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Zeoce's Therapy Thread
#11
RE: Zeoce's Therapy Thread
I to disagree with the diagnosis. I'd like to see the diagnosis be a indication of the problem being Central Apnea where that is the case. I fee a diagnosis of OSA to often precludes getting and advanced machine such as an ASV because officially you do not have Central apnea. To have a possibility of getting an ASV you need a diagnosis of CSA.

And yes I agree with Sleepriders suggestions. My biggest variance is the strength I'm using to get you to push for the correct diagnosis with your doctor.

We can certainly optimize the machine for you but you have to decide which path to go down. ThAt is to more or less fail at CPAP utilizing your doctor's settings and thus qualify for the more advanced AsV, or let us help you to tweak your current machine to get you the best results that machine can give you.
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#12
RE: Zeoce's Therapy Thread
Hey Cberistain,

I'm using the F&P Vitera full face mask, as it's provided a good natural fit. I wanted to wear the ResMed Airfit P10 (found it noisy, and it caused me to let air out of my mouth) & Airfit N30i (it caused me to let air out of my mouth as well). I don't generally think of myself as a mouth breather during the night, so have wondered if the nasal bed/pillow style's pressure forced me to be a mouth breather, waking me up. Amazon prime in Canada has a few masks that could be returned and with fast delivery, so that worked well for me before I settled on the Vitera.

I'm a CPAP mask noob, but will say cleaning the slight oil off the mask daily with wipes or soapy water does seem to help with the seal and reduce "face farts" haha.

Zeoce
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#13
RE: Zeoce's Therapy Thread
Hi Gideon & Sleeprider

Thanks for the additional info. As a Canadian, I don't think a Rx will be required for a purchase from Supplier #2 since it would be considered an international order. Just placed an order for the cheaper refurbished ResMed S10 AirCurve ASV from their site. Hopefully it ships soon!

In the meantime I'll keep using my Airsense 10 at min/max 7 EPR 1, and post the OSCAR data.
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#14
RE: Zeoce's Therapy Thread
Can't beat the security and customer service of SecondWindCPAP. Great company, even if prices have increased in the past year or two. I didn't know you were from Canada, but as I understand it, central apnea does not exist there. Glad you were able to save a couple $K. You have the titration protocol, so set it up to defaults for ASVauto.
Sleeprider
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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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#15
RE: Zeoce's Therapy Thread
Haha, yes it appears that way.

Will enter the ASVauto defaults once the ASV machine arrives and report back.

Cheers
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#16
RE: Zeoce's Therapy Thread
Below is some more OSCAR data from my  Airsense 10:
  • Min/Max pressure at 7
  • Increased EPR from 1 to 2
  • Used new headgear with Vitera full face mask


Attached Files Thumbnail(s)
   
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#17
RE: Zeoce's Therapy Thread
As you can see, this falls within generally accepted levels of CPAP therapy efficacy. This is the kind of results we suggested could be achieved in spite of the fact CPAP has no approved therapeutic effect on central apnea. It also illustrates the difficulty of performing a titration study on individuals like yourself. There are many hours of quiet sleep with no recorded events; however that does not mean that the tested pressure represents a therapeutic effect or that there is even a correlation between pressure and events. The use of fixed pressure and low EPR has worked for many members to reduce CSA to acceptable levels. Some went on to use ASV due to unsatisfactory sleep quality, while others have found the CPAP therapy good enough. In the U.S. results like this would be disqualifying for coverage of ASV which is why we warned at the start that we may be able to achieve good results with CPAP, but it is still not the ideal therapy where unpredictable clusters of CSA are likely regardless of the pressure or EPR used.

You can see the flow rate graph has what we call a "hairy" appearance with numerous spikes above and below the median inspiratory and expiratory flow rate. Zooming in on the flow rate will reveal the nature of those respiratory variations and might disclose why this is disruptive to sleep. If you want to analyze a zoomed segment of your graphs, it might be interesting. There is not much to see at the full-night resolution, but a 3 to 4 minute zoomed view usually tells us more. It is also useful to track the tidal volume, minute vent and inspiratory time as these likely vary much more for you than for an individual with treated OSA.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#18
RE: Zeoce's Therapy Thread
Re: CPAP for AHI improvement and continuing CA's - yes you hit the scenarios nail on the head here. Although the AHI is good - I don't feel very rested (scientifically speaking, moderate on the zombie scale). There was some external issue with sleep last night, as well as I may be developing a cold, which may partially explain the fatigue also. Excited by the partial improvement though, my sleep app is starting to show marked improvements in deep sleep: have been as low as 30min/night the last few years and am seeing occasional 2+ hour nights since starting CPAP.

Attached are a zoomed in view of Flow Rate centered on the CA cluster (hopefully to an ideal range), a medium zoom view of a 5min section, as well as a birds eye view with the requested graphs.

Does the flow rate indicate Cheyne-Stokes Respiration (CSR)?


Attached Files Thumbnail(s)
           
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#19
RE: Zeoce's Therapy Thread
Pretty typical for CSA with alternating hyper/hypo ventilation. This is not Cheyne-Stokes, but it does resemble it in some ways. CSR is usually seen in heart failure, and the cycle time and duration of the central apnea is usually longer than the 15-20 second duration we see here. I have some examples of CSR I could post, but it's worth noting that CSR is not even flagged here. What is happening is a feedback loop where CO2 is out of balance and your response is like a new driver that over-steers to correct a directional error. The deviation between hypercapnea and hypocapnea get greater and greater until it finally triggers the CA cluster.

In areas where events are absent, what we see in your chart is a variable breathing pattern as you cycle in and out of your apneic threshold. Your respiratory volume became increasingly unstable before the cluster of event occurred. These are not counted as events, but are extremely disruptive. Your tidal volume, Mv and Ti are constantly changing through the night. That is why you are persistently aroused from deeper sleep stages and these variations are what ASV will target. The ASV will compensate for the low breath volumes that lead to hypercapnea so you never get into the apneic cycle, and will even cause a breath where a CA or hypopnea would otherwise occur. This in turn prevents the hyperventilation leading to hypocapnea. We can compare this chart to your ASV results once you get started, and I think the difference will be pretty remarkable.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#20
RE: Zeoce's Therapy Thread
Fascinating. Good to know CSR isn't present (didn't even think that OSCAR/CPAP would be flagging them automatically like they do with CA's etc.).

I really appreciate the level of detail and insight you've provided - very impressed. The personalized info has made 'compliance' with CPAP, and soon ASV much more tolerable.

Now to start ASV ASAP!
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