Therapy for LPR, OSA, and… UARS?

[SarcasticDave94]

I think our standard time window if it's more or less defined as treatment emergent is 3 months PAP use. Some we'll know before then, especially telling is if there's CA on a diagnostic sleep study. In that scenario, CA are pre-existing and not treatment emergent. Sometimes these 2 types respond similarly to pressure swings or lack of them. We may attempt editing settings to see what happens on OSCAR and how you feel. Noting these result inputs then you need to decide if it had gotten good enough on therapy or if it's not responding. There's a 3rd CA type that's a catch-all, idiopathic.

I'd start this ASAP, make a notebook of symptoms and complaints regarding therapy in general and specific on CA. You'll want to present this to doc if in fact you need to get an ASV.

[hoselife]

Wow, noted. The idea of having even 23 centrals in a 5 hr night (last night's improved result) for three months is pretty scary to me. And I have a 60 day window to return the machine if it's wrong. This could prove to be an expensive year. But I need to get healthy, so I'll be patient -- I'm only 2 days in.

I had only a handful of centrals on my WatchPAT. I suppose it's possible that the obstructives were miscategorized, or, perhaps more likely, that the RDIs were central. I did get the raw WatchPAT data, perhaps there is some way I can figure that out.

I've done as you instructed and started a sleep journal for the time being!

[SarcasticDave94]

FWIW I'm fairly certain we can make a determination of how your CA are being treated or not before that 60 days expiries so you should be able to do something.

[hoselife]

Thanks Dave! It truly is such a relief to not be alone in this.

[hoselife]

Some fun oximetry observations.

1) I'm sure that this has been pointed out before, but look at the correlation between heart rate spikes, movement sensor spikes, and flow rate disruption between the O2 Ring and the Vauto! There's some latency between the O2 Ring and the Vauto, and who knows which is off-clock, but when zoomed out it really starts to line up.

2) Seeing the role of my heart in this run of 60 second+ CAs from the first night is quite interesting too. Which is to say, aside from the moments of labored breathing and hypopnea -- it's not doing much! I consistently have 30 bpm spikes through the night and this makes me think they aren't due to CA? Though they may be due to related events. Data is so cool. Someday we're gonna be able to pull up OSCAR and look at everything that's happening, and maybe even figure it out.

[SarcasticDave94]

You're welcome. Keep trying it so you have attempts at the therapy. Don't quit until it becomes unbearable. Probably you'll need to clue doc in soon that you're running into CA trouble. You may need to consider finding out if this doc will support treating CA or if there's CA blindness. If the latter you'll need a new doc.

[hoselife]

Quite a rough night last night. I woke up often and laid awake too long for the data to be legible. That being said, I think I made some real progress at tolerating the higher trigger setting! I'll be back with more charts soon.

In the meantime, there are two flow rate interpretation mysteries this beginner is trying to solve. 

1) What makes this 60 second (!!) OA from last night an OA? There doesn't seem to be any flow limitation or much waveform distortion as far as I can tell. Could it be it's a CA that's been mislabeled? 

2) On the other hand, with this cluster of CAs, we see that there is a mask leak with flow limitation, leading to increased tidal volume, followed by a ton of labored breathing before recovery. In terms of airway patency this seems worse than the OA? Or is it just that the mask leak leads to increased pressure which tips the apneic threshold and sends things spiralling out of control.