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Unusual CSR report on Oscar
#1
Unusual CSR report on Oscar
Hi all,

My first post here, but frequent info gatherer!

A bit of background on my OSA.

I was diagnosed with OSA in Jan 19 with an AHI of 29 and put on CPAP therapy. I would love to say that since then all things have been going great guns, though that would be a lie. Truthfully it has been a bit of a rollercoaster journey and if anything it has been a case
of trial and error, trying to get rid of excessive aerophagia (wife says she doesn't know what's worse, the snoring or flatulence). The terrible wind I get is quite painful, so I seeked this great place out to try and help with the symptoms and after some adjustments to my min pressure
and max pressure managed to almost get rid of the aerophagia.

Current potential scary issue.

For whatever reason, my AHI's and large leaks have been a lot higher over the past few weeks, so I got a new mask (UK NHS is brilliant and I'm fortunate that it hasn't cost me a penny), which has been great so far. Last nights sleep though showed an abnormal report of Cheynes Stokes Respiration and after looking back
on all my daily reports using OSCAR, I have noted another CSR from 5 nights ago, which to be honest has me a little worried and concerned. These are the only two events of this kind throughout my use of CPAP therapy. I have to be totally honest and just got on with the diagnosis and only pursued it to give my wife some respite from all the loud snoring. I feel I've been a  little naive and not taken it as seriously as I should have been with lifestyle changes, etc.

I have included the screenshots as attachments and hope someone can shed some light on these. Both these events happened when my AHI was unusually high, at least for me anyway.

I have included some info on the machine and settings I am using below -

Machine - Resmed Airsense 10
Mask - Quattro Air
Min pressure - 8
Max pressure - 17

It should be noted that the dates and time is all messed up, due to me attempting to change the time to the correct time (It wouldn't go back for whatever reason and kept going forward, so would also be great if anyone had any info regarding how to set the ResMed back to the right time and date it would be a great help). Thanks for all your help on this.


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#2
RE: Unusual CSR report on Oscar
Also, I see a lot of folk here and other forums talk of central sleep apneas reported on OSCAR, but I can't find anything of note on there? Is it reported as something else? Just a curious question.
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#3
RE: Unusual CSR report on Oscar
(09-20-2019, 03:33 PM)Teejay73 Wrote: Also, I see a lot of folk here and other forums talk of central sleep apneas reported on OSCAR, but I can't find anything of note on there? Is it reported as something else? Just a curious question.

They are reported as Clear Airway and are purple in colour you have a couple around 3:30
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#4
RE: Unusual CSR report on Oscar
Ahh right thank you , I assumed it was through a process of elimination. Any ideas on my original post?
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#5
RE: Unusual CSR report on Oscar
I don't think this is csr. periodic breathing maybe but it's my understand csr would be accompanied by ca not oa. if you're up to it you can raise min pressure to 13cmw to knock down some of the oa, h and flow limitations (~ 1cmw under your 95 percentile. if too much of an increase, start pushing min up incrementally. also if you can, ditch the ramp; it's just time without adequate treatment. if that's too much, raise the min ramp pressure incrementally and shorten the ramp time over time.
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#6
RE: Unusual CSR report on Oscar
G'day Teejay73. Welcome to Apnea Board.

What you're seeing there is definitely not Cheyne-Stokes Respiration. CSR by definition is a periodic waxing and waning of airflow, with a central apnea or hypopnea during each cycle. What I see in your chart is a repeated obstructive apnea - Resmed flag this as CSR but it's more properly termed periodic breathing.

This repeated obstructive event is often associated with "positional apnea" - in particular tucking your chin down to your chest, which can cause obstruction of the airway. In the condition the machine has raised its pressure to the maximum, but can't "blast through" the apneas. You need to look for a way to keep your neck slightly extended, so the airway is maintained open. You could try a contoured pillow or a soft cervical collar, worn loose, but enough to prevent the chin tucking.

There's an excellent write-up in our wiki: http://www.apneaboard.com/wiki/index.php...cal_Collar

Good luck!
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#7
RE: Unusual CSR report on Oscar
(09-20-2019, 05:02 PM)sheepless Wrote: I don't think this is csr.  periodic breathing maybe but it's my understand csr would be accompanied by ca not oa.  if you're up to it you can raise min pressure to 13cmw to knock down some of the oa, h and flow limitations (~ 1cmw under your 95 percentile.  if too much of an increase, start pushing min up incrementally.  also if you can, ditch the ramp; it's just time without adequate treatment. if that's too much, raise the min ramp pressure incrementally and shorten the ramp time over time.
Glad to hear it! After some research, I honestly didn't think it was, however, I'm no expert and wanted a second opinion. My OSA's do tend to fluctuate, so will be trying some of the information provided here - thank you so much for your advice!
(09-20-2019, 09:34 PM)DeepBreathing Wrote: G'day Teejay73. Welcome to Apnea Board.

What you're seeing there is definitely not Cheyne-Stokes Respiration. CSR by definition is a periodic waxing and waning of airflow, with a central apnea or hypopnea during each cycle. What I see in your chart is a repeated obstructive apnea - Resmed flag this as CSR but it's more properly termed periodic breathing.

This repeated obstructive event is often associated with "positional apnea"  - in particular tucking your chin down to your chest, which can cause obstruction of the airway. In the condition the machine has raised its pressure to the maximum,  but can't "blast through" the apneas. You need to look for a way to keep your neck slightly extended, so the airway is maintained open.  You could try a contoured pillow or a soft cervical collar, worn loose, but enough to prevent the chin tucking.

There's an excellent write-up in our wiki:  http://www.apneaboard.com/wiki/index.php...cal_Collar

Good luck!

Hi DeepBreathing and thank you for your help regarding my OP. I feel a fair bit less stressed than I did yesterday. I really do think a lot of it is how much I move in the bed. Last night, for example, I had an AHI of 3.7, yet crazy high large leaks!? I really need to get consistent with my machine. Will try out some of the suggestions posted here Smile


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#8
RE: Unusual CSR report on Oscar
Teejay73,

Just want to comment on your leak rate, which is a bit high.  I do agree that you are tucking you chin to your chest and resulting in the clusters of Obstructive that show on your graph.  

Also consider that when your chin drops down to your chest, this position can push your full face mask out of position and cause leaking, which is showing up as a high leak rate on your charts.  

Your leaks need to be addressed, as it can affect how and if your machine can handle the apnea events properly. Read the mask primer and adjust your mask accordingly.  

Also, wearing the soft cervical collar as already recommended will make a big difference, not just in keeping you from tucking your chin, but possibly helping with the leaks.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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