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sfr79's Treatment Thread / Analysis, Opinions, Suggestions Welcomed
#1
sfr79's Treatment Thread / Analysis, Opinions, Suggestions Welcomed
Hello all,

First let me offer a sincere thank you to all of you here that make this an amazing resource for newly-diagnosed apnea sufferers like myself. You've made this interval since my diagnosis immeasurably better by making me a more informed patient -- and for that, I thank you!

I was diagnosed in mid-December with moderate OSA, after submitting to a 2-night at-home NightOwl sleep test. For any not familiar with this particular test, this is a basic at-home test that measures blood oxygen saturation, pulse rate, and movement. 

I was prescribed an APAP, at 4-20cm h20 w/ EPR =3, and I purchased an AS 10 Autoset and begin treatment 11 days ago on Jan 10th.

I have attached the Oscar daily screenshots for the 2nd, 7th, and 11th nights of my treatment thus far, which I feel is a representative sample of my progress. [I have also uploaded all 11 nights of OSCAR screenshots, and a copy of my sleep study, to a hosting website, but I am unable to share links until I get a couple more posts. I will add these links to provide the full picture as soon as I'm able.] My worst day so far was actually Day 6 (Jan 15th), with an AHI of 14.6, nearly all CA's. This is beginning to look like a bit of an outlier though, given the otherwise steady downward trend in AHI.

I was surprised to see after the first night of sleep that the vast majority of my apneas were Centrals. These have abated significantly over the intervening days (AHI below 5 for the last 5 days), and I'm trending in the right direction, but Centrals still make up the bulk of my events. My obstructive index has been nearly 0 since Day 1 of treatment. Not sure if this is because the CPAP is crushing all my obstructives, or if I didn't have any / many to begin with.

Looking at my 95% pressure each day, it sure seems to me that there is a strong correlation between higher pressures and the frequency of my CA events. Does this, combined with the fact that they have lessened significantly in the 1.5 weeks of my treatment, hint that these are likely treatment-emergent apneas, rather than primary central apnea?

I have my follow-up with the sleep doc in a couple weeks, and I want to ask the right questions, so I appreciate any thoughts / suggestions, or guidance. 

Cheers!
sfr79


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#2
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
Hello all,

Just had my follow-up with the sleep doc after ~1 month of CPAP therapy. Doctor says my usage is excellent (7.5 hours / night average), and the CA's are likely treatment emergent, trending downwards, and nothing to worry about given their frequency. Also mentioned the handful of CSR flags early in my treatment were false detections.

He did change my pressure settings from the initial wide open 4-20cm, to a more narrow 7-11cm, which I'll begin tonight. I've attached summary reports of my treatment thus far in case anyone would like to take a look.

I would appreciate thoughts on the newly prescribed pressures given my usage data so far.

Thanks!
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#3
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
The pressure change should show improvement for you. It does look like the CA's are trending downwards. If the CA's rise, then you may need to make a small adjustment to the EPR setting, but for now it looks good.

Post another chart with the new settings tomorrow.
OpalRose
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#4
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
Thank you for the input. As suggested, I've attached last night's daily chart (2/9) which is the first night at 7-11cm pressure. I also included the two previous days as a point of comparison. Interestingly, 2/8 was my single best day from an AHI and CAI standpoint.

I seemed to sleep a little less soundly last night, but overall no significant difference (I guess not all that surprising given my 95% pressure was within 2cm of what I have been averaging prior to the change). 

To my untrained eye it seems I tolerated it fairly well. Was happy not to see a spike in CAs.


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#5
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
I'm going to bet those CAs will continue to settle down. If you were to zoom in on your flow rate, you'd probably see a little bit of arousal breathing before many of the CAs. Arousal breathing is less regular and often has greater amplitudes than asleep breathing. The arousal breathing can wash out enough CO2 that your drive to breathe is temporarily reduced and you pause. If the pause is 10 seconds or more, it's flagged as a CA. As the CO2 builds back up during a pause between breaths, your drive to breathe increases and you resume breathing. Over time, your body will probably adjust so that this happens less frequently after arousals, and ideally you'll also be having fewer arousals as you continue to get comfortable with using the mask and machine.

