[CPAP] what happened to me last night?

[mallwalker]

hey all. i'm new to cpap and newly diagnosed with osa a few months ago. i've been using my machine for about ten days, i feel worse than i did before starting treatment, and am now beginning to wonder if i even have OSA as the data in OSCAR never shows anything that would seem to indicate it's treating OSA... anyway. my AHI numbers for the last week or so are usually around 4 or less, but last night the AHI was 25. this is twice what i was diagnosed as having on a watchpat when i was diagnosed with OSA. almost all of the events are central according to the software, and all of the events in the last ten days have been central as well. i'm not even able to talk to a doctor for another few weeks, this machine feels like it's ruining my life that was already bad, when its supposed to be helping...


   
   

[sheepless]

it's not uncommon for new pappers to develop treatment emergent / pressure induced central apnea. it's also very common for sleep docs to ignore ca & automatically diagnose osa. review your full test report to see if it checked for ca and if so look for the ca index (frequency per hour).

assuming your sleep test didn't show much ca, treatment emergent ca should abate in 30 - 90 days of pap use. meanwhile you can try to avoid them (your machine will identify but doesn't treat them) by reducing or turning epr off & setting a narrow range or a fixed pressure.

also, your min pressure of 4 is too low for most people, leaving them feel air starved. in addition, anything lower than 7 renders epr 3 useless.

I'd start with dropping epr one by one for at least 2 nights each (or go for broke and turn it off). I'd raise your min to at least 6 if you choose to maintain a range (min & max) or try setting both min & max to 8.

with apap you're looking for your personal sweet spot balancing oa & ca because avoiding one tends to increase the other.

check in daily, posting charts & describing in some detail how you feel.

titration is trial & error so expect further adjustments along the way. in addition, once the treatment emergent ca diminishes, you'll want to optimize your settings all over again.

[Sleeprider]

This is far worse than treatment emergent central sleep apnea. If you have a copy of your sleep study, please post some images of the results with personal information redacted. You appear to have central or complex apnea that will require adaptive servo ventilation. I also want to see the baseline AHI and make sure CPAP is not making this worse. Meanwhile, try again and turn off EPR. Set pressure to minimum 6.0, maximum 8.0.

[Gideon]

Welcome to the forum.
You have what unfortunately is a very common problem. You were given a very capable machine but it was given to you wide open and likely with the words "It's automatic, it will find the optimum settings." As you have found out that is not the case.

Min = 4 the machine's min, is always too low. set your Min to 7
Max = 20 The machines Max, This isn't nearly as important as the min unless your pressure is running away to the max. Yours is not so, for now, we will leave it alone.

EPR=3 This is the setting that normally works magic on your machine treating hypopneas, flow limits, RERAS and UARS. For you, right now it is most likely causing disaster. See all those Clear Airway/Central Apnea events, well the EPR is likely causing most of them.
Set EPR = 1 This should notably reduce the central apnea.

Please post a redacted copy of your sleep tests, the full copy with the charts and tables. We need this to better understand your apnea.

Now, what is going on.
I believe you have Treatment-Emergent Central Apnea. Without that, I believe you will be doing fine. The lack of significant central apnea on your sleep test will confirm this.
The reduction of EPR is to definitely move us in the right direction.

What is happening is your breathing has improved. Your oxygen levels have likely improved and your CO2 levels are down, and this is where your problem lies. You have
increased the flushing of CO2 from your system, to below your apneic threshold. When this happens a central apnea occurs. The main dr
ive for our respiratory system is the need to reduce CO2, not to increase Oxygen. Low oxygen makes us breathe faster, but it does not start the breathing cycle. In your case the increased EPR (now 3) caused you to take deeper breaths which increased the flushing of CO2 from your system gradually making you breathe shallower until your CO2 levels dipped below your apneic threshold and you stopped breathing, central apnea. Now that you are not breathing CO2 begins to build up resulting in initial shallow breathing that is gradually increasing until you are once again taking the full breaths you started with and once again flushing too much CO2 from your system as the cycle repeats many times.

You have had in the past with this machine and without this intervention, have once again periodic breathing that ResMed always calls Cheyne Stokes Respiration. In this case the pattern will look like CSR, Unless you have CHF, Congestive Heart Failure, it is EXTREMELY unlikely that you actually have CSR.

Actions (from Above)
Set Min Pressure = 7
Set EPR = 1
Post copy of your sleep study.

