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[Treatment] New User Seeks Guidance
#31
RE: New User Seeks Guidance
Your screenshots look right to me - what screen resolution is your computer? How much is visible is going to depend on that as much as anything.

Otherwise, your pressures look good to me - seems everything is nice and steady most of the night, it's not maxing out, it's not shooting up and staying there... I'd say keep at it if it's helping so far!


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#32
RE: New User Seeks Guidance
My Centrals appear to wake me up., followed by a flurry of centrals upon going back to bed in the middle of the night.  Would you characterize this as SWJ?  How do you know the difference between real centrals and SWJ, if there is actually "flatline" flow rates on the centrals as it appear here?

Thanks for the feedback Ratchick.  Yes, my computer is at a higher resolution.  You are correct.


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#33
RE: New User Seeks Guidance
OK, I'm going to preface this with the fact that I am very much a novice compared to the others on here, and this is just an overview of what I look at. Some of it is related to other graphs as well, but here's my understanding (and I stand to be educated by the more knowledgeable folk if I'm wrong!).

There are several things to look at when it comes to determining if they're SWJ or not. Some of it is just based on if you know the person is asleep or awake at the time, or if they're just falling asleep. If it's during that time, and only during that time, it's easy to tell if it is SWJ.

The ones after you get back into bed I would feel comfortable were probably where you were switching from awake to asleep, and so yes, would be SWJ. If you look (especially if you zoom in a bit on the first sort of 5-10 minutes of the second session, you can see that before the centrals, the flow graph is slightly bigger and more jaggedy compared to the breathing rates after it. The more jaggedy rate is often a sign of wakefulness (or some kind of arousal at least). Sleep breathing tends to be much more smooth and regular on the whole.

Sometimes when you look at the flow diagram, you can see that there's a bigger than normal breath right before the apnea - that's probably something you can ignore as it's often a sign that you've roused (at least partially) from sleep, taken a deeper breath, and then simply not needed to breathe for a little longer than normal. This is why sometimes you see an obstructive apnea, hypopnea or RERA right before a small bunch of centrals in someone who is sensitive to them, because they're sleepy enough that the first deep breath triggers a short run of "real" centrals, but they taper off quickly. This is (hopefully) something that will ease in time, and is often treatment-related, especially in new users, until their body gets used to the new "normal" carbon dioxide levels.

"Real" centrals can often look two ways - the first (like much of mine) is simply regular breathing interspersed with random centrals. No trigger, no periodic breathing, just boom, random central in the middle of (what appears to me, anyway) to be regular sleep breathing. The other type is the kind that often gets flagged as "CSR" when in reality, it's periodic breathing. That is basically what happens above when the obstructive event triggers a short run of centrals - only these might happen without an obvious trigger and not resolve after a few events. If you look at the flow graph zoomed in, you can see that each CA is separated by a waveform that starts off small, gets larger in the middle, then tapers down to small again, until the next apnea happens.

All of them happen basically because, for some reason, the carbon dioxide level is not high enough in the blood to trigger the next breath before ten seconds is up. This might be normal, because you took a deep breath. It might be that the increased effectiveness of the new CPAP treatment has lowered your overall carbon dioxide levels to the point where it's easier for a deep breath to tip you into that place where it doesn't trigger a breath (which may or may not result in that feedback cycle that causes periodic breathing).

And that feedback cycle is that initially, there's not enough carbon dioxide to trigger a breath, so you have a CA, then the carbon dioxide is high enough to finally trigger a breath, but only a small one, because it's only just over the trigger point. That small breath isn't enough to even out the carbon dioxide, so it continues to build, and you take a slightly bigger breath, and so on and so on until suddenly, you've blown off a little too much, and so you take a smaller breath, but it's not small enough to counter it, and the carbon dioxide level keeps dropping, and your breaths keep getting smaller until eventually you have an apnea and start all over again. So basically, in most cases, central apnea is down to either how sensitive the receptors are that measure the carbon dioxide in your blood and/or how quickly and effectively your brain works to remedy that. If either, or both, of those things are affected for some reason, then you can find yourself in Centralsville.

The good thing is that for many people, they can get a balance between managing centrals and obstructive events, but definitely get yourself a pulse ox to make sure that your oxygen levels are staying healthy, even though the numbers are low and mostly seem to be short-lasting (at least on good nights).

I couldn't really see the close up of the ones before because of the tool tip... They could have woken you, or something else could have and they might have been a result of the waking.

Edit: I looked on the big graph again, and yes, it looks like there was a spike a little way before the central, so whatever caused that breathing spike may have triggered that central and woken you, or the central itself could have, or something else.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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#34
RE: New User Seeks Guidance
Wow, Ratchick.  What a thorough review. I am most appreciative of your efforts to examine this, and to provide your insight. I will be reading it multiple times to try to absorb all that you have stated.
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#35
RE: New User Seeks Guidance
I'm not well versed with OSCAR settings as I'm untreated until I get a level of machine above ASV, but there's user's preferences that address high resolution screens and will make it appears more correct. That 4 line not zoomed shot is ok for CA work IMO. The flow limit issue can't be dealt with properly unless we wish to multiply your CA.

Leaks are in good shape so no issues there BTW. Keep that up as you'll need that to carry to ASV if you in fact transition. Note the belief you have that CA wake you or prevent deep sleep. More to the reason to move on if you see what I'm saying.

The rest of that is typical and it's what it is with your particular Apnea and the tool given.

Normally I don't want a summary chart, but pop yours up that shows the running stats of Apnea, etc. Specifically focus on CA and how long you've been on PAP. No hurry on it.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#36
RE: New User Seeks Guidance
PS yep she's got it right. I'll pop in a copy of one of my old BPAP Auto charts if I can make it cooperate. See if you can notice any similarities between yours and mine.

OK this was one of my first screenshots on the DreamStation's BPAP Auto in my request for guru support.

[Image: vGrMiGs.png]
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#37
RE: New User Seeks Guidance
Thanks, Dave.  Not a lot of data yet for the summary chart, as I just converted from DreamStation 2 (no Oscar) to ResMed (with Oscar). However, I have attached it. All the best.


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#38
RE: New User Seeks Guidance
Ok that's good enough. At least the news is CA are not overwhelming the chart.

Refresh my braincells, how long have you been on any PAP rather continuous? X months or weeks is fine. And a lot of moving to another machine if needed is contingent upon lack of comfort. The doc and insurance will see CA of under 5 and be incredibly hard to convince.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#39
RE: New User Seeks Guidance
Already got a hint of Doc being underwhelmed by CA's under 5.  Anyway, I've now been on APAP for a little less than 60 days. However, was diagnosed with mild sleep apnea in 2018, and started with a dental device that worked at first (per a follow-up sleep study). Flash forward to present. In a recent sleep study (a few months ago), the dental device proved totally ineffective: home sleep test -- AHI of 40; and then a follow-up in-lab sleep test, which demonstrated reduced apnea of only 14 AHI, but I slept on my side for most of the lab test. On my back, my apnea index was 35. Centrals first presented at the lab sleep test. My bout with nocturia, and a scary O2 desat on the home study (140 minutes below 88), got me to commit to APAP. Pleased so far with my progress, and glad to be on this board.  That's my story.
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#40
RE: New User Seeks Guidance
OK, copy. I understand your story a bit better now. Try it for a little bit longer I suppose.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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