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[Treatment] First Night with cPAP Oscar Data - Central Apneas =[
#1
First Night with cPAP Oscar Data - Central Apneas =[
Good morning!

Attached is last night's sleep data from Oscar pulled from my Resmed Airsense 10 cPAP, as well as my initial sleep study.

A bit of background, I took the watchPAT sleep study January this year but didn't start tackling the issue until may/june. I figured because the AHI was just shy of an average of 5  I wouldn't be able to get treatment. I went ahead and scheduled an appointment with a sleep doctor around the end of may/beginning of June after I posted my results on Reddit. Someone advised me that I fall into UARS category and to seek treatment.

So far, I've had a cpap for about 3 months. I started with a dreamstation and took some time getting used to the machine, buying any and all masks I could to try to find the most comfortable one. During this time I saw an ENT had septoplasty/turbinate reduction to help open the airways in my nostrils. This has helped me switch to a nasal pillow mask and reduce my overall pressure, but I think the pressure might be too high for cPAP.

About a month ago I picked up an Resmed Airsense 10 (dreamstation recall) and have been putting as many hours into as I can to acclimate myself to it. Historically, I've always been a mouth breather due to severe sinuses/allergies. I had my tonsils and adenoids removed as a child, as well as a chin strap, to try to reduce my snoring.

I've gotten to the point where I can fall asleep quickly and consistently with my nasal pillow mask. It took me some time to get used to breathing through my nose and keeping my throat closed in a way that didn't allow air to escape my mouth while wearing the cpap mask. Since I've been able to fall asleep with it on, I stay asleep for about 2-3 hours and then wake up repeatedly during the second half of my sleep. The crap airsense app doesn't give much info, so I did some research and found about oscar.

Last night I fell asleep around 1. The early info is me awake, wearing the mask before bed/trying to fall asleep. I've been using melatonin to sleep and did not take any last night, so it took me a while to fall asleep. It looks like I slept for a few hours just fine, and then just like the past few weeks, it all goes to sh*t after about 2-3 hours.

Can someone assist in advising why these central apneas might be happening? Or perhaps what I can do to narrow down the issue? It looks like there's some correlation between leaks and the central apneas. I'm wondering if the pressure gets so high I can no longer keep the air from escaping my mouth. When I first started using the cPAP I used a full mask. I would wake up when the pressure would increase, and the machine would usually be around a 10 or 11 on the pressure. With the nasal pillow mask, I tend to see 9's on the cPAP when I wake up.

I've got an appointment next week for a bipap titration since cpap has been unsuccessful. I was told early on that this would be the ideal treatment since my sleep test indicates UARS and early stages of OSA. I'm hoping they can get me to sleep and keep me asleep, but any info/insight/advice on what to do over the next week before my titration would be much appreciated.

           
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#2
RE: First Night with cPAP Oscar Data - Central Apneas =[
I think your central are ones that many people get when they are getting use to a new machine. They are driven by a lack of CO2 and actually show your new therapy is delivering better therapy. They should go away in about 8 weeks.

However you can try to lessen them. What usually helps is to lower the EPR. EPR also helps with flow limits and H events. So it becomes a balancing act between lessening centrals and flow limits H events.

Try using EPR =2 and see if it helps, if so go to 1, checking on FL and H events.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: First Night with cPAP Oscar Data - Central Apneas =[
Would it be best to wear the cpap until I wake up, and then sleep without it the rest of the night to limit central apneas?

Or power through the second half of the night like I have been?
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#4
RE: First Night with cPAP Oscar Data - Central Apneas =[
I would wear the mask as much as possible. You will get through all this quicker and you must have had enough apnea to warrant the use of Cpap. Without no therapy is given and you will have apnea although it may not be centrals it will still happen.

By the way you do NOT have a lot of centrals compared to many others.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: First Night with cPAP Oscar Data - Central Apneas =[
if 1.21 central apnea per hour is typical for you, they're not enough to worry about. ignore them.

your stats are good but what concerns me is how fragmented your sleep is and the 'hairbrushy' look to your flow rate waveform. I'd be looking for the reason(s) you seem to be working hard to breathe and are waking up and masking off. could be a variety of things, one of which is movement. I suggest you scroll through your flow rate graph at a 10 minute view scale (set the view scale using the slider at the bottom of the daily/events tab) looking for a repeating pattern of a larger inhale, followed (usually) by 3 to 10 smaller breaths (the number isn't important but whatever the number is will be repeated pretty uniformly), followed by another large inhale. search the forum for periodic limb movement to find screenshots of how that looks in the flow rate or I can post one here if you prefer.

also try scrolling through at around a 3 minute view scale looking closely at the standard graphs of the last 2 minutes of each sleep session, looking for hints as to what's waking you. might be ragged breathing, flow limited breathing, an event, a leak, and more. or post a few screenshots of the last few minutes of sessions during which you know you weren't awake and chart readers will comment if there's anything noteworthy there.

movement may not be an issue for you but if it's present, it will seriously mess with sleep and there's nothing pap machines can do about it. might as well rule it out, or if present, address it sooner rather than later.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#6
RE: First Night with cPAP Oscar Data - Central Apneas =[
The 2 things to adjust on the AutoSet would be lowering EPR and turning off Ramp. On the ResMed, if Ramp is programmed it'll run each restart versus Respironics that has a manual button.

Agreed this is treatment emergent Central Apnea due to none being on your diagnosic report. Maybe the VAuto BPAP might be better as you've indicated about making the move. It might be the CPAP troubles are from your sinus/allergy history.
Dave

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