Make the changes then repost here in this thread

[DaveL]

mallwalker welcome to the forum! You've come to the right place.

I was diagnosed over 30 years ago. I've been compliant all that time. My story isn't important----except maybe you can learn from my experience.

I'm a slow learner. I have severe sleep apnea. I went along with my sleep doc from h*ll for a long time. My treament didn't work until I came here, asked questions and listened.

The people here are awesome. You will be transformed when you start to implement change. Don't expect overnight. I had to learn patience.


Observations. Being a hoser or cpap user isn't easy. But it will make you feel so much better as you move along. My story? That "getting better" took over 30 years. Now I feel better because I've listened and become my own advocate for my care. I have a better machine. It was recommended here. I've changed the settings---a little bit at a time. I've found a mask that works for me.

Hope this helps.

[SarcasticDave94]

Welcome to Apnea Board, Central Division.

The others have already covered it all for now. We need to see that diagnostic sleep study detailed data. No summary. HIPAA law permits you to request and receive it. No isn't an acceptable answer from doc.

As was mentioned, your 4-20 pressures are default out of the box. Dr. Dolittle didn't sweat over real specific settings. Fail 1. Well the rest needs to wait on the report. Your assignment is to call 3, 4, 5, 6 times, even daily until some joker answers the phone at the doc's office. Get the report ASAP.

EPR needs to drop and Min pressure needs to go up a bit, whatever Gideon and Sleeprider have suggested.

OK let's fix the mess from that awful trainwreck of Centrals.

[mallwalker]

thanks all for responding. this is the only thing they gave me after my sleep study (attachment)

how would i go about changing the settings on the machine? i 've looked through the menus and i don't see anything that would allow me to adjust the pressure levels or the epr (other than an option to turn it off completely i believe?). also slightly worried that if i mess with it i'll be out of compliance with the insurance or that they'll just reprogram it remotely... anyway. this study always struck me as slightly odd because i don't snore but its saying i do. maybe it was just picking up some other random noise in the room or my partner who does snore lol

   

[Gideon]

Hold the selector knob and the home button in for several seconds and the clinician mode will come up

The insurance company only cares about usage, not the settings.
The DME cannot make a change without a prescription. They have the capability to remotely change it. Don't worry about that. Later you can tell them not to change it without your permission

This is a case of it's better to ask for forgiveness. Set the Min to 7. And EPR=1

We will check the results in the morning and likely suggest changes.

Once we correct this train wreck of centrals, Call your doc and let him know. Likely he will say you shouldn't do that but the results are great. Leave them there and he will enter the new settings in your medical record and you become a success story for him.

After you post the results we will know what you need to do. Likely 1 more adjustment, maybe 2, then just dealing with comfort issues, if any.

Based on your sleep study this is treatment Emergent Central Apnea.

[SarcasticDave94]

OK here's the starting point for the CPAP Setup Manual. You need to find your machine, ResMed AirSense 10 AutoSet. Read that to know what your doing. Link is here for convenience.

Access to Clinical Menu where the pressures are changed. Push and hold both Home button and the big dial in for 5 seconds. A new screen pops up. Scroll down to edit pressures accordingly.

https://www.apneaboard.com/adjust-cpap-p...tup-manual

Now your report says CA were at 9 under pAHIc listing, other Apnea at 67, and RDI of 138 is listed too.

So this means these Central events are likely to be treatment emergent, as Gideon describes. Based on that, EPR needs to be reduced. Possible move pressure off of the minimum 4 and go to 6 or 7. That EPR needs to drop down, we could step down 1 at this time, EPR 2. Watch your OSCAR data to monitor CA. See if they go down at all. Also tell us how you feel after the edit.

Edits, can you or should you do them? Yes. Insurance is only concerned about "Will the patient use the PAP?" They don't care if it's default or adjusted.

On somebody changing the pressure. Call the doc and DME and tell them you're revoking permission to have remote adjustment on your PAP. Make a letter stating this, sign, and send to both, keeping a copy too.

[mallwalker]

Thanks for guiding me into the menu! I changed the pressure from 6-15, and lowered the EPR by one down to 2. Unfortunately for some reason last night I also kept taking the mask off in my sleep, something I've never done before. So I don't think I ended up getting a good reading of the therapy. I'm going to keep the settings as they are and try again tonight!