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Thirteen years of CPAP - now failing again. [Central apnea]
#1
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Thirteen years of CPAP - now failing again. [Central apnea]
[attachment=14660][attachment=14658][attachment=14659]I was diagnosed with mixed obstructive and central apneas in 2005.  I was put on a Cpap with an oxygen concentrator providing 2 liters of oxygen. I have used a Cpap or Apap every night, 7-8 hours for nearly 14 years. I am 72" tall and weigh 170. This has made a huge difference in my life. But now I only get one night with a good AHI  (<10)  one night in 10. I am falling asleep while working at my computer keyboard; feel like I'm falling asleep sitting at a traffic light ; and cannot stay awake all through a movie.

I have an Apap that records sleep but can find no medical person who can read the information.   Called my new ENT and they said they only work with those who need some type of surgery for obstructive sleep apnea. They recommended I go to my PCP and start over.  In the eight years I been sleep recording, no one has looked at any the information on the chip. I have an appointment with my PCP in a week and will be showing him my laptop with OSCAR on it. I have attached a typical night's data and the statistics page. My reading of the information is that the ratio of my apneas is six central apneas to one obstructive apnea in the last 30 days.

So what can I tell my PCP when I see him?
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#2
RE: Thirteen years of CPAP - now failing again.
OK Michael, we can and will help you.

I believe that you are on the wrong class of machine for at least 6 months (since February)!
Your Obstructive Apneas and Hypopneas have varied but are approximately the same, I'm estimating just over 5 for Obstructive AHI and your Central Apneas have varied all over the place, mostly well over 5.

Here we have a lot of users that used the ResMed version of the ASV or Adaptive Servo Ventilator. Other classes of CPAP machines, including yours, are NOT capable of treating Central Apneas so with them we try to avoid Central Apneas. This, the ASV, is the only class of CPAP machine that can actually treat Central Apneas, and it handles obstructive Apneas at the same time as well as Periodic Breathing which I want a closer look at, preferably tonight, do this by left clicking on 3 different green areas (one at a time) then pasting the resulting screenshot in this thread.  keep clicking until the time span shows 5 minutes.  I want to see what kind of periodic breathing it is because some kinds are dangerous. IF that is what I see I will let you know.  

This is ResMed's recomedation, the info is from the ResMed Sleep Lab Titration Guide

  • ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
You currently have all of these except snores.

Read this WIKI article:  http://www.apneaboard.com/wiki/index.php...P_Machines

Is it OK is we work with you to change some pressure settings?  Or do you want to go thru your doctor to do that.  We would be following standard titration protocols.

First I would really like to see closeups of those Periodic Breathing sections.
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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#3
RE: Thirteen years of CPAP - now failing again.
Hi tykelmice,

Welcome to the Apnea Board.

I see bonjour has given some insight into your limited apnea therapy success. I’ll admit I’m not super good at chart reading, but honestly there’s some similarities between yours and mine in the past. I’ll be quite frank, you’re in need of some assistance and that is what we’re here to get done. Bonjour and I see you’re likely going to be up to fighting for an appropriate machine to do battle with your entire apnea therapy need. You’re going to need to get an ASV. I’d personally suggest the same machine I’ve got now, the ResMed ASV. Reason for that specific one? It works great for mixed apnea therapy. No I don’t get money from ResMed, but I can prove it will work. Give you a hint, some of my info is in the links below.

I’d like you to read a wiki we’ve got called Dealing with a DME.

I see bonjour gave a link for some research for you as well. Please read these to get an idea what is soon going to be needed to help you get better. I’ve been there so believe me it’s not fun. However success will be available soon.

If you have any questions about anything on this post it here. I’ll do my best to answer or find the answers I don’t have currently.

One final thing, best wishes for your future success.

Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.


OSCAR Chart Organization
Mask Primer
Dealing With DME
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#4
RE: Thirteen years of CPAP - now failing again.
PS if you are wanting to read how I got treated successfully, here’s the thread...

Newbie ready for guru input

When you get to your PCP, explain what you see with the high level of central apnea AND you do not feel better for the therapy.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.


OSCAR Chart Organization
Mask Primer
Dealing With DME
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#5
RE: Thirteen years of CPAP - now failing again.
tykelmice,
Welcome to Apnea Board!  
As it’s not uncommon that doctors don’t look at our data, I have to ask if you’ve had a complete physical lately or have you been seen by a Cardiologist?

The combination of Clear Airways (Central Sleep Apnea) and Periodic Breathing is something that needs addressed by your doctor.  Even as compressed as the flow rate chart is, it’s evident to see a pattern that looks similar to Cheyenne Stokes Respiration.

See bonjour’s thread above for showing a closer view of the flow rate and PB.  

You will need to get a referral to a cardiologist and get checked out. 

With that said, it looks like you have been on the wrong type machine for a long time.  
Only an ASV machine can treat Central Sleep Apnea.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com
Dreaming


https://www.sleepfiles.com/OSCAR
http://www.apneaboard.com/wiki/index.php...ganization
Using Attachments to Post ScreenShots.
Mask Primer
Machine Choices



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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#6
RE: Thirteen years of CPAP - now failing again. [Central apnea]
While I agree you need ASV, you can reduce the central events by turning your Flex setting off or to 1. Give it a try.
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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#7
RE: Thirteen years of CPAP - now failing again. [Central apnea]
I have 3 green areas with 6 minutes each from last night. Last night I tried sleeping on my side which can be difficult due to two bad shoulders. Last night no shoulder pain. The screenshot from 8:06 a.m. is while on my left side.

I am quite happy to try changing pressures. Was not aware that auto pap has that option.
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#8
RE: Thirteen years of CPAP - now failing again. [Central apnea]
I shut off the flex for tonight (tuesday). What should I look for to see what effect that has had?
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#9
RE: Thirteen years of CPAP - now failing again. [Central apnea]
I don't want to upset or scare you.

You NEED to talk to both your Cardiac doctor and your Sleep doctor tomorrow!!!  The zoomed views did what I was hoping they would not do.  They are showing fairly classic CSR.  This is one of the indicators for CHF.  Treating cardiac issues is beyond our scope.  

On the Apnea side.  You NEED a different machine, you need the ASV that several of us have talked about.  So you need to talk to the Sleep Doctor about getting a machine that will treat both obstructive and Central Apneas!  That machine is the ASV, Adaptive Servo Ventilator.  This is important.
ResMed ASV is working well for most of the ASV users here so that is what we typically recommend.

Now to treatment.  As I said Centra Apnea cannot be treated with your machine so we are going to work hard in avoiding it.  On your machine Pressure variance from both Flex and Algorithmic changes.  In addition, Higher pressures also tend to promote central apneas so we will favor lower pressures.

In this pass, I'm ignoring the obstructive events completely, ok not completely (obstructives fit into my selection of 6 cmw for both min and max pressure,

New settings:
Flex = off.  this to eliminate the pressure fluctuation or variance of pressure and is solely to try and reduce your central apnea and maybe have an impact on your CSR
Min = 6, max = 6.  Yes this is basically CPAP mode.  The idea is to both eliminate the pressure variance and to lower the pressure to minimize central apneas.


Please post again tomorrow and let us know what your doctors are saying.
In your charts I would like to see.

Events
Flow Rate
Tidal Volume
Minute Vent
Mask Pressure
Leak Rate

Please include a full night view and a couple of 5 minute views like above and a list of meds, especially any cardiac, opioids, stroke, and siezure meds as some of these are known to cause centrals.

Thanks
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#10
RE: Thirteen years of CPAP - now failing again. [Central apnea]
Hey tykelmice kudos on the charts, even if the situation seems a bit negative. I'm hoping you can see these doctors that bonjour mentioned, that way you'll have an idea what is wrong with the therapy. Please keep us posted, we're sincerely wishing you get all the success in this trying situation. If there's anything I can help with on guidance with this pursuit to get the ASV feel free to post it. Seriously, I've been there trying to get my own not too long ago and even block head Dave learned a few things on how to get and keep things moving. Best to ya.

Coffee
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.


OSCAR Chart Organization
Mask Primer
Dealing With DME
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