[Diagnosis] What does it all mean ???

[AtlasAus]

Hi All,

Very new to all of this CPAP stuff. 

I believe my AHI events should be below 5, I am averaging 8, but they are fluctuating wildly, perhaps as I get used to it all. 

I also switch time zones a lot and it is throwing my data out, I cannot find how to change the date/time as I wander around the planet, any ideas ? 

Would love some advice as I go forward. 

   

   

I am feeling better, much more refreshed and not tiring during the day. I know when I have had a bad night without even looking at the data !! 

Any help appreciated.

[DeepBreathing]

G'day AtlasAus.

The first thing that jumps out boldly is that nearly all your apnea are clear airway (central). In the common obstructive apnea your tongue falls back and/or your airway collapses, physically blocking the flow of air. In central apnea your brain fails to send the "breathe now" signal to your diaphragm. This can be caused by a wide range of conditions, or it can be caused by the pressure of CPAP/APAP causing a reduction in the CO2 levels in your body. The brain sees a low CO2 level and doesn't see any need to breathe for a while. This is called "treatment emergent" central apnea.

It's important to know if the central apnea showed up in your initial sleep study or whether it has just shown up since you started on the hose. Are you able to post a copy of the study report please? Include all the charts and tables, not just the summary. Make sure you delete identifying information like your full name, Medicare number etc.

It would also help if you could post an OSCAR daily page from a typical night. The page must be formatted according to the instructions on this page: http://www.apneaboard.com/wiki/index.php...ganization

Regarding the time zone issue, it's probably best to leave things alone unless you find it a big problem. The thing is you can easily set forward the machine time (ie when going east) but if you set it back (going west) it causes all sorts of complications.

[AtlasAus]

Gidday Mate,

Thanks for the detailed reply. Trust all is well in your part of the woods, the views from over here on the TV look horrific...

Please see the report from what I can make out is I have all types of Apnea and barely get REM. I have up to 66.3 events per hour, the longest of 92 seconds !! That blew me away.   So did the leg movements, I wondered why I always have sore calves ! 


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Apologies for the quality, can't upload higher because of restrictions. Page 4 follows.

TIA 

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[Sleeprider]

At least half of your apnea in your diagnostic sleep study was central, and CPAP won't treat it. Central apnea occurs when you don't make the effort to breath, and it is more common than you may think. Your best path forward is to let your doctor know you have not achieved the efficacy and results you expected due to a lot of central apnea while using your Resmed Airsense 10 Autoset. You will need a different device called an "Adaptive Servo Ventilator ASV". This machine prodides an auto-adjusting exhale pressure (EPAP) to keep your airway stable and prevent obstructive apnea, and provides pressure support (PS) to increase your inhale pressure (IPAP) causing you to take a breath when you have a central apnea, or hypopnea (shallow breathing).

Your doctor needs to schedule you for a sleep test to evaluate ASV; however the common path is to try a bilevel device first. This illogical and circuitous path of dispensing central and complex apnea patients CPAP and requiring them to demonstrate failure, then BiPAP and requiring them to fail, before fianlly dispensing ASV which will work is the ingenious solution of insurance and Medicare to cut costs.

We have discussed what you need, now we can discuss how you can improve on your very high AHI using your current machine. Use these settings:
Minimum pressure 7.0
Maximum pressure 9.0
EPR off

You are currently using EPR (exhale pressure relief). This acts like bilevel and reduces your exhale pressure by 3-cmH2O on each breath. This is comfortable for most people but it greatly increases central apnea. The use of very little pressure fluctuation is intended to treat your obstructive apnea but to not trigger centrals. You will still have events, but if you implement these changes you will cut them at least in half.

Finally, quit changing the time on your machine as you travel. This is not your alarm clock, and you really don't need to have it on local time. The purpose of the internal clock is to monitor the hours of your sleep and use of the therapy. Your data will show that your hours of sleep change as you change time-zones, but all the important information will be there. Choose what time zone you want to call "home" and don't change it.

[AtlasAus]

Hi Sleeprider,

Thanks so much for taking the time to help. I have adjusted the settings as suggested and will see how I go tonight. 

I am fortunate to be under the Aussie health care system, so we don't have to play games and can get what is needed when required. By the time I get back I will have a lot more data and will see my GP and have the machine changed if required. 

Cheers