New ResMed User, can someone look to see if I'm interpreting the OSCAR data right?

[ShutterbugLCH]

            Hello forum,

I was recently diagnosed with moderate obstructive apnea, AHI during the test of 21 and AHI of 1.2 with a BIPAP during the study.   I've been on a ResMed AirCurve10S for 3 weeks.  BIPAP, set to 17/13.  The pharmacy tech that dispensed my machine told me that the SD card needed to be brought in every 90 days.  That seemed like way too long, and I asked around to see if there was another option.  Several very nice people told me about OSCAR, and recommended this site, so I downloaded it.  What I saw shocked me, according to the data my apnea is not being helped by the machine, and looks even worse than the sleep study I had done showed!

What I'm seeing from my results is that my apnea is way more central than obstructive, unless I sleep on my back.  Then it's more evenly split.  I've only had two nights out of 21 that my apnea was slightly more obstructive than central.  Since downloading my results I've made it a point to only sleep on my side the last two nights, and with that my AHI is much better.  I screenshot some of my results, and tried to pinpoint some of the episodes of central from last night (my best night since starting BIPAP).  The charts look like I just stop breathing, that's what I'm attributing the almost flat at zero lines on the flow rate for that time as.

Should I be concerned?  I have called the pharmacy tech at our small town pharmacy that dispensed my machine and handles all the CPAP patients, and she said to go ahead and bring my card in the first of next week, it'll be close enough to 30 days to send the info to be analyzed.  She had no idea what OSCAR was!

I've always been a very shallow breather anyway, sometimes I catch myself barely breathing, or not breathing and have to remind myself to breathe.  Thanks for reading this, and looking at my data!  I'm trying to figure this all out, but sure could use a little guidance.  

[Gideon]

Thanks for the charts. I'm going to assume the CA is CO2 driven/Treatment Emergent.

What we are going to do is slightly decrease the efficiency of your breathing so you don't flush as much CO2 from your system.

Reduce your IPAP by 1. Note we may repeat that on subsequent nights.

Repost after you use the new settings

[SarcasticDave94]

Just thinking out loud, it would be good to actually see the redacted, detailed, diagnostic report and probably the titration too. HIPAA does permit you to receive a copy of these. I think it somewhat odd that you weren't issued a VAuto but the S. I could be wrong, but just maybe Centrals were an issue and they're doing the avoid CA by way of this. That's why I would like to see the diagnostic.

[ShutterbugLCH]

Is that possible on my basic AirCurve 10S?  Since I'm brand new to apnea and this is my first machine, I think they stuck me with a basic machine.  I'm taking my card in for them to upload on Monday, hopefully they'll make adjustments as necessary to my machine after that.  One thing for sure though, I'm going to push for them to address this central apnea issue, even if it takes a referral to an ENT or a pulmonologist.  Just a really bad time to have to do that with Covid ramping up again, no telling how long I'll have to wait to get in!  But your comment has me wondering if there's something deeper going on than just apnea with my heart or lungs.  

Thanks for your reply!

[Crimson Nape]

If CAs are still plaguing you, try increasing the "Trigger" value to "Very High". This will increase the sensitivity of your inhale cycle and will up the pressure at the slightest sense of a flow direction change. This is not a cure-all if you are predisposed to having CAs, but might help in their reduction.

[ShutterbugLCH]

I would too!  Especially since my first sleep study was pretty much a disaster.  My Dr. ordered a split study, but I was so uncomfortable with their rock hard pillow and all those wires everywhere that I didn't think I slept at all.  My referral for a sleep study was from a rheumatologist specialist that my regular rheumatologist sent me to.  I have bad arthritis due to a collagen disorder I was born with, that's gotten markedly worse in the last 5 years.  The tech said I did actually fall asleep twice, which was just enough to tell I have apnea, but not enough to be able to hook up the CPAP for titration.  

They started me out on CPAP for the second study, and my Dr. gave me one diazepam to take right before the study.  I don't normally take anything like that, so it knocked me right out.  Plus I was taking the cyclobenzaprine (muscle relaxer) the rheumatology specialist prescribed.  I didn't wake up once during the study.  So I'm thinking my results may have been skewed towards obstructive anyway.  When I first started my BIPAP I was taking the 2 cyclobenzaprine as ordered every night, but dropped down to one, then stopped completely.  I just uploaded last night's data, and my AHI was 8.66.  CA was 8.14, OA was .26, and H was .26.  Slept on my sides all night, and again heavily skewed to central episodes.  I looked at the prices of the ASV machines, and wow.  

Thanks for your reply, and sorry if there's TMI here.  I'm so new to all of this that I don't know what's relevant and what isn't.

---

If CAs are still plaguing you, try increasing the "Trigger" value to "Very High".  This will increase the sensitivity of your inhale cycle and will up the pressure at the slightest sense of a flow direction change.   This is not a cure-all if you are predisposed to having CAs, but might help in their reduction.

Thanks!  I'll look into that.  And I just realized I should have been including quotes with my replies all along.  Not used to this kind of a forum, but I'm learning!

[Crimson Nape]

We ask that you keep the "Reply with Quote" to a minimum. Many members are vision impaired, and it gets very monotonous to here the same text over and over. If the post is very close to your reply, most people can figure out as to whom you are responding to.

[ShutterbugLCH]

Thanks Crimson Nape, good to know!

[SarcasticDave94]

FWIW, most doctors may order PAP adjustments a few times. Most PAP users get too frustrated with the loop of get appointment to see doc to discuss pressures, looking at data or likely not, waiting on doc to decide what to edit, then waiting for someone else to change it. You can self advocate, access the clinical menu and turn the dial and click the new numbers in yourself in seconds for free. Less stress and frustration. Despite wild claims we'd hurt ourselves and blow up lungs, it hasn't happened, because a CPAP can't do the damage they claim. Dr. Scare tactics get called out and shut down here.

[Joe Bezz]

What exactly is the "Trigger" setting you keep referring to?