Patter - Therapy Thread

[Patter]

   
   
   
I was concerned about rising levels of central apneas (clear airway.)  My primary care doctor said the respiratory therapist at the DME supply knew more about it but I could never get in touch with him.  Six weeks later, I showed my doctor the graph of central apneas and she was a bit alarmed.  She sent an order for me to be seen by a pulmonologist/sleep doctor.  It's been over two weeks and they haven't called...she'd said they were very busy and it might be a while.  I started reading Apnea Board and tried a few things.

My original settings on my Resmed Airsense 10 were 4 - 20.  The ramp is off.  I felt I couldn't get enough air at the beginning and changed the minimum to 6.  Much better!

I still had too many central apneas.  I changed the EPR from the original 3 to 2 and saw an improvement, so then changed it to 1.  I really can't tell the difference while breathing.  My AHI is so much better.  I still need to get rid of the centrals and fear they might go up when I start on a diet like they did in the summer.

[PeaceLoveAndPizza]

There is nothing going on in your posted chart where you need to be concerned. Things look good. A few leaks, but nothing big.

A few centrals is no big deal. The CA in your chart are not true central apneas, just holding your breath as you toss and turn. 

Only thing I would suggest is setting min to 7, max to 12, EPR to 2. Should hopefully be much more comfortable.

[SarcasticDave94]

Welcome to Apnea Board,

The centrals at a 0.88 CAHI level are well under 5 (medical treated), total events still controlled and under 5. I'd not concern at all about them given the low levels. Your event level being below 2 AHI means you should focus on comfort and rest.

Besides, attempting to treat CA (Central Apnea) requires sacrificing Obstructive Apnea therapy with this machine. Not indicating anything is wrong with your AutoSet, but that's due to this machines focus on OA.

[Patter]

I was about to fall asleep watching tv, so made myself go to the bed and start the Cpap.  I like to use a P30i mask a friend gave me for nap....it's so nice not to have the hose in front of me.  I've tried to use that one at night, but I get a higher AHI with it.  I sleep on my side, which blocks off air from one side, so it's not as comfy.  I kept feeling like I was having a hard time breathing and waking, sometimes with my cheeks full of air.  I've been doing so well at night lately with my P10.  I was amazed to see my AHI score on the Resmed when I awoke after 42 minutes....  28!  I have no idea what could have happened. 

   

   

[Crimson Nape]

Patter - Both of your threads deal with your therapy, therefore I am merging them into one. I will rename name the title to "Patter - Therapy Thread". Please keep all posts that deal with your therapy in this thread. Having all posts in one location provides a reader your history and avoids trying to jump between other threads.

- Red

[Patter]

Since I changed the EPR to 1, I wake one time each night with a very dry mouth. I'd never had that happen before.  It's not bad, but I'd wondered if I should turn off EPR.  Now I'm wondering if 2 would be better for me.  I'd like to end the central apneas.  They're low now....just fearing they'll go up when I start trying to diet after Thanksgiving.  The night before last was great AHI!

   

   

   

---

I forgot to mention, my wakeups in the night are almost always due to my Australian Cattle Dog.  For some reason, he has to pee around midnight and poop around 5:30.  I try to make him and my Weimaraner mix go out before bed, but sometimes they're too sleepy to go out.

[SarcasticDave94]

I'm not certain what your settings are regarding humidity. Maybe an edit to add a bit. However, dry mouth can indicate airflow through your mouth.

As for EPR and the CA, you'll want to balance EPR and comfort leveraged against the CA, even though CA is rather low already. Feel free to try all 4 levels EPR 0-3 to find the best compromise. And you may find the CA will drop off at some point allowing you to add EPR.

PS my dog mostly sleeps through the night like I do. We both snore too. Neither of us are on PAP right now.

[Old Codger]

I would suggest you are having onset sleep Centrals caused by arousals related to mouth breathing and leak causing you to wake up, then go back to sleep. Each time this happens, your brain wakes up briefly and then goes back to sleep, and it can cause a pause in breathing. Your machine doesn’t know the difference between a real central apnea and a sleep onset central apnea. Therefore, it tags them all. Lots of things can cause sleep onset centrals like: your dog kicking you in his sleep and waking you up, your mouth sputtering open from high leaks, your mask leaking and waking you up, your spouse waking you up. You need to get potential arouses under control and you’ll see the CA events drop off more (not that an AHI under 2 is concerning). Sleep onset central arousals are not scored in the Sleep lab. Unfortunately, your machine cannot tell the difference between a real central, and a sleep onset central, because there is no EEG to confirm what is waking you up. So your machine scores everything. Given the high leak rates on your report, I would wager that you need to have your machine turned down 1 or 2 cm and see if that doesn’t help control your leak or switch to a mask that doesn’t leak at all like the Eclipse mask from Bleep. Then, if you continue to have leaks, then you will know it’s your mouth, which you can address by using mouth tape. The last thing I would add is if you were on a Resmed auto, you should be aware that their autos overtitrate pressures by 2 cm. You should tighten up your range of pressure, because the more leak you have the higher it’s going to try to compensate for that leak. Exacerbating leaks even more as the pressures go up.

[Patter]

Climate control is auto and Tube Temp. is auto.  It seems just right usually.

Funny how a snoring dog doesn't bother me, but when hubby does, I put an ear plug in and turn on a you tube sleep train thing.  He says to wake him, but I pull covers and hit his shoulder, but nothing wakes him.  I wake if an ant walks across the floor.

[SarcasticDave94]

FWIW do you know what your actual apnea diagnosis was? If you have your copy, which you should, the full sleep study report, you can post it redacted. If not, you should request it. HIPAA permits this request, so doc cannot refuse.

Even if you don't post it here, you need your copy in case verification is asked some time later, like from DME, insurance, a different treating physician. Remember, things can happen and files get lost.