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How to identify central or complex apneas using software
#1
How to identify central or complex apneas using software
I am using ResMed ResScan software plus SleepyHead/Oscar on a daily basis.   How can I identify central or complex apnea events.  AFAIK, ResScan does not identify obstructive or central specifically, only total apnea and AHI.   Oscar identifies only as Obstructive or as Unclassified.

I need to resolve problems but to do so I need to look to see what is happening.   Oscar is reporting, for example, Obstructive 0; Unclassified 11.53 and Hypopnea 13.89.   It is the Unclassified category I need help with.   Just what is happening and how can I sort out the central events?

Thanks in advance for guidance.  Help is greatly appreciated.  C!

ResMed AirCurve 10 ST  - pressures 14 - 23.

PS   Of possible interest - Unclassified apnea events increased ~~250% following hip replacement surgery with general anesthesia 10 months ago.
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#2
RE: How to identify central or complex apneas using software
The Resmed ST does not distinguish between Central and Obstructive events, so there is nothing for OSCAR to report so it reports all full apnoea events as UA’s and partially reduced airflow as Hypopnoea. It sounds to me like you have complex sleep apnoea, and have been prescribed the ST to try and resolve this condition. Post some graphs so we can see if we can help you tune your machine. But if you truly have complex sleep apnoea then an ASV will be the correct machine for you unless you have CHF.


Are you on any drugs that could be causing your Central Apnoea to increase since the HIP replacement
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#3
RE: How to identify central or complex apneas using software
Attached are details from Oscar for 1 May 19 along with a detailed graph from ResScan.    I hope I have submitted attachments ion acceptable format (not too much).   Thanks for help and attention.


Attached Files
.pdf   BiPap_Oscar-ResScan_for_190501.pdf (Size: 1,001.44 KB / Downloads: 138)
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#4
RE: How to identify central or complex apneas using software
The first thing is to stop the leaks. There is a mask fit function on the machine that will blow higher pressure. There is also a link in my signature and lots of youtube videos. There is not much I can suggest till this is done.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#5
RE: How to identify central or complex apneas using software
Pertinent comments:   Prior to hip replacement surgery ten months ago I was using same AirCuurve10 ST machine with 6 month results AI 4.3 HI 7.4 AHI 11.7.   Results prior to surgery was with ResMed Swift FX nasal pillows mask.   ////  Most recent 6 month period 11/1/18 - 5/1/19:  AI 11.1 HI 13.8 AHI 24.9.  Results post-surgery with nasal pillows were "horrible."   Using Respironics Dreamwear full face mask for last six months with results posted above.   ////   I am very aware of leaks but have not been able to resolve them.
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#6
RE: How to identify central or complex apneas using software
Thank you for your assistance and comments - I will proceed accordingly.
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#7
RE: How to identify central or complex apneas using software
Other than DIY, are you able to get to your DME and try different masks and get help to fit?
If you look at the mask pressure chart, you can see how low it is, compared to your ipap setting. You aren't getting much treatment.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#8
RE: How to identify central or complex apneas using software
DME is helping, or trying to help, and DME, mfg and respiratory specialist (MD) are all involved.   But in the end, the patient is the patient's best advocate if they are able.  I concur, I am not getting adequate treatment at this point.  I am frustrated and have spent a lot of time to resolve without success.

I believe I read your comment to say to turn down the IPAP from 23 to 20 as a starter.   I wasn't aware of mask pressure ratings.   I have never seen those printed.

You asked:  NO, I am not on any drugs post-surgery that I wasn't taken prior.  I am not on any narcotics, pain meds, nor NSAIDs (except aspirin).   I do not have CHF. 

I have been on BiPap S/T from 12/1984 but prior to Jun 2017 I had no way to monitor nightly results.  I started using the REsMed AirCurve10 ST at that time.   I do not have the May '17 sleep study results.  Actual range of AI is from 0.54 to 36.83 with Median of 11.49.  With that range of results it seems to me anything is possible coming out of a sleep lab - good night bad night situation.  The sleep lab concluded study using the nasal pillows and chin strap.   The first night with the AC10 ST gave a 95% leak rate at 105.6.  Leaks have been an on-going problem.   They were used until October '18 when the full face mask came into play due to "lousy" results.  "Lousy" results have persisted.

For a trial I am returning to nasal pillows with chin strap tonight with reduction of IPAP to 20.     TNX, clif
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#9
RE: How to identify central or complex apneas using software
IPAP reset to 20.0
Mask set to Nasal Pillow
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#10
RE: How to identify central or complex apneas using software
No I didn't suggest turning down ipap. I don't see a need to do so. I would stay with a FFM till you are sorted, you could try a nasal later. Your DME isn't doing their job. It is their job to get a mask to seal on you face. Or change DME, it really isn't that hard to fit a mask, when you have all of them to choose from and have been trained to fit them.

The forum will work with you to help fit your mask, starting with the link below in my signature on mask fit, as well as the youtube videos. It may take a few pages and a few people helping you. The forum normally gets there in the end.

Start with the mask fit function on your machine that blows a higher pressure. clean shave and lay on bed. Put the mask on with the hose over your head and out of the way. push the mask against your face then release slowly and see what strap is tightening first, then adjust the other 3. repeat until it doesn't leak and is not too tight. Then wriggle the mask on your face to see if it leaks. If it still leaks, see DME for another mask, this should be at no cost to you. Until you find the one that they can fit. At the moment you have very little seal and constant leaks.

Have a look at the mask pressure chart in blue. after ramp time has stopped, it should be at 14 and 23 as a solid blue area. It is a wispy chart that hardly reaches the 14, let alone the 23.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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