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not getting great numbers and they are all over the place
#1
not getting great numbers and they are all over the place
Okay - who wants to take a crack at this.....

Sleep Study last summer - AHI of 30, RDI of 44 (severe), severe positional OSA. 

Got a Resmed Airsense 10, already had a pulse oximeter, use oscar (see output attached). Used it weeknights for the last 8 months.

The problem is my numbers are not particularly good, and rather inconsistent - I might have an AHI of 60 on a Monday night and then have a 10 on a Tuesday night.  (see overview attached) On nights when I have high AHIs, it seems to be a relatively small number of hypopneas and OSAs triggering a large number of clear airway events. (see sample day attached) I have methodically experimented with various pressure ranges (see statistics page attached), and while the high end of the current range is certainly too low (i will likely go back up to max of 16 or 17), the numbers haven't been that good all the way up to max pressure of 20.

I hit the attachment limit with oscar output but can upload the sleep study if it helps.

Thanks very much in advance.


Attached Files
.pdf   OscarStatistics.pdf (Size: 45.29 KB / Downloads: 26)
.pdf   oscardaily062920c.pdf (Size: 737.79 KB / Downloads: 29)
.pdf   oscaroverviewc.pdf (Size: 555.36 KB / Downloads: 18)
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#2
RE: not getting great numbers and they are all over the place
I'd say that it's safe to say CA is a very big problem for you. If insurance is to be involved, you'll need to make mention of all these CA events to your doctor. You will need to form a serious notation on how badly your therapy has been. Note the detailed symptoms and it's very likely you need a lab sleep study with ASV in the center of the discussion. It's been months longer than the 3 month timeframe given if these were treatment emergent. They've not gone away. If you'd have had a lab sleep study, I will guess the CA would have dominated.

For now, if you have EPR on, it needs to go to 1 or Off. If you're using Ramp, it needs to go Off too. To avoid some of the CA, we need to reduce your pressure swings. Again this is an avoidance tactic only. If this were my OSCAR, Doc Dolittle's phone is ringing as soon as his office opens. Hey doc, I have this many CA. Let's fix it. Side note, CA are consistently inconsistent, AKA up then down then back up again.

The notes I mentioned will need to focus on the answer to "How do you feel?".
Dave

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#3
RE: not getting great numbers and they are all over the place
Thanks very much!
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#4
RE: not getting great numbers and they are all over the place
Beowulf9,
Open up the flow rate chart and give us a 2 minute segment around 1:30am.
OpalRose
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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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#5
RE: not getting great numbers and they are all over the place
You need an adaptive servo ventilator ASV to replace your CPAP. Your central apnea index often approaches 30 to 60 per hour which is extremely severe. We cannot treat your CA with a CPAP. With pressure of 4 to 12 cm and EPR off you generally maintain low pressure until a cluster of OA strikes and raises pressure to the maximum. In my opinion you urgently need to contact your doctor about a change in prescription. This will require a sleep study where bilevel and ASV are titrated. If you don't have good insurance, let us know and I will direct you to the machine you need through a vendor like DotMed where you can quickly get the therapy you need for about $500. If you can afford more, then a good option is Supplier #2.

Your current results vary a lot from night to night, and I'm going to recommend we try fixed CPAP pressure at 6.0 with EPR off to stabilize your pressure and hopefully reduce events. Based on a sleep study result of 30 AHI, your condition is often worse with CPAP treatment than without. Please call your doctor or get the right machine.
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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#6
RE: not getting great numbers and they are all over the place
(07-02-2020, 05:37 AM)OpalRose Wrote: Beowulf9,
Open up the flow rate chart and give us a 2 minute segment around 1:30am.

Here you go...


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#7
RE: not getting great numbers and they are all over the place
I agree that you may need to be on a ASV machine.  I looked back at some of your other threads, and you seem to have had this pattern with the CA's prior.  I also see CSR flagged quite a bit along with the CA's.  
It could be just period breathing, but you might want to consider getting checked out by a Cardiologist if that pattern continues.
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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#8
RE: not getting great numbers and they are all over the place
(07-02-2020, 05:55 PM)OpalRose Wrote: I agree that you may need to be on a ASV machine.  I looked back at some of your other threads, and you seem to have had this pattern with the CA's prior.  I also see CSR flagged quite a bit along with the CA's.  
It could be just period breathing, but you might want to consider getting checked out by a Cardiologist if that pattern continues.

Thanks very much for the insights - will follow up with the doc. You're correct - CAs have always been a preponderance of my AHI. Interestingly, the CSR rarely appeared until I dialed back the maximum pressure to 13, so while I will definitely check that too, my suspicion is that the CSR is spurious.

Thanks again.

(07-02-2020, 09:07 AM)Sleeprider Wrote: You need an adaptive servo ventilator ASV to replace your CPAP.  Your central apnea index often approaches 30 to 60 per hour which is extremely severe.  We cannot treat your CA with a CPAP.   With pressure of 4 to 12 cm and EPR off you generally maintain low pressure until a cluster of OA strikes and raises pressure to the maximum.  In my opinion you urgently need to contact your doctor about a change in prescription.  This will require a sleep study where bilevel and ASV are titrated.  If you don't have good insurance, let us know and I will direct you to the machine you need through a vendor like DotMed where you can quickly get the therapy you need for about $500.  If you can afford more, then a good option is Supplier #2.

Your current results vary a lot from night to night, and I'm going to recommend we try fixed CPAP pressure at 6.0 with EPR off to stabilize  your pressure and hopefully reduce events.  Based on a sleep study result of 30 AHI, your condition is often worse with CPAP treatment than without.  Please call your doctor or get the right machine.

Thanks very much - appreciate it.
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