjusted quite well, for the most part, and my 30-day rolling average AHI is below 1.00.  I'll likely post some updated charts soon for review, but i'm currently testing out a fixed min/max pressure in APAP mode on the Autoset in an effort to fine tune a few things. Yes, I know, don't chase the numbers Wink It's more to try to limit flow limitations some more. More on that later.  I've been reading steadily since February and have learned an extensive amount.  Again, thank you.  Just a quick update without charts, though.  CSR doesn't seem to be an issue. My Dr. is not concerned. I believe it "may" have had to do with the terrible sleep and exasperated breathing I had the night of the home study, as I didn't sleep well at all and was annoyed, breathing heavily and strangely.  It has never shown up a single day since I started PAP therapy. All the flags are set for indication within OSCAR. It doesn't even show as a "0" category on the left hand side table. Someone confirmed the other day, that in order for the CSR to show, there needs to be a single event/day where CSR is present, for it to even subsequently show up in OSCAR reporting.  Also, O2 desaturation seems to have been rectified as well.  I've checked my data multiple times wearing the Wellue O2 Ring, assuming it's accurate. Ha. Maybe the CSR in the report was related to the O2 desaturation?  Who knows!

With that said, I was reviewing my old Sleep Study, and had a question that I hope someone could answer for me.  I've attached the report to this post.

My Apnea index on the report shows Obstructive as 6.8 and Central as 7.4.  Now, i'm not a math wiz, but the Central # is clearly a higher index amount.  Why then, in the "Interpretation Section" did the Dr. reviewing the report denote "This patient has severe (OSA) G47.33 and mild (CSA) G47.31, when the aforementioned apnea index showed more Centrals?  Sure the "G" number, whatever that is, indicates a larger amount, but only by .02.  Again, not a math genius, but ostensibly, that seems to be relatively the same, without taking into account my complete lack of detailed sleep knowledge. Ha!  As a dovetail comment, my sleep Dr. seemed to comment similarly to me, in that my Central number was prominent, but he himself wrote an RX which listed the reason for APAP issuance as "Obstructive Sleep Apnea'.  Are they lumping in my significant amount of snores and Hypopneas from the report, and stacking that on the "Obstructive" scale for some reason?

My conspiratorial thought regarding the Dr.'s RX is that Dr.'s work hand in hand with the insurance carriers and don't want to initially write "Complex" sleep apnea on the RX because that may benefit the patient later on if arguing for an ASV.

Thanks in advance!


Attached Files
.pdf   Redacted Sleep Report.pdf (Size: 167.59 KB / Downloads: 7)
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