At any rate, just keep an eye on the CAs but don't worry about them. And be aware that the number of CAs you have will tend to bounce around a fair amount from one night to the next. That, too, is nothing to worry about.

You're doing really well in every other respect. I'm glad you now have a minimum of 7. A pressure of 4 actually makes some people feel starved for air.

Are you feeling any better during the day?
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#6
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
(02-10-2022, 01:57 PM)Dormeo Wrote: I'm going to bet those CAs will continue to settle down.  If you were to zoom in on your flow rate, you'd probably see a little bit of arousal breathing before many of the CAs.  Arousal breathing is less regular and often has greater amplitudes than asleep breathing.  The arousal breathing can wash out enough CO2 that your drive to breathe is temporarily reduced and you pause.  If the pause is 10 seconds or more, it's flagged as a CA. As the CO2 builds back up during a pause between breaths, your drive to breathe increases and you resume breathing.  Over time, your body will probably adjust so that this happens less frequently after arousals, and ideally you'll also be having fewer arousals as you continue to get comfortable with using the mask and machine.

At any rate, just keep an eye on the CAs but don't worry about them.  And be aware that the number of CAs you have will tend to bounce around a fair amount from one night to the next.  That, too, is nothing to worry about.

You're doing really well in every other respect.  I'm glad you now have a minimum of 7.  A pressure of 4 actually makes some people feel starved for air.

Are you feeling any better during the day?

Thank you so much for the reply Dormeo. I've learned a lot in the last month (my wife calls this my new hobby), but was not aware of the specifics related to pre-CA arousal breathing and their profile on the flow rate graph. I will have to check when I get home from work this evening, but I'm fairly sure many of my CA's are immediately preceded by non-uniform, higher-amplitude waves on the flow rate chart. Great information!

As for how I am feeling, interestingly (and fortunately) enough, my symptoms pre-treatment never really manifested as severe daytime drowsiness or excessive fatigue like so many others deal with (I went to the sleep doc because I was snoring terribly 100% of the night, and I was jerking awake choking / gasping with my heartrate racing -- sleep test results revealed moderate OSA). I was aware that I would get tired earlier in the evening than I did in my 20's and early 30's (just turned 40). I would get through the day just fine, but by 9 or 10, I'd be falling asleep on the couch, whereas I've historically been a night owl. Still a small sample size since I began treatment, but I haven't noticed excessive early evening drowsiness, so that's a plus. Overall I feel great.
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#7
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
(02-10-2022, 01:57 PM)Dormeo Wrote: I'm going to bet those CAs will continue to settle down.  If you were to zoom in on your flow rate, you'd probably see a little bit of arousal breathing before many of the CAs.  Arousal breathing is less regular and often has greater amplitudes than asleep breathing.  The arousal breathing can wash out enough CO2 that your drive to breathe is temporarily reduced and you pause.  If the pause is 10 seconds or more, it's flagged as a CA. As the CO2 builds back up during a pause between breaths, your drive to breathe increases and you resume breathing.  Over time, your body will probably adjust so that this happens less frequently after arousals, and ideally you'll also be having fewer arousals as you continue to get comfortable with using the mask and machine.

At any rate, just keep an eye on the CAs but don't worry about them.  And be aware that the number of CAs you have will tend to bounce around a fair amount from one night to the next.  That, too, is nothing to worry about.

You're doing really well in every other respect.  I'm glad you now have a minimum of 7.  A pressure of 4 actually makes some people feel starved for air.

Are you feeling any better during the day?

Check out these 10-minute zooms of 3 of my centrals from last night. Sure looks like arousal breathing could be involved given your description. What do you think?


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#8
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
Yes, indeed. The CAs follow arousal breathing.
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#9
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
Last night my daily charts show a strange period of time where my flow rate and mask pressure are solid bars, reaching high and low limits of the respective chart ranges. Is this corruption in the recorded data, a potential machine issue, or something else? Any thoughts?

   

   


Edit: I uploaded into ResScan and the charts seem to be normal, so maybe an issue with loading the data into OSCAR?
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#10
RE: sfr79's Treatment Thread // Analysis, Opinions, Suggestions Welcomed
It does look like some kind of data issue, doesn't it? If it happens again, you might want to raise your question in the software support forum:

http://www.apneaboard.com/forums/Forum-S...port-Forum
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