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[Treatment] Newbie need some help
#1
Newbie need some help
First, thanks for viewing my post

A little background.  I was first diagnosed in 08 with AHI 35+ and was able to stay for the first year and gradually stopped the therapy because would leak allot and I would wake up with very dry mouth even when using the humidifier.  Last year I went to get a physical and one of the test that measured carbon dioxide was very high but the PA dismissed as a mistake.  I started doing research and appeared it may have something to do with apnea.  I went and purchased a Viaton SP02 reader and it confirmed too many drops in 02 levels and as low 80 through out the night

I went and purchased an S10 Autoset for her and started therapy. It has been around a month now but I feel I haven't gotten better results I still hover around 30 AHI with central apnea being the dominate I also have allot of leaks through out the night. I have used DreamWear full face, DreamWear cushions, P30i and mouth strips with same results. I do feel therapy is somewhat working because my 02 desaturation events where sometimes as high as 300 now it's lowered to as low as 30   

My main question is what do I do to lower my apneas i.e increase/decrease pressure, turn on EPR , different mask ?

Thank you in advance       Thanks


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#2
RE: Newbie need some help
Welcome to the board!  There are a lot of people here that can help. 

You have 2 main problems. First centrals and I will leave that for others but the second is you have a very large amount of positional apnea.  What is positional apnea?  It is what it sounds like. You are sleeping in a position that you are cutting off your own airway. You have to find out what position that is and stop doing it. Almost all positional apnea is when your chin drops to your Sternum and cuts off your airway. 

You may be sleeping on your back or sleeping on to high of a pillow and allowing you chin to go down to your Sternum. If this is not your problem you need to look into a cervical collar. I have a link at the bottom of this post. In it you can see people that were not wearing a collar and then the same people with collars. It shows a great deal of improvement with the collar. 

You can tell you are chin tucking by the GROUPED event in the night H row.
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: Newbie need some help
Welcome to the forum

First we need to fix the positional apnea.  This is best done with a soft cervical collar.  Please read the article linked in my signature.  I can't overstress the importance of this as no amount of pressure will fix this.

Next let's look at the standard charts.  
Events
Flow Rate
Pressure
Flow Limits
Leaks

I also want to see a close up featuring your Central events.  A 10 minute view around 0800 on the 11th.  Show all the above charts.  I want to see the character of your centrals.

If I understand it correctly in '08 you started but stopped treatment until about 30 days ago.  Is that correct?
If so you may have treatment-emergent central apnea.  If so your centrals could diminish over 2-3 months of CPAP use.

I'm going to ask you to set your settings to some standard starting values.

Ramp Off
EPR = 3, Full Time.  NOTE: This may increase your central apneas.  That is OK, we will adjust.  This will better manage your obstructive events but may increase your central apnea.  This is important information to know.

Keep your current min and max settings,  We will likely change them when we how your pressure is behaving.

Most importantly fix the chin tucking.
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#4
RE: Newbie need some help
Welcome to Apnea Board,

I'd agree on the positional Apnea aspect and I'm interested to see how this plays out with a bit of a possible Central Apnea issue.
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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#5
RE: Newbie need some help
Gideon, Thank you for your help I will get the collar asap.  I started treatment in 08 and stayed on and off for a year I started back in 14 for about six months and then started again about a month ago but I did not have a card and was not recording until last two weeks. I included a screen shot of a CSR event.  Thank You   

Thank you


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#6
RE: Newbie need some help
The good news is many of the "centrals" I believe are a part of the chin tucking problem, those will go away when you fix those.
The CA's don't appear to be idiopathic (unknown cause), that means they should be able to be somewhat reduced, no promises. Some are definitely being driven by your CO2 levels.

Any CPAP will improve your breathing. In fact you are expelling a bit too much CO2. When you do this to below your apneic threshold a central apnea occurs and you stop breathing. Now the CO2 concentrations build up and you resume breathing. Repeat.

The EPR =3 should confirm that this is the case and then we will take it from there.

CSR, that is what ResMed labels all periodic breathing. You do not have CSR.

Your leaks are excessive and they need to be managed. You are using a FFM so they pretty much have to be mask leaks. Please review the Mask Primer in my signature. The mask should fit comfortably and not tight. Tight actually causes leaks. If you need tight to manage them the mask doesn't fit you.
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#7
RE: Newbie need some help
Thank you Gideon that is good news so let me be clear on settings 

EPR 3 
pressure 10-17 
Autoset for her  
Ramp -off 
Cervical collar 
and expect increase in ca
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#8
RE: Newbie need some help
yes, i'm sure we will adjust after.
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