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A new wrinkle--big CSR event - Printable Version

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A new wrinkle--big CSR event - dclaryjr - 08-16-2016

SleepyHead rated my AHI as 'Horrible" and now I have a new concern. What's with the long CSR event?

http://imgur.com/0j21Ghu


RE: A new wrinkle--big CSR event - OpalRose - 08-16-2016

Well first I would be more concerned about the Obstructive events, and hypopneas, and they line up with the PB.

How long are those obstructive events? Also, are you sleeping on your back during that time?

Is there a reason you are using a straight pressure of 10 instead of using a pressure range in auto mode? Your set pressure obviously isn't treating your apnea events, and you may do much better switching to Auto mode. Have you talked to your doctor?


RE: A new wrinkle--big CSR event - dclaryjr - 08-16-2016

I did try using settings recommended by you in another thread (APAP 5-12) and the first night I had my only sub-5 AHI ever. But then it reverted back to the AHI 7-11 range. I since had a second study where once again it showed a steady pressure of 10 alleviated all events. I brought my SleepyHead printouts to the lab with me, but they acted as if they didn't mean anything. So I decided to set it back to 10 for one more week of data gathering before I went to my doctor to try to get some answers. I'm not under the direct care of a sleep specialist--the sleep center just contracts a doctor to interpret and sign off on their studies.

Do you see my leak rate as being a problem? This looks pretty typical.

Thanks,

Dave

RE: A new wrinkle--big CSR event - OpalRose - 08-16-2016

(08-16-2016, 08:03 AM)dclaryjr Wrote: I did try using settings recommended by you in another thread (APAP 5-12) and the first night I had my only sub-5 AHI ever. But then it reverted back to the AHI 7-11 range. I since had a second study where once again it showed a steady pressure of 10 alleviated all events. I brought my SleepyHead printouts to the lab with me, but they acted as if they didn't mean anything. So I decided to set it back to 10 for one more week of data gathering before I went to my doctor to try to get some answers. I'm not under the direct care of a sleep specialist--the sleep center just contracts a doctor to interpret and sign off on their studies.

Do you see my leak rate as being a problem? This looks pretty typical.

Thanks,

Dave


Actually, I recommended a range of 7-12 in the thread you are referring too.

http://www.apneaboard.com/forums/Thread-First-SleepyHead-stats-Ugly?pid=171392#pid171392

You need to set a pressure range "around" that titrated pressure of 10 that the Sleep Lab gave you. And do whatever you can to stay off your back. Smile

And you leak rate is fine.

I think that in time you will realize that your sleep lab won't or can't advise properly on pressure settings.



RE: A new wrinkle--big CSR event - Sleeprider - 08-16-2016

You have an abundance of obstructive events. If this is a common feature of your sleep at 10 cm pressure, I suggest you change to auto mode and allow the machine to increase pressure as needed to prevent the events. If you look a the flow limitation chart you have abundant flow limit at your current pressure, and this predicts OA and H events. I would not stop at a maximum pressure of 12, but would set pressure at 9-16 to see where these obstructive events are extinguished.

The extended periodic breathing period corresponds to a cluster of OA that is pretty impressive. This is not CSR, but is your obstructed breathing creating a periodic pattern.

RE: A new wrinkle--big CSR event - dclaryjr - 08-16-2016

(08-16-2016, 08:24 AM)OpalRose Wrote: You need to set a pressure range "around" that titrated pressure of 10 that the Sleep Lab gave you. And do whatever you can to stay off your back. Smile

Unfortunately, I've been a life-long back sleeper, and I don't think it's possible to change. I can do stretches on my side, but I always revert to my back.

Quote:And you leak rate is fine.

That's good to hear. Again, the Sleep Center wants me use a chin strap with my FF mask. I HATE that thing--gives me a headache almost immediately. My office mate's leak graph looks similar to mine and his AHI is <1 99% of the time.

Quote: I think that in time you will realize that your sleep lab won't or can't advise properly on pressure settings.

I think the point is finally driven home. Wink

Thanks!

Dave


RE: A new wrinkle--big CSR event - dclaryjr - 08-16-2016

(08-16-2016, 08:30 AM)Sleeprider Wrote: You have an abundance of obstructive events. <snip> I would not stop at a maximum pressure of 12, but would set pressure at 9-16 to see where these obstructive events are extinguished.

Sounds like a plan!

Quote:The extended periodic breathing period corresponds to a cluster of OