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over 100 days in to therapy, seeking feedback
#1
over 100 days in to therapy, seeking feedback
Hi All-

I'm a bit over 100 days since starting therapy. I believe my statics screenshot will detail the history of pressures and CPAP vs APAP. During my sleep study my indexes where : Obstructive 21.6, Central 7.5, mixed .2, hypopnea 37.3, AHI 66.5, RERA 33.1, respiratory 99.6. 

Since I started using the Airfit N30i I actually look forward to wearing it and it almost never wakes me up during the night. I'd say I'm doing better than I was before, but its still rare I wake up feeling "refreshed." In addition I have these "periodic breathing" flags that have me wondering if that's par for the course or something I need to look into further as a cause for concern. 

I'd appreciate any suggestions or feedback from the experts on the board. Hopefully I've attached the correct data in the proper format, if I didn't and you coach me up I promise to do better the next time.

thanks!

           
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#2
RE: over 100 days in to therapy, seeking feedback
Welcome to the forum.
Look at the organize link in my signature for a better format

This looks like CO2-driven breathing, it is NOT CSR. Since EPR is off and you are over 3 months into your therapy I'd like to see full (redacted) copies of your sleep tests, especially your initial diagnostic tests. THE MOST IMPORTANT THING i'M LOOKING FOR IS THE PRE-EXISTENCE OF cENTRAL aPNEA. Yes I see the summary above.

The suspicion is preexisting Central Apnea that is not clearing up, thus indicating the need for an ASV machine.
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#3
RE: over 100 days in to therapy, seeking feedback
Yes let's get the diagnosic. Post a redacted detailed version.

Yep you're in the US. HIPAA law permits you to request and receive this. No isn't an acceptable answer to the request.
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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#4
RE: over 100 days in to therapy, seeking feedback
Thanks guys- here is the redacted copy. I just did the one study- the Dr said with APAP the second one wasn't really required given the cost of another study. At the follow up one month later he told me to switch to CPAP at 10 PSI and check back in with him in 1 year.

The study will be a bit clunky as I'm new and needed to convert the PDF to JPG- it will take a few batches 

thanks!

           

continued sleep study...

           

last batch sleep study

       
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#5
RE: over 100 days in to therapy, seeking feedback
OK, here's what I'm seeing...
547 total events
118 Obstructive
205 Hypopnea
41 Central
1 mixed
182 RERA
CSR N/A
AHI 66.5 RDI 99.6
All sleep was supine
Lowest oximeter was 80%, with 15.2 minutes below 90%

Alright, it'll be hard to say exactly, but despite an Obstructive Apnea diagnosis, it might be mixed, as both OA and CA are present.

Next SpO2 data of being below 90% for 15 minutes is a flag.

We need a standard not zoomed OSCAR to see overall what you're dealing with now. A strong consideration is the request for Titration including ASV mode. IMO necessary due to CA of 41, but we need to convince Dr. Dolittle.

Realistically speaking, any of the Hypopnea might be Obstructive or Central. My experience on my own tests is they don't separate these Hypopnea into Central or Obstructive but just call all these Obstructive Hypopnea.
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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#6
RE: over 100 days in to therapy, seeking feedback
PS beginning immediately I'll suggest you begin taking notes on how you slept, felt, whether you're well rested or not, what disrupts, comfortable or not, any other symptoms or complaints about sleep. You need this to keep it fresh in your memory, as this is evidence for or against current therapy is working or failing. AND it can be evidence to move to another device.
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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#7
RE: over 100 days in to therapy, seeking feedback
thank you! Is this the standard Oscar view you are looking for?     
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#8
RE: over 100 days in to therapy, seeking feedback
Yep.

OK, at 5.36 AHI, you're currently untreated. If like some of the former jokers that I've dealt with, but but but. They will probably say anything below 20 AHI at home is OK. But with whom; to you? NOPE not close. I'm assuming you're similar to me, as a person, not so much the Apnea thing specific just yet.

Someone else can crunch numbers for you on any of this; but I will not accept the label TREATED until AHI is below 5 on my machine, and that I'm well rested most nights. I'm betting you're not there yourself.

A few notes:
CSR is not real CSR on this so don't worry on it unless you have serious heart condition
CA will be consistently inconsistent, they will be up and down a lot with no PAP edits, they just will be this
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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#9
RE: over 100 days in to therapy, seeking feedback
I'll slightly disagree with Dave. Your numbers are OK, IF and only IF you are feeling well rested and your apnea symptoms are substantially resolved. Note this is a subjective opinion, yours, not ours, and not your doctor's. So watch, but ignore your numbers, go by how you feel.

The official standard to qualify for an ASV is Obstructive events managed and in control ( OAI < 5 ) and CAI Not managed ( CAI > 5 ). So by the numbers alone you will not qualify). Thus Dave's suggestion to keep a log.

With any change in settings note (on paper) which feels better to you and why, be specific.

With the goal to make you more comfortable try setting EPR { 1, fulltime. Note this may increase your CAI and should decrease your hypopneas.

Consider getting a recording oximeter to validate that your O2 levels are good and resolved with your CPAP.. I don't expect a problem but you have never proven that your desats to below 90 we're resolved as they should be.
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#10
RE: over 100 days in to therapy, seeking feedback
Agreed with what everyone else is saying above. You had enough pre-existing central events that I'd be wondering how many of those hypopneas were central vs obstructive (and most of the time, they're not separated out).

As Gideon says, the periodic breathing is probably related to your propensity towards centrals, it just means that you're swinging from your carbon dioxide levels being either a little too low to a little too high and just cycling back and forth between that.

I'd also second keeping a note, especially of the central events, and see how they go. I just went from CAI of 42 to 10 from one day to the next. Keep a track of how you're feeling, and definitely, I'd recommend a pulse oximeter that you can upload to OSCAR after recording overnight.
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