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#1
Been using my Resmed Airsense 10 autoset since February 10. AHI during sleep study was 20.1. AHI since using Airsense 10 has been in the 4 to 9 range. Hypos have been 1 to 2, OSAs have been 1 to 2. CAs have been the vast majority of events, roughly 60% to 80% plus of nightly events.

Last night the same pattern emerged. 1 hypo, 1 OSA, 4 plus CAs per hour. I tracked my awakenings and they occurred coincident with the CA events.

I am generally pleased with the therapy. Pressure settings seem to be fine (auto, 8 cmH2O to 14 cmH2O, with peak pressure usually approximately 11.6 cmH2O). My next appointment with my cardiologist is on 4/22. I will continue to track my therapy using sleepyhead and if there is no improvement in the CSAs, I will be asking for a new machine to eliminate the CSAs. Thoughts?
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#2
The fact that most of your apneas are central may be indicative of another underlying health issue. The machine you're using will only help with hypopneas and obstructive apneas, so this also might not be the best machine for you (there are machines or other treatments that address central apnea). That said, I suspect this is worth follow-up discussions with your cardiologist and sleep doctor.
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#3
Thanks Possum. Luckily, I have really no other health issues than the OSA. I am under "preventive" cardiology care due to a family history of premature CAD. My cardiologist is my sleep Doctor. I suspect that I may need and ASV type machine due to the CAs. I will monitor this for the next few months to see if improvement occurs as I understand occasionally happens. If not, I have the data to push for a machine change.
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#4
I am in a similar situation. Most nights my CA's are under 5 an hour, so my sleep doc can't do anything because insurance requires higher levels. Cardiologist says he knows nothing about any of this. My Pulmonologist is going to get my sleepyhead plots in two weeks and I will see what she has to say.

My AHI for CA's is fine, but for the 30 minutes before I wake up I can get up to 26 CA's which of course I think is what wakes me up 3-10 times a night. For insurance the magic number is AHI of 5 or greater consistently and I just don't make that.
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#5
Did you have so many CA on your initial study? or are they therapy induced? If the first, then to eliminate them would certainly require the ASV type machine which will initiate a breath for you. If the latter, you may be able to improve the situation in a couple of ways.
  • Time. As your body gets accustomed to therapy pressure induced CA can just stop
  • Tighten up the change range, or go straight CPAP. Some folk get CA in response to changes in pressure
  • Turn off EPR. Same reason as above
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#6
Thanks Daria. I do not remember any CAs on my sleep study. I find straight CPAP to be very uncomfortable, the APAP is much more comfortable for me. I will turn off the EPR and narrow my pressure range. I hope that this just disappears. Thank you.
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#7
definitely make 1 change at a time! and stick with it for a couple weeks. An AHI that is ~ 5 is still a lot better than the untreated one, I would guess! Being you are otherwise healthy, I am going to make a SWAG and say it probably will resolve Smile

another thing people find helpful is to reduce max. you should take a hard look at what is happening near the CA events - that might help you to see what needs to change.

regarding discomfort with straight pressures, first of all ---- me too!!! Thankfully I took to APAP like a duck to water! I am able to use EPR 3 and a wide range and get good rest --- however pressure is not any where near as uncomfortable after more than a year. Amazing what we get used to!

Take a good look at your data and where events of all types occur. If CA only happen above 12, then cap it there; if obstructives happen while the pressure is on the way up, raise the minimum.
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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#8
If a number of the events are occurring within 30 minutes of waking up or going to sleep, they can be caused by the transition between wakefulness and sleep or what we like to call sleep/wake junk. This is normal to non-apneaic sleep and should be ignored even though the machine counts them. The machine does not know whether we are asleep or awake. It just knows that it is running or not.

If you feel that you must have an AHI, you can add up the total number of apneas and hypopneas leaving out those that are within 30 minutes of awakening or going to sleep. Divide this total by the decimal hours for your sleep session for the night and you have a good representative AHI. This paragraph is my feeling based on my experience. I do not bother to recalculate my AHI when I have sleep/wake junk, I just make a mental note of it.

Best Regards,

PaytonA
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#9
Reducing max pressure may help. Currently set at 14 cmH2O and my observed max per sleepyhead has never been above 12 cmH2O. 14 is just a little wiggle room.

My AHI without the CAs included is usually 2 to 4 plus. With APAP treatment, I have very few OSAs and hypos. The CAs bring my AHI up into the 8 to 9 range. My CAs appear to be associated with awakening and may indeed be transitional in nature. I know that when I am going to sleep that I do forget to breathe. I will be comfortable in bed and sort of dozing; I will notice that I have not taken a breath in awhile. Is the drive to breathe caused by a CA enough to awaken me from a sound sleep? I THINK so, but I am not sure. I will be tracking times of awakening and CAs as shown on the sleepyhead graphs. I will keep you informed.
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