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Day one. Poor results.
#1
Day one. Poor results.
First day back on CPAP after 5 years away. ResMed S10 auto set to 6-12. Time was off by 12 hours but I have changed that now. Any advice appreciated on what I can change on my machine to get a better AHI.


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#2
RE: Day one. Poor results.
Given that most of your apnea are centrals, you cannot be adequately treated with the machine you have. Turning off EPR should help a little but I would be shocked if it brought your AHI to 5 or below. You will need an ASV machine (Adaptive Servo-ventilatin) which, unfortunately, is much more expensive and hard to justify for insurance coverage. Do you have a copy of your sleep study? if so, please post it with personal information redacted. Hopefully, others with more expertise with the type of apnea you have will jump in soon with more complete advice.
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#3
RE: Day one. Poor results.
I'm afraid I have to agree.  There is what appears to be a great amount of clustering of events, and we would normally suggest a remedy that works surprisingly well, a soft foam cervical collar.  In fact, don't be dismayed if it turns out that you eventually have to use one in addition to a proper therapy going forward.  But as Melman has pointed out, your events are essentially all centrals, meaning your brain doesn't send out a signal to cause you to inhale.  You're going to need a more sophisticated software running a machine with higher capabilities than your APAP.
Serial Tapist
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#4
RE: Day one. Poor results.
I would agree with turning off EPR. If you have your recent sleep study, post the redacted of personal info detailed report. We need to see CA to OA event count especially.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Day one. Poor results.
My original sleep study was done probably 9 or 10 years ago and I don't have copy available. (not sure if would help being that old anyway.) I'm afraid that if this current machine doesn't help, I will just be out of luck. I don't have any insurance and live outside the US. The cost of equipment is already outrageous here so I can't imagine what an ASV machine would cost. For example, I have about $1200 US in this used S10 auto. The government doesn't allow import of a used machine so purchasing is extremely limited. A new S10 auto is about $2100 USD here. How concerning is the number of centrals I am having?
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#6
RE: Day one. Poor results.
At this time, like others above have said, you are being poorly treated.
Two things jump our,
1, your central apneas, Set EPR to OFF and let's see what happens to them, it may not work, but we need to try.
2. you are tucking your chin, this is evidenced by the clustering of obstructive events, no amount of pressure will fix this but, as stated above a Soft Cervical collar will.

Make these changes and repost your charts and we will go from there.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#7
RE: Day one. Poor results.
(06-08-2020, 10:34 AM)bonjour Wrote: At this time, like others above have said, you are being poorly treated.
Two things jump our,
1, your central apneas, Set EPR to OFF and let's see what happens to them, it may not work, but we need to try.
2. you are tucking your chin, this is evidenced by the clustering of obstructive events, no amount of pressure will fix this but, as stated above a Soft Cervical collar will.

Make these changes and repost your charts and we will go from there.

Thanks. I will post again in a couple of days with the new data.
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#8
RE: Day one. Poor results.
I agree with Dave asking about the sleep test results. just out of curiosity, how do we know that 5 years after quitting presumably unsuccessful treatment, the OP's ca isn't pressure induced / treatment emergent? I suppose untreated ca may be why earlier treatment was unsuccessful but we don't know that. pressure settings are relatively low, also suggesting the ca might not be pap related but that remains to be seen as well. there isn't enough information yet to be so sure asv is necessary (although I lean that way as well).

corvous' pressure rises to close to max mostly against flow limitations and obstructives. maintaining epr is the setting to help reduce flow limitations but also may contribute to centrals. it's not clear that corvous is bothered by the flow limitations but he may need to search by trial and error for the sweet spot in epr and min/max or fixed pressure that best keeps ca down but works against flow limitations (hence bonjour's test without epr).

in addition, a soft cervical collar should reduce both obstructives and flow limitations and may enable lower max pressure to help with centrals, particularly if they are not pre-existing.

I think I just repeated everything that's already been said or implied, but maybe in a different way.
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#9
RE: Day one. Poor results.
(06-08-2020, 10:14 AM)corvous512 Wrote: My original sleep study was done probably 9 or 10 years ago and I don't have copy available. (not sure if would help being that old anyway.) I'm afraid that if this current machine doesn't help, I will just be out of luck. I don't have any insurance and live outside the US. The cost of equipment is already outrageous here so I can't imagine what an ASV machine would cost. For example, I have about $1200 US in this used S10 auto. The government doesn't allow import of a used machine so purchasing is extremely limited. A new S10 auto is about $2100 USD here. How concerning is the number of centrals I am having?

I would consider in light of the chart data you've shared the Central count is something that needs your attention. I am not saying it's a dire emergency issue, but the AHI on the chart is 21, with a 13 or so being CA as flagged. Again, I'd say eliminate the EPR and if you can try the collar. Post new results sooner than next week, probably now or the next day. If these were mine, I'd be in a continual fighting CA mode.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Day one. Poor results.
Note: if we were in a Lab, we would be 'validating the sext step based on 10-30 minutes data. One night is enough to see if the changes need to be adjusted or if we should let it ride for a while.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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