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Losing hope feeling worse on CPAP than without. Any advice?
#31
RE: Losing hope feeling worse on CPAP than without. Any advice?
Hypopnea can actually be Obstructive or Central, just like an Apnea. The duration is still a minimum of 10 seconds, and with an Obstructive Hypopnea, the blockage would be about 50-80% compared to a full Apnea. I'm not quite as sure on the Central Hypopnea, but due to your pre-dominant Central status, I'm inclined you'll have some Central Hypopnea.

With Obstructive events, you can get them to diminish with higher Min pressure, but with Centrals, it might respond differently.

The lower pressures will likely be part of that "avoidance plan" that's eventually not going to go well. The lower pressures shouldn't be causing any more disturbances than your untreated Centrals and I'm quite sure the why you're not feeling well rested is all on the Centrals.
Dave

OSCAR
Standard OSCAR Chart Order
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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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#32
RE: Losing hope feeling worse on CPAP than without. Any advice?
I see thanks for that. I wonder why hypopnea is not really picked up by OSCAR, since it seemed so prevalent in the test.

On the low pressure suggestion, apparently it's since my pressure line is very active and that's when breathing disturbances happen. That means my pressure is too low apparently. I guess maybe I can raise the pressure a bit and see how that goes? What do you guys think?
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#33
RE: Losing hope feeling worse on CPAP than without. Any advice?
If you're seeing less of a certain event while on PAP therapy versus events on the sleep study, this would be the result of the PAP addressing those events. But as we've been discussing, the part that gets untreated, in this case Centrals, will be present until the right machine is brought in to do a full range therapy.

Certainly, you can try editing pressures and see what happens. I myself would limit it to one setting that is edited and to a small change. My reason for this is to go slow with changes, and to limit what is changed so you know exactly what gets the credit or blame. If things go badly, just return it to the starting point, the last known good setting. By that I mean your pressures now are X Y Z and act as a current default base, whatever you have now needs to be returned to if edits go badly. This is entirely up to you about managing this however. And if you try any edit, note the change and results so you can discuss with doc. This is new evidence that may be used towards getting the ASV.
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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#34
RE: Losing hope feeling worse on CPAP than without. Any advice?
(11-04-2021, 02:09 AM)AFAFAF Wrote: I see thanks for that. I wonder why hypopnea is not really picked up by OSCAR, since it seemed so prevalent in the test.

I think I might know the answer to that -- my sleep study has a whole section on "definitions of terms" and their definition of hypopnea vs apnea is that apnea is 90% or more. A ResMed algorithm scores an apnea at 80% or more. So the simple answer is that your APAP calls it an apnea while your sleep study called that same thing a hypopnea. A more subtle question is "percent of what?" In my breathing patterns I see long slow decays which are interrupted by arousals, and after I go back to sleep with each one I start back at the top and decay exponentially down. Which means that you can make very reasonable arguments about just where you put that baseline for deciding what you have decayed from.

Another really useful way to use OSCAR: Take your 1 November night. Zoom so that only the first sleep session is showing. Then look at the "fine print" above the Flow Rate graph -- it shows your Duration (which will be about 2-3/4 hours or so) and it shows your AHI over just that time slice. That AHI will be hair-on-fire level. If you take the left knob and make the left sidebar go away, then print it out and use a highlighter to go over the AHI or circle it in red. Then  take it to your doctor and say "look, this is NOT treatment!"
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#35
RE: Losing hope feeling worse on CPAP than without. Any advice?
Actually I like this. Here's a way to highlight the failures of this machine. Tell the doc to put that fire out or you'll fire him. Whatever day that the doc fails to listen to this data, tell him he's fired yesterday.

It's not fun to start over with a new doc but it certainly beats the seriously no fun state of Central Apnea Trainwreck.
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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#36
RE: Losing hope feeling worse on CPAP than without. Any advice?
Seems I'm getting consistently around 2-3 AHI. Still don't feel much improvement. Any tips based off these recent 3 days? Since AHI continues to be so low I don't think they would want me to try the ASV too. What should I do? Should I revert the lower pressure and see if the AHI goes back up?


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#37
RE: Losing hope feeling worse on CPAP than without. Any advice?
Same as above I guess


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#38
RE: Losing hope feeling worse on CPAP than without. Any advice?
I'm not certain what else to try. You'll see the CA give the classic consistently inconsistent attribute, the roller coaster up and down per night thing.

I'd consider 2 things to address. Maybe your Ramp is an issue being at 5 cmH2O, even though it's on Auto time. Any Ramp can be a negative variable to Centrals. Second point on Ramp, ResMed Ramp engages every time you start the PAP.

Possibly the bigger issue now besides ongoing CA is mask leaks. Your spikey leak pattern indicates mask leaks at a rate of 20 plus typically. And this leak pattern seems consistent in OSCAR charts, meaning it's not a one time issue, it's nightly. Your therapy effectiveness and accuracy both can be hindered by this. Revisit mask fitting size, strap adjustment, consider looking at our mask wiki in my signature.
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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#39
RE: Losing hope feeling worse on CPAP than without. Any advice?
How many CA events is enough to consider ASV do you reckon? Havn't had over 5 in a while.
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#40
RE: Losing hope feeling worse on CPAP than without. Any advice?
Well dr was fairly adamant I don't have central sleep apnea citing the sleep study diagnosis and something about how in the sleep study the chart doesn't look like a person with central apnea. I reread the sleep study and they said the majority of the hypopnea are obstructive, so that's probably why they diagnosed with obstructive and not central, despite double the central apneas. He said I don't need to continue since it hasn't helped, and to just practice sleep hygiene. I wonder if my medications might've caused this tiredness and poor sleep, but the symptoms didn't really occur until a fair bit after I started.

Is ASV still on the table despite AHI being fairly low? I'm really not sleeping well as the sleep study said 3% of my sleep is REM so feeling quite hopeless.
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