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[Equipment] Airsense 10 & Central Apnea Detections
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trwolf0901 Offline

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Machine: ResMed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift
Humidifier: AirSense Integrated-Auto
CPAP Pressure: 7.0
CPAP Software: ResScan

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Sex: Male
Location: Texas

Post: #1
Airsense 10 & Central Apnea Detections
   
Here is my 90 day info from my S-8. Normally, my daily apnea is rarely more than 1.0, but I have many hypopneas - giving me a 90 day AHI of 7.0 I just upgraded the Airsense 10 and I'm a little shocked at the difference in the resulting data. Has anyone else experienced the same? Here's the full story:

   

I've been using my new AS-10 for almost a week now, after more than 7 years on my S-8 auto. On night 1, running on the default auto settings, I experienced miserable sleep. The pressure ramped up extremely high for me using my Mirage Quatro FF Mask. I fought leaks all night and had pain from how tight I had to get the mask to stop leaks. I was surprised to see the unit detected most of my apneas as Central. I also didn't realize EPR was off by default and I was used to sleeping with it.

   

Night 2 I switched to my new Swift pillows (changed the machine accordingly) and turned on Fulltime EPR to 3. Again, my apneas were detected as mostly central. The EPR at 3 seemed like too much and the pressure was so low, I felt like I was "pulling" air just to breath. Not a great night for my comfort.

   

Night 3 I reduced EPR to 2 (and I see that is common based on this thread) and found it more comfortable. I also began loosening my headgear. After night one with the FF mask - and never wearing pillows prior - I had over tightened my pillow setup and my nostrils were very sore (and my face was marked deeply). It was more comfortable, but still felt like I was "pulling air" a few times.

   

Night 4 I increased the minimum pressure to 5 and found more comfort. I also turned off the Ramp (it was only set to 5 minutes) based on reading here.

   

Night 5 I bumped my minimum pressure to 6. I actually slept pretty well. I suspect the low pressure just wasn't comfortable after so many years on my S-8 with a starting pressure of 8. I actually had an AHI under 1.0!!! However, I'm still shocked that most detections are Central. Has anyone else experienced this with the AS-10?

Thanks for hosting this great discussion forum!
04-19-2015 10:48 AM
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worn_out_in_lebanon Online

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Posts: 271
Joined: Jan 2015

Machine: Resmed A10 Autoset
Mask Type: Full face mask
Mask Make & Model: F20 (newest Resmed ffm)
Humidifier: Included, ClimateLine tubing
CPAP Pressure: 13-15, EPR:0
CPAP Software: SleepyHead

Other Comments: I.T. Project Manager. Started CPAP therapy March 16, 2015. Untreated AHI 39.

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Location: TN

Post: #2
RE: Airsense 10 & Central Apnea Detections
(04-19-2015 10:48 AM)trwolf0901 Wrote:  I've been using my new AS-10 for almost a week now, after more than 7 years on my S-8 auto.

On night 1, running on the _default auto settings_,
I experienced miserable sleep. The pressure ramped up extremely high

Night 2 ...The EPR at 3 seemed like too much and the pressure was so low

Night 3 I reduced EPR to 2

Night 4 I increased the minimum pressure to 5 and found more comfort. I also turned off the Ramp (it was only set to 5 minutes) based on reading here.

Night 5 I bumped my minimum pressure to 6. I actually slept pretty well.

However, I'm still shocked that most detections are Central. Has anyone else experienced this with the AS-10?

From looking at your profile info, it looks like you were running a straight 7 on the old machine. And it sounds like you may have been running wide open (4-20) on the new machine.

As you discovered, a starting pressure less than 6 or 7 is not workable for most people.

I also couldn't use EPR 3. Too much delay in the pressures switching back and forth. I used EPR 2 when I had a higher pressure range on my ffm (10-15) and use EPR 1 on my lower pressure range on my nasal pillow (7-9).

I got a lot of CA's when I first started. I believe these were caused by frequently waking up.

There is something about the transition between sleep and waking, where the body changes over systems that drive breathing, and the CO2 level required to trigger a breath is different between these two systems.

If you are toggling back and forth, you can be riding that line where it was enough CO2 to trigger a breath on one system, but not quite enough when you switch over. Then you just stop breathing for a few seconds until the CO2 rises a little more, and then start breathing again.

I'm searching for something that explains better about the two breathing systems and the CO2 threshold. Will post back when I find something suitable... Smile
04-19-2015 11:11 AM
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trwolf0901 Offline

Members

Posts: 9
Joined: Jan 2015

Machine: ResMed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift
Humidifier: AirSense Integrated-Auto
CPAP Pressure: 7.0
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Texas

Post: #3
RE: Airsense 10 & Central Apnea Detections
I had mistakenly posted this under another person's thread and didn't get any responses, so I'm reposting it under my own.

My story is still the same. I continue to show mostly Central Apnea detections. I'm happy to report after 66 days:

AHI: 1.1
Apnea Index: 0.9
Obstructive: 0.0
Central: 0.8
Unknown: 0.0
Hypopnea Index: 0.2

Leak (L/min):
Median: 0.0
95th: 0.0
Max: 4.8

Pressure (cmH2O):
Median: 7.2
95th: 7.8
Max: 8.4

As low as my AHI is I'm not complaining, but should I be concerned about the Central Apneas? I'm being prompted by a close friend with OSA to get another sleep study. Honestly I can't imagine what good it would do. I think in this case, the extra knowledge (distinction between Obstructive and Central detections) is simply not a factor at levels this low. I think the more important detail is how my AHI dropped when I switched equipment and went from full face mask to nose pillows... From 7.0 to 1.1, now that's a change! Was it due to the equipment (S8/S10) or the interface (mask/nose pillows)?

Too many questions... But at least I'm sleeping.
04-19-2015 11:16 AM
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justMongo Offline

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Post: #4
RE: Airsense 10 & Central Apnea Detections
Still good numbers. Most people cannot "get enough air" [as they commonly describe it] at starting pressure of 4.
Detection algorithms have evolved and changed with each generation of machine.
Likely what you see are pressure induced apneas.

The high rate flow data and pressure at time of apnea would be meaningful to look at.
If you're getting some 10 to 12 seconds CAs; it's no big deal.

These machines raise pressure aggressively in response to snore and flow limitation, that you may be abating all OAs; but having a few CAs.

I suggest you download some computer resident software; and pull the SD card out of the left side.
I'd wager, with a little study of the graphs in context to each other, you'd understand what's going on; and be more confident in your therapy.

Kindest regards,

Mongo

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.
04-19-2015 11:18 AM
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trish6hundred Offline

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Machine: Resmed S9 AutoSet for Her
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Post: #5
RE: Airsense 10 & Central Apnea Detections
Hi trwolf0901,
WELCOME! to the forum.!
Hang in there for more responses to your post and much success to you as you continue your CPAP therapy.

trish6hundred
04-19-2015 11:28 AM
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worn_out_in_lebanon Online

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Posts: 271
Joined: Jan 2015

Machine: Resmed A10 Autoset
Mask Type: Full face mask
Mask Make & Model: F20 (newest Resmed ffm)
Humidifier: Included, ClimateLine tubing
CPAP Pressure: 13-15, EPR:0
CPAP Software: SleepyHead

Other Comments: I.T. Project Manager. Started CPAP therapy March 16, 2015. Untreated AHI 39.

Sex: Male
Location: TN

Post: #6
RE: Airsense 10 & Central Apnea Detections
Here's some info on how waking up, or arousals, followed by drifting back off to sleep, can contribute to CA's.


From the wikipedia entry for Sleep_and_breathing.
It describes (very briefly) that on waking you may breathe faster for a bit to drive down the CO2 which is now perceived to be too high, and on falling asleep you may breathe slower or even stop to let the CO2 level climb again to the different "set point" needed to trigger the next breath.

Sleep onset
Set point of ventilation is different in wakefulness and sleep. pCO2 is higher and ventilation is lower in sleep. Sleep onset in normal subjects is not immediate, but oscillates between arousal, stage I and II sleep before steady NREM sleep is obtained. So falling asleep results in decreased ventilation and a higher pCO2, above the wakefulness set point. On wakefulness, this constitutes an error signal which provokes hyperventilation until the wakefulness set point is reached. When the subject falls asleep, ventilation decreases and pCO2 rises, resulting in hypoventilation or even apnea. These oscillations continue until steady state sleep is obtained. The medulla oblongata controls our respiration.


From a book titled Fundamentals of Sleep Technology by Teofilo Lee-Chiongy:
The sensitivity of the respiratory system to CO2 is affected by the sleep/wake state. CO2 sensitivity is highest during waking and lowest during quiet, non-REM sleep, with REM sleep having intermediate sensitivity. The abrupt decrease in CO2 sensitivity at sleep onset, while the waking CO2 level persists for a few seconds, may be a mechanism of sleep-onset central apneas.


Anyway, the net effect for me, is if I sleep soundly, I get less CA's. If I'm restless and waking up a lot, I get more CA's. I always see a small cluster in the beginning of my graph every night at the time I'm drifting off to sleep. I often see a couple after the gap in the graphs where I took the mask off for a bathroom break. I figure the random ones are probably pegged to a period where I was fidgeting with the mask, waking up while rolling over, etc.

If you are getting disturbed more, from getting the new machine dialed in, I would guess your CA's are from those disturbances more than anything else.
04-19-2015 11:42 AM
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trwolf0901 Offline

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Posts: 9
Joined: Jan 2015

Machine: ResMed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift
Humidifier: AirSense Integrated-Auto
CPAP Pressure: 7.0
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Texas

Post: #7
RE: Airsense 10 & Central Apnea Detections
(04-19-2015 11:18 AM)justMongo Wrote:  Still good numbers. Most people cannot "get enough air" [as they commonly describe it] at starting pressure of 4.
Detection algorithms have evolved and changed with each generation of machine.
Likely what you see are pressure induced apneas.

The high rate flow data and pressure at time of apnea would be meaningful to look at.
If you're getting some 10 to 12 seconds CAs; it's no big deal.

These machines raise pressure aggressively in response to snore and flow limitation, that you may be abating all OAs; but having a few CAs.

I suggest you download some computer resident software; and pull the SD card out of the left side.
I'd wager, with a little study of the graphs in context to each other, you'd understand what's going on; and be more confident in your therapy.

Kindest regards,

Mongo

Thanks for the reply Mongo.

I've been using the ResScan Software since I first got my S8 years ago. My S8 was set to start at 9 and run full auto when that 90 day average was recorded. I made the mistake of trying the S10 at a lower starting pressure (4), but obviously I'm more comfortable at 7.
Overall, my CAs are usually 10-14 seconds. To date, my longest is 33 seconds and there has probably been less than three dozen over 20 in the 66 days of use.
As I think more about it, I wonder if all the hyponeas the S8 was detecting are now occasionally long enough to be flagged as CAs by the S10? Regardless, the levels are very low at less then 1.0

I'd offer to post some charts, but apparently my 200 Kb attachment limit would require me to delete my other info first...
04-19-2015 11:53 AM
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PaytonA Offline
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Post: #8
RE: Airsense 10 & Central Apnea Detections
trwolf0901,

I do not have any experience with the Airsense 10 but I did upgrade from an S8 to an S9 VPAP Auto. When I did, my AHI dropped and my hypopneas almost went away. It is known that Resmed changed their scoring requirements for hypopneas for the S9. This was done to more accurately score them.

We have had a fair number of forum members whose AHI has dropped when they switched to nasal pillows. Your reduction of AHI would be expected but I am not sure that I would have expected as much as you actually got. It looks like both changes combined to make the reduction pretty large. Anyway, great job. Be happy in your newfound numeric nirvana. Big Grin

Central apneas are no worse than obstructive apneas. They just require a different treatment, if treatment is actually needed. As Mongo says, a modicum of short duration centrals are not anything to worry about. They could have developed as a result of the change of machine and mask and may well go away by themselves. You never saw centrals before because the S8 could not discriminate between CAs and OAs.

Best Regards,

PaytonA
04-19-2015 11:58 AM
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trwolf0901 Offline

Members

Posts: 9
Joined: Jan 2015

Machine: ResMed Airsense 10 Auto
Mask Type: Nasal pillows
Mask Make & Model: ResMed Swift
Humidifier: AirSense Integrated-Auto
CPAP Pressure: 7.0
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Texas

Post: #9
RE: Airsense 10 & Central Apnea Detections
(04-19-2015 11:58 AM)PaytonA Wrote:  trwolf0901,

I do not have any experience with the Airsense 10 but I did upgrade from an S8 to an S9 VPAP Auto. When I did, my AHI dropped and my hypopneas almost went away. It is known that Resmed changed their scoring requirements for hypopneas for the S9. This was done to more accurately score them.

We have had a fair number of forum members whose AHI has dropped when they switched to nasal pillows. Your reduction of AHI would be expected but I am not sure that I would have expected as much as you actually got. It looks like both changes combined to make the reduction pretty large. Anyway, great job. Be happy in your newfound numeric nirvana. Big Grin

Central apneas are no worse than obstructive apneas. They just require a different treatment, if treatment is actually needed. As Mongo says, a modicum of short duration centrals are not anything to worry about. They could have developed as a result of the change of machine and mask and may well go away by themselves. You never saw centrals before because the S8 could not discriminate between CAs and OAs.

Best Regards,

PaytonA

I was not aware of the scoring change. That is great information.

As for not seeing CAs before, I completely agree. However, I was shocked to see the shift from Hyponeas to CAs. Based on your other input, it now makes much more sense.
Thanks.
04-19-2015 12:16 PM
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justMongo Offline

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Post: #10
RE: Airsense 10 & Central Apnea Detections
(04-19-2015 11:53 AM)trwolf0901 Wrote:  I'd offer to post some charts, but apparently my 200 Kb attachment limit would require me to delete my other info first...

Best way to post image files is to open a free account on a site like photobucket under a nom de plume.

Upload is just a drag and drop. You put the URL for the image between HTML IMG tags.

[IMG]...[/IMG]

Keeps them off the forums servers; and permits more data to be displayed than by attachment.

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.
04-19-2015 12:47 PM
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