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[Treatment] New User Seeks Guidance
New User Seeks Guidance
Hi All, 

I am a new user and have been reading your board --- amazing content and information!  Kudos for what you guys bring to this difficult process. 

Would appreciate your guidance.  I am 30+ days into this process. I am moving to ResMed AirSense 10 AutoSet this evening; because Dream Station 2 does not provide Oscar data. I will post ResMed compatible Oscar information as it becomes available (I am starting that tonight).

In the meantime, I have the following and would appreciate setting guidance for the ResMed AirSense 10 Auto Set.

Recent Lab Sleep Study results:
Sleep disordered breathing was more severe on back (156 minutes on back) with an AHI for that time period alone of 35.5;
Overall AHI for entire sleep study was 14.0;  (Note: a home sleep study done the previous month --- mostly on my back, showed AHI of 40 with significant Oxygen Desat). 
Lab study showed 71 total events consisting of 28 OSA's, 23 Centrals; 0 mixed apneas; and 20 Hypopneas; with maximum duration of 41 seconds.
Respiratory Disturbance Index; (RDI) was 31.3 events per hour.
Sleep Saturation: Avg. 95%; Minimum 78%; 6.3 minutes below 88%;
Arousals: Arousal Index 18.9/hour; 96 arousals; 88 of those arousals (91%) were RERA (respiratory event related arousals).
Tracheal microphone revealed moderate-loud snoring; During sleep-disordered breathing, EKG revealed no significant change.

Where am I today?
My average nightly usage of my APAP machine is 6.5 hours.  I have shifted to sleeping on my side with good results (clearly demonstrated positional apnea). I have been using my DreamStation 2 set at pressure of 7/14 and experimenting with pressures of 8.5/15.  AHI moves from a low of 3.4 to a high of 9, but appears erratic with no continuity each night. Average AHI is 6.7 for the 30 day period. AHI appears good overnight with readout in the 4 to 5 range, until 1 hour before I get out of bed, and I invariably see increases of 2 to 3 points in final AHI (maybe due to sleep wake junk).  I have gotten mask leaks under control, and am using a soft cervical collar to help control my chin drop., so I think I am good there.  I am seeing "cear airway apneas" flagged on dreamstation that generally account for approximately 50%-60% of my AHI, with balance OSA's and Hypopneas.

I start my ResMed Air Sense 10 AutoSet tonight and want to get the settings right.  Would like to see consistent AHI under 3, if possible, but have not been able to achieve that (except for an occasional few nights) on DreamStation 2 so far. 

Any thoughts on best way to do my ResMed launch with first available Oscar data would be appreciated.  Or do I need to wait for Oscar before it makes sense for any of the experts to comment on my situation? 
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RE: New User Seeks Guidance
7/14 looks good, try EPR 3 but you may get some centrals from it. You had 0 before so I think you should be ok. I will be interested in OSCAR and I would bet it will be better with that S10.
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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RE: New User Seeks Guidance
Thank you, StacyBurke
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RE: New User Seeks Guidance
You have a significant number of centrals on your sleep study as well as your results on APAP. Centrals are nothing if not consistently inconsistent and may well be the reason for your variability of AHI. Unfortunately, APAP isn't really designed to control centrals, so we'll have to look at the data from the Resmed. You might find that just switching to the Resmed helps to squash the other obstructive events too. Sometimes, when people are prone to centrals, APAP can worsen that (either just until your body adjusts or in a few people, full time while using APAP) but as you already had a significant number without APAP so we'll have to see and compare.

How are you feeling in yourself? Do you feel better? The numbers are a great guide, but how you feel is the main thing.
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RE: New User Seeks Guidance
I am posting my first Oscar data for last night.  I would greatly appreciate your thoughts. Also, a few questions:
  • What are your overall thoughts on my current settings? (I did not use EPR so far).  Before last night's move to a ResMed Air Sense 10 Auto Set, I used Respironics DreamStation 2 (with no Oscar data available) for approx 30 days and seem to see a similar AHI result as last night, along with Centrals also similar. 
  • I understand that we have limited data, but are centrals looking like they could be an issue? (My lab sleep study is at the top of this thread, and shows my centrals for that night). 
  • Why is the MyAir/ResMed app showing 6.2 AHI, whereas Oscar shows 5.58.
  • On the one other night that I had Oscar data (not attached), I had a terrible night for my mask and awakenings, etc., and Oscar showed 4.7% Cheyne Stokes respiration with a large leak (2.79%). Is this likely a false reading? I don't want to obsess about something that is likely not accurate. 

I am new at this, and would greatly benefit from any guidance or advice.  

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RE: New User Seeks Guidance
Thanks, Ratchick.  I have just posted my first full night Oscar report.  Please give me your thoughts.  Regarding how I feel, I am feeling better than before APAP, with a number of clear improvements, including a reduction of a severe nocturia problem, and some more clear-headedness. I generally feel better rested until after dinner, when I crash in front of the TV. It is like clockwork, and I would like to fix that.
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RE: New User Seeks Guidance
BTW, it appears that I had a power failure, as my data cuts out for over one hour.  There was a power problem earlier that evening, so it would be a logical explanation for the lapse.
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RE: New User Seeks Guidance
Do you have smartstart turned on? I'm just wondering because that's a lot of sessions.

Some of those centrals could be related to the high pressure but they're not consistent. Some do look like they're maybe "junk" ones - the ones right at the very start of the chart I would imagine are - do you use ramp? If so, I'd turn it off if you can tolerate that. If you could do an hour (ish) zoom from about 3.15 to 4.15 ish (to catch the big cluster of OA, H and CA on one end, and the three central blips on the other, and then a ten minute of the big cluster and one of the other central blips?

Don't worry about the supposed CSR. It's almost certainly periodic breathing that the ResMed just labels CSR. Unless you have severe cardiac issues, it's almost certainly just related to the central events. What was your AHI/centrals like on the bad night?
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RE: New User Seeks Guidance
I do have smart start turned on.  Should I leave it on?  I do not use ramp, and am not using EPR at this time.  I attached a zoom and 10-minute view, but don't know if it is satisfactory for your purpose.  Please let me know, as I am still learning your jargon and how to execute this in Oscar.  

On the one other (bad) night My AHI was 10.95 and Centrals were 6.26.  There were large leaks of 2.79%.  My heart is fine, so I will not worry about CSR.  Please advise on the different AHI in Oscar vs. ResMed MyAir app, and your thoughts on my settings.  Also, let me know if you need better or different screen shots.  Thank you again.
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RE: New User Seeks Guidance
I'm thinking with nearly equal Obstructive to Central, you mentioned 28 OA to 23 CA. Given that Centrals are consistently inconsistent, these Centrals will frequently be more then less than Obstructive with or without PAP intervention/treatment. You win the pre-existing CA award.

What you need to do right now is make a sleep journal of how good or bad therapy is helping or hindering, how rested you're feeling or not, noting the CA trends of up and down, etc. Second, you need in your hand that detailed study report that showed CA 23 to OA 28. You want this for your personal health file so it doesn't end up getting lost in health file shuffles that commonly occur. AND you need this to prove pre-existing CA, as eventually the APAP may leave you wanting in therapy.

If it goes as I'm suspecting, eventually your CA will be "too much" to handle and will rob yourself of being well rested. At that point, you need to talk with Dr. Dolittle and suggest a new titration including ASV mode in a titration pressure trial.

You may have to try and fail APAP and BPAP. Refuse the ST machine and demand ResMed AirCurve 10 ASV at that time.

Of course, MAYBE the AutoSet treats Apnea well. Maybe... Keep a sharp eye on CA and really take notes NOW.

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