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Some help/advice please
#1
Some help/advice please
I have been on the CPAP since early this month.  I do not wake up more refreshed at all.  I had some low overall AHI nights (below 5) but overall not the improvement I was hoping for.  I seem to have many CA events (according to SleepyHead software).  Before I woke up this morning I was in CSR for 75 minutes.  The machine seem to do its job when it comes to reducing obstructive apneas.  When I did my sleep study I was diagnosed with OSA at a rate of 15.5 - so medium.  During my period with high volume of CAs, my projected AHI for that period is 38.  My snoring is pretty much gone, which makes the wife happy, but I got the CPAP machine for better sleep which so far seems to be eluding me.

What to make of this data - that is my question?


         
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#2
RE: Some help/advice please
Hi mjongeiu, your chart is interesting but a bit alarming in that it does show a strong likelihood of Cheyne Stokes Respiration (CSR), which is often associated with congestive heart failure or a serious central apnea condition. I don't know anything of your medical history, but you need to bring this to your doctor's attention, and if you have not had a cardiac workup, you should also do that with a cardiologist. T

You appear to be using a Resmed adaptive servo ventilator that is trying to augment your breathing during the central apnea. If you could look at the link on organizing your chart in my signature and re-post, including the left margin we can tell you more. Your settings appear to be fixed ASV mode with an EPAP pressure of 7 or 7.5 and it looks like your pressure support is in the range of 0 to 8 cm. The pressure support settings are not sufficient to overcome the central apnea.

We can take a look at additional data, including the full night pressures and events to see if we can help reduce the number of events, however it would help to know what conditions you have discussed with your doctors that may relate to this. I notice that your summary data shows this is not necessarily a typical result for you, and there are nights with much lower event rates. The CSR pattern is one I hope you don't see often.
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: Some help/advice please
It would be useful if you could upload you sleep study so we can take a look at types and amounts of apnea there. Also can you include the statistics from the left hand side of the sleepyhead daily screen so we can see the machine settings an overnight statistics.


See the sleepyhead organising data link in my signature
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#4
RE: Some help/advice please
       

Hi,

Thank you for your reply.  I have added the extra information asked for in your reply.


Thanks,


Martin
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#5
RE: Some help/advice please
Hi,

I'm using a ResMed AirSense 10 - not an ASV machine.  I have high BP (usually something like 94/140 - while taking meds).  I scuba dive and have had heart stress tests done for that and have been cleared for scuba diving.  I'm mostly using auto settings and my pressure is set for 9 according to my sleep consultant.  The details are in the new attachments.  High CSR or CA seems to be at least every other day.  I had a trial machine for 3 weeks before I purchased the same model starting March 9.

I appreciate all the feedback.

[attachment=4983]        


Thanks,


Martin
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#6
RE: Some help/advice please
Martin, Let's do this. Since your are using an Airsense 10 machine, turn off the EPR (exhale pressure relief). EPR can make central apnea worse, or cause it in some individuals. On your chart above, I missed that the pressures were actually following the apneas, not trying to intercede. Turn off EPR and a lot of this may just go away. EPR can be found in the clinical menu (control knob+home button and enter clinical settings). EPR can be turned on full time, ramp only or off, and set a 1 to 3 settings. You need to turn it off. It looks like you may be using a pressure of 8-20 and EPR at 3. Turning EPR off should help both the obstructive apnea and the centrals. Most of the night looks pretty good, and eliminating EPR should resolve most of this. I have to say, that was a pretty awful looking chart you posted above. I'm sorry for making some alarming statements without more information on your results and health, but you really don't want to see that kind of periodic events again.


[Image: attachment.php?aid=4984]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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#7
RE: Some help/advice please
I will turn EPR off and see if that makes a difference.  I don't want my CPAP to introduce more CAs compared to normal.  Thank you!!
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#8
RE: Some help/advice please
The central events could be pressure induced. The sleep study report has a CAI of 1.
PaulaO

Take a deep breath and count to zen.




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