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Swapped to ResMed, Having periods of CSR reported, not sure what to make of it.
#1
Swapped to ResMed, Having periods of CSR reported, not sure what to make of it.
Hi,

I used a Phillips machine for over 266 days, I never got a consistent treatment on the machine with my AHI fluctuating from 2 to 30 on any given day, eventually, after returning the machine and having it replaced twice under warranty I decided to try a Resmed machine because my doctor dismissed the machines results as they were different to my sleep test results.

I however wasn't satisfied and decided to buy a Resmed AirSense 10 Autoset and see if I have a different experience. My AHI is pretty stable, sitting at about 5-8, which is an improvement. The only issue is that they are all Centrals and I am having periods of Cheyne-Stokes respiration every few nights; where I will have 17-33 Centrals in the space of 25 minutes.

My Doctor doesn't seem to think anything of it - but because I don't understand it, seeing 5% CSR regularly & no OSA (which is what I was diagnosed with) and 5-8 centrals an hour... I thought that would be something to be concerned about? am I wrong?

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Thanks
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#2
RE: Swapped to ResMed, Having periods of CSR reported, not sure what to make of it.
Your not wrong, may be time to change your DR you need an ASV
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#3
RE: Swapped to ResMed, Having periods of CSR reported, not sure what to make of it.
First, the "CSR" is not CSR, it is periodic breathing. ResMed calls all CSR periodic breathing. CSR has a much more pronounced waxing and waning with each node or cycle is separated by a Central apnea. CSR is defined by your CO2 levels cycling gradually from normal (high) which signals the need to breathe, to below your apneic threshold where you have no drive to breathe causing the CO2 to build up gradually increasing your volume where this increased volume once again flushes the CO2 out of your system and then repeating the cycle.
Your close-ups are showing a very slight indication of the pattern indicating that your Central Apneas may have a CO2 driven component.

Your charts are incomplete thus I do not have enough information to make specific suggestions

The left sidebar is missing, without the pie chart and calendar please, and with are important breathing stats and settings. Important charts are missing. These should include

Events
Flow Rate
Flow Limits, ResMed responds aggressively to these to prevent additional obstructive events
Pressure, CPAPs are all about using pressure to manage events so this is needed
Leak Rate, too high and your machines ability to compensate, identify, and treat events is compromised

Your treatment is a balance between obstructive and Central events. Your machine cannot treat Central events, it can only attempt to avoid them. What decreases obstructive events tends to increase Central events, thus it usually is very much a Ballance.

Step1: decrease EPR, EPR increases the efficiency of your breathing which in some means flushing out CO2 to below the apneic threshold resulting in Central Apneas. I cannot tell if you are even using EPR and this is critical info

Step 2: reduce pressure a much lessor effect than EPR but it is there.

Step3: minimize pressure fluctuations, often ending up with a fixed pressure, essentially CPAP mode. as these can impact your Central Apneas

Provide more info and we can provide more specific suggestions.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#4
RE: Swapped to ResMed, Having periods of CSR reported, not sure what to make of it.
A wiki article in Optimizing Therapy discusses clear airway clusters http://www.apneaboard.com/wiki/index.php...y_Clusters

We need the OSCAR chart to be posted with the left column that shows respiratory statistics and machine settings and include the needed charts for pressure. The current version of OSCAR can help you format the chart by using the View menu and selecting Standard or Advanced, then using the F12 function to take the screenshot.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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