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New Equip (Airsense Auto) - Weird CA/CSR
#1
New Equip (Airsense Auto) - Weird CA/CSR
           

Hope everyone has gotten off to a great 2020.

Question:  Bought a Airsense 10 Auto with Humidifier, and used it last night for first time.  I know its early days (had been using S9), and I switched last night from Full Face Mask (which had crazy leak numbers) to nasal pillow, where leak numbers are ok.

In any event, surprised at all the CAs in my Oscar report...and even more surprised by the CSR.  I am attaching the screenshot from the Oscar daily.  Any thoughts?

Thanks guys...you folks are real experts.  And looking forward to night 2!

Thanks

John
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#2
RE: New Equip (Airsense Auto) - Weird CA/CSR
Your pressure is moving on flow limitation and it's all over the place. You don't have obstructive events, so I'm going to suggest a narrower pressure range of minimum pressure 6.0, maximum pressure 8.0. We might want to look at EPR if the central events settle down. I do think most of the CA events are related to sleep disruption from all the leaks. See what you can do to limit that problem, and most of the other things should fall into place.

Next time around a single chart with Events, Flow Rate, Pressure, Leaks and Flow Limitation are all we need.
Sleeprider
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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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#3
RE: New Equip (Airsense Auto) - Weird CA/CSR
Thanks Sleeprider...you are the best...you do god's work on this site.
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#4
RE: New Equip (Airsense Auto) - Weird CA/CSR
        Hello all...Happy February

Just wanted to check back in, week later.  My AHI is coming down from 8 to 4, which is good.  Still using the resmed nose pillows (but over a year old) and will be ordering new ones.  Tomorrow a Resmed Nose Mask is coming, so will be experimenting with that.  Hopefully one of these two will help with the leak issues.

Anyway, here is the updated graph....any further thoughts for improvement?

Thanks!

John
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#5
RE: New Equip (Airsense Auto) - Weird CA/CSR
I would like to see a 2-minute zoom image of a couple of the CA events. I want to see what the chart looks like around them.
Also, very important, a critical view of how you feel. This is to see if it is worthwhile to chase events, this does include your CA events. I want to see if your centrals look like they are based on your blood CO2 level and your CO2 apneic threshold.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#6
RE: New Equip (Airsense Auto) - Weird CA/CSR
Making decent progress in bringing AHI down.  Have a new N30i mask which I have been using.  Still a lot of CA and despite tightening mask, seem to have large leaks.  Include a zoom of a CA event.  Any further thoughts?


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#7
RE: New Equip (Airsense Auto) - Weird CA/CSR
You probably need ASV to resolve this. Your flow limitations are resulting in long inspiration times relative to expiration, and it's clearly a struggle to breathe. Pressure support or EPR can help with this, but would greatly increase CA events. A higher central apnea event rate may be needed to move you towards qualifying for an advanced PAP machine. Read this wiki http://www.apneaboard.com/wiki/index.php...P_Machines

I think it is better if you fail CPAP sooner than later, and move on to the next level. It's really easy, add EPR full time at a setting of 2 or 3. and increase maximum pressure to 10.0.
Sleeprider
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____________________________________________
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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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#8
RE: New Equip (Airsense Auto) - Weird CA/CSR
   

Hi Sleeprider and Bonjour,

Thanks for all your advice.  Getting settled into my new equipment (N30i mask and Airsense Auto) for about a month.  In that time, I set an upper limit for auto pressure at 8 (at your suggestion), then more recently lowered the upper pressure slightly to 7.6 (thinking CAs would come down, and they have).  Feel pretty good about the progress (you can see previous charts above)....AHI from 8.76 to 2...CAs continue to drive the AHI...I certainly can live with 2, but any further suggestions...you guys are great.  I've never played around with the Epr settings, have it at zero...not sure if that matters, or would make CAs worse.  Thanks again.

John
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#9
RE: New Equip (Airsense Auto) - Weird CA/CSR
You still have very high flow limitations under therapy, but you have controlled CA by using essentially fixed pressure. It might be interesting to look at a closeup of the flow rate (2-minute segment where individual breath waves are visible) and see how flattened they are.

EPR with your Airsense 10 is the equivalent to up to 3 cm of pressure support in bilevel. In your case it would greatly increase CA events. It normally helps to reduce flow limitation which is very persistent in your results. As I said before, if you want to fail at CPAP, adding EPR is the way to do it. It will increase your AHI and move you towards ASV. if you are comfortable with your current setting at 7.6 cm, then your best bet is to continue as-is.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

How To Deal With Equipment Supplier


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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#10
RE: New Equip (Airsense Auto) - Weird CA/CSR
There is another option though with an AHI around 2 I wouldn't recommend it.
There is a system called EERS or Enhance Expiratory Rebreathing System which creates a little dead space in your mask system thus rebreathing a SMALL amount of CO2 increasing the CO2 level in your blood above the apneic threshold and minimizing your centrals allowing a greater application of PS to better treat Flow Limits.
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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