Interpreting OSCAR, Clusters of Central Apnea

[letsrun100]

Yesterday my doctor sent pressure and other changes to the DME vendor so they could make changes to my machine, but as of 10:00 PM they had not sent the changes. So I made them myself. Since I am getting a new nasal mask, I wanted to tape my mouth, which I will probably have to do when the new mask arrives. With the new constant pressure set at 10, I could not keep my cheeks from inflating with air. After a couple of hours of fighting this, I returned to the original settings. Fully awake at 5:30 AM and decided to give the higher settings another try. After tightening the FF mask, I was able to tolerate the higher pressure just fine. Maybe I set something incorrectly last night, it was late. My AHI numbers are down to the lowest since I started, 5.91, almost acceptable. Still a few CAs and very few OAs.

       

[Sleeprider]

With central apnea, we find constant (CPAP) pressure at lower pressure, usually reduces events. I'm a bit perplexed by the selection of 10 cm as an effective pressure because you don't apparently experience obstruction. You read the wiki on justifying advanced PAP machines, and your doctor is following the predicted path. Since you know what will happen with bilevel and especially ST, you need to keep your doctor tracking towards ASV titration rather than the shotgun approach we have seen fail countless times.

Here is another source for reading. https://www.resmed.com/us/dam/documents/...er_eng.pdf That is the Resmed Sleep Lab titration Guide, and it describes what each machine is intended to treat and the appropriate response for any given problem. Please carefully follow the decision-tree for central apnea and CSR. Also, note the intended use of bilevel (again does not treat CA) and ST (intended for obstructive, neurological and obesity related obstructive events). You can use this resource to constantly remind your doctor that a particular machine is unsuitable for the conditions you both are looking at, continuing to point to the only logical choice, ASV.

[SarcasticDave94]

The shotgun failure plan sounds familiar. Go that route if you'd like to feel like death warmed over for a year and a half while failing the CPAP and BPAP. Or do as Sleeprider said and constantly keep your doctor on the ASV path. I do mean constant as in pretty much daily nudges to stay on track until you have the ASV at your house.

[letsrun100]

Okay, all agree, including me that ASV is warranted. So, to keep my doctor on that path I need to show him data that supports the need. He has directed me to set my machine to a constant 10. You all are telling me, and I agree a constant 10 will not reduce CA. Since i don't have an ASV machine yet, what can I do right now that may help? Nothing?

If I do as he has directed, come Monday and no improvement, he said he would order a Sleep Titration. I think I need to do what he has told me to do if I expect him to follow through. 

Since I am not having any OAs and CPAP will not help CAs, in all honesty I probably don't even need to be using the CPAP machine, correct?

[Gideon]

You don't have enough time at 10 to show anything useful.

From your doctor's point of view.
"See how you are getting all those events while you were playing around with the settings, and how while you were at a fixed 10 you were doing much better? Just use the setting that I gave you and the results will be better."

You need more time at 10 to show your doctor that it doesn't work.

[SarcasticDave94]

Exactly. Your doc wants proof that it does not work, so show him lots of evidence of what 10 looks like. I had to do similar on the BPAP before I got on the ASV path. It was ugly but I gave evidence by use as much as I could tolerate. I showed about a week of nasty data, then I called and stated I can't go any further, I'm done. Set me an appointment so I can show you my nasty charts. The nurse that I had the appointment with saw my messy chart. Then I asked "Looks like I need ASV right?" There is where it began.

[letsrun100]

That's the plan. If He's not convinced by Monday, I can send him a screenshot everyday if need be.

[letsrun100]

Last night's data:

New pressure setting of constant 10

Did not sleep well – many mask leaks in nasal area seemingly all night long (?)

O2 low (90% -> 82% -> 90%) between 1:45 AM and 2:30 AM = 45 minutes - Exactly when 9 CAs occurred

Total 23 CAs

Total 0 OAs

AHI = 4.03 Lowest number since starting therapy

It seems my biggest problem last night, aside from the high Leak Rate was low O2 from 1:45 AM to 2:30 AM when 9 CAs occurred.

CAs are still a major problem.

           

[SarcasticDave94]

This needs to be brought to the doctor's attention ASAP. You cannot accept being subject to oxygen levels at the low 82+/-%. This is at or very near dangerous to your health as I see it. I was told that if I recorded at or below 88% I'm getting supplemental oxygen. I think this is seriously wrong to be subjected to this very bad circumstance.

[Gideon]

First ignore the low, it is likely to be just a blip. Always consider the 'low' as the exception. BUT look at the amount you have around 85%, that and the CSR that is evident in your zoomed image, Yes, this deserves a call to your doctor TODAY!!!