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Please help! How can I reduce these LONG CA's?
#1
Please help! How can I reduce these LONG CA's?
Hi

I originally posted this on the software forum as it was a query about understanding the OSCAR charts. Now reposting to this forum as it's to do with my CPAP treatment.

I've been having a high AHI lately from CA's. The CPAP seems to be doing its job in getting rid of the obstructive apneas. But the CA's (I think) are responsible for my feeling exhausted in the morning.
Now I see that many of the CA's are of very long duration - up to 25 seconds.

It's been suggested that they might be caused by my mouth opening - but I think I would have noticed because of dry mouth and throat. I recently changed the mask to a p10 to reduce noise and leaks.
Here is the latest screen. Can someone please help?

Thanks!


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#2
RE: Please help! How can I reduce these LONG CA's?
Benzi,
I've looked back through some of your charts you posted over the last year, and it appears that you have suffered with CA's for quite awhile now.

You can try turning the EPR to off, but in all honesty, you are only using EPR 1, so it may not make a difference.

I think you may want to talk to your doctor and try for an ASV study. This is where you are probably headed.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization
OSCAR - The Guide
Soft Cervical Collar
Optimizing therapy




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: Please help! How can I reduce these LONG CA's?
Correct, the higher CA count could in fact be causing your tiredness. Try turning off EPR and see if these CA go down.
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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#4
RE: Please help! How can I reduce these LONG CA's?
PS as was mentioned by Opal Rose, is that you've had higher CA for some time, yes discuss this with the doc. State that your higher CA count is robbing you of a well rested state. Request a titration with ASV included.
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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#5
RE: Please help! How can I reduce these LONG CA's?
Thanks, I know that's what's indicated - but the "sleep specialist" I went to doesn't believe in using ASV for treatment. The sleep doctors here seem to have 2 items in their toolkit: CPAP and sleeping tablets. I don't even think the Resmed distributor here imports ASV machines.
In another couple of weeks I have an appointment with someone from a sleep institute that's supposed to be good - so good that I've had to wait 4 months for a virtual appointment. I hope the guy is open to your suggestion. If not - I don't know what's next. I'm hesitant to buy (and import) an expensive machine that has no local support from a distributor or a doctor. The one good thing about the guy who sold my the S9 was that he gave me a lot of help during the first few weeks when I was getting used to the machine. And in an emergency they can fix or replace it. Which would not apply to a machine that they don't sell. 
Thanks again for all your help
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#6
RE: Please help! How can I reduce these LONG CA's?
This is amazing to me. I understand that Israel has come of the best medical care in the world, so if mystifies me that Benzi's options are limited. Could it be that the medical establishment doesn't consider sleep apnea to be a serious medical condition? That doesn't make sense either.  Thinking-about Thinking-about
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#7
RE: Please help! How can I reduce these LONG CA's?
(06-30-2021, 03:07 PM)clownbell Wrote: This is amazing to me. I understand that Israel has come of the best medical care in the world, so if mystifies me that Benzi's options are limited. Could it be that the medical establishment doesn't consider sleep apnea to be a serious medical condition? That doesn't make sense either.  Thinking-about Thinking-about

That's exactly the question I've been asking. Unfortunately it's not something that can be answered by anyone in this forum....
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#8
RE: Please help! How can I reduce these LONG CA's?
I tried turning off EPR. No difference (as you expected).
So last night I tried a sleeping pill, which I've been trying to avoid (because the last sleep doctor got me hooked on benzos - so now I know what it feels like to go through withdrawal). AHI was 3.8, lower than I've had for months. From experience I know that if I keep taking the pills for a few days, eventually I'll feel less tired. But I don't dare to get hooked on pills again. I'll let you guys know what the sleep doctor says on July 19. Maybe this time I won't get a caveman.... I'll try to get him to recommend trying out ASV.
As a matter of interest - would I be completely crazy to import a machine and try to set it up and use it without the importer's help?
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#9
RE: Please help! How can I reduce these LONG CA's?
It may not apply in your case but I noticed a article about heart failure patients who
also has sleep apnia. After going through cardio rehab there little or no reduction in 
there obstructive apneas but  centrals were reduced by about 50% .
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#10
RE: Please help! How can I reduce these LONG CA's?
First, it is not a good practice to rely on a single night's results for changes to therapy.  Because each night is different in several ways, it is best to run a trial for three consecutive nights....generally.

Secondly, with EPR of 1 or 0, and no change, what would you have to lose by trialing three nights of EPR 2?

I'm not sufficiently savvy about this to do more than to remark on the apparent clustering of events, but they do tend to cluster, as your chart clearly shows.  It might be worth the few $$ to trial a foam cervical collar to see what, if any, effect it might have on the tendency to cluster.  I know, the foam seems to work best for obstructive events as a rule, but....we're fishing here and trying to catch something.
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