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One month in, trying to improve
#1
One month in, trying to improve
I am totally new to this world and about 1 month in to treatment. I did a home sleep study for 2 nights and the first night didn't do well due to poor mask fit. The second night had an REI of 21.8 and I was diagnosed with Obstructive Apnea. I was given a Respironics Dreamstation APAP set to 5.00-20.00 and a Dreamwear Nasal Cushion. I have since tried a Dreamwear Full Face (not good) and a Nasal Pillow mask, but the Nasal Cushion seems to be the best fit. I get almost no mask leak so that's not an issue. My AHI has varied between about 12 and 7 and I have only been below 5 once. The more I learn in Oscar and on this forum, I have adjusted my lower limit up to 6.5 but otherwise haven't made changes. I have become concerned about my periodic breathing and my CAs. I'm hoping I can get some help from some of the more experienced here to analyze my charts and give me some advice. I'm attaching my best day (AHI 4.55) and 2 of the most recent (high PB). I'm especially wanting to know if I need to worry about the amount of periodic breathing. Thanks in advance for any help or advice.


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#2
RE: One month in, trying to improve
Better night last night. Upped my lower limit to 7.0, only change I made.
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#3
RE: One month in, trying to improve
G'day wdarner. Welcome to Apnea Board.

It would be great if you could post a copy of your sleep study report so we can get a baseline. We need to see all the charts and tables, not just the summary. In particular I'd like to see if the central apneas occurred before you got the machine. Make sure you erase any personal ID on the report.

Looking at your charts, the apneas are just about all in clusters, and the periodic breathing is occurring during the same clusters. I suspect this is a case of positional apnea, where your sleeping position is compromising your airway. Most commonly this happens when your chin falls forward and tucks down to the chest, compressing the windpipe. To overcome this, you need to sleep so that your head is tilted very slightly backwards and the neck is slightly extended. The most successful approach is to use a soft cervical collar.

Read about it here: http://www.apneaboard.com/wiki/index.php...onal_Apnea

and here: http://www.apneaboard.com/wiki/index.php...cal_Collar
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#4
RE: One month in, trying to improve
Deep Breathing,

Thanks for the response. I will order and try the collar, seems like an easy attempt to see if it makes a change.

Unfortunately, all my doctor supplied was a one page summary for each night of my sleep study. I did not received the full blown detailed results. I will call today to see if they will send them to me. I am due in mid April for my first follow-up.

My biggest concern is that the periodic breathing pattern is not Cheyne-Stokes. Could I possibly be headed towards an ASV device?
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#5
RE: One month in, trying to improve
I believe they have a legal obligation to provide the full report if requested.

I'm pretty sure the periodic breathing is not CSR but if you zoom in close so that 3 minutes or so fill the screen and give us an image of that, it will be fairly easy to tell one way or the other.
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#6
RE: One month in, trying to improve
DB you have 2 rights here. In the US The patient has the right to a copy of all medical records and tests because of our HIPPA laws, that and I too believe a Soft Cervical Collar is indicated here.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#7
RE: One month in, trying to improve
(03-27-2020, 08:18 AM)DeepBreathing Wrote: I believe they have a legal obligation to provide the full report if requested.

I'm pretty sure the periodic breathing is not CSR but if you zoom in close so that 3 minutes or so fill the screen and give us an image of that, it will be fairly easy to tell one way or the other.

Spoke to my doctor's office and they are mailing me the report. In the meantime, I will expand the chart and send another image when I get home this evening.
Thanks for the help!
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#8
RE: One month in, trying to improve
Here are three zoomed-in screenshots. Let me know what your thoughts are!
The collar is ordered and set to arrive on Sunday, so we'll see how that helps.
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#9
RE: One month in, trying to improve
OK, they do look like genuine central apneas to me and the waxing / waning waveform is typical of Cheyne Stokes Respiration. Perhaps members with more experience in the condition will confirm or deny this.

I don't want to alarm you, but if this was me I'd be getting to a doctor for a thorough review. CSR can be associated with congestive heart failure, stroke, neurological conditions - or it might just happen for no apparent reason. Best to get those nasties eliminated if you can.
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#10
RE: One month in, trying to improve
(03-29-2020, 05:40 AM)DeepBreathing Wrote: OK, they do look like genuine central apneas to me and the waxing / waning waveform is typical of Cheyne Stokes Respiration. Perhaps members with more experience in the condition will confirm or deny this.

I don't want to alarm you, but if this was me I'd be getting to a doctor for a thorough review. CSR can be associated with congestive heart failure, stroke, neurological conditions - or it might just happen for no apparent reason. Best to get those nasties eliminated if you can.

Thanks DB,
I have my first follow-up with my doctor in 2 weeks and I'll definitely discuss it with him then.

I have the Cheyne Stokes Respiration event flag set in Oscar and it has yet to be flagged in any of my charts, so I am hopeful if it's happening it's a mild condition so far.

My PB has been a little more controlled the last few nights. I tried a cervical collar last night for the first time. It was comfortable enough to wear but didn't seem to make a huge difference in my Oscar chart. Here is last night's chart and a zoomed chart of the PB area.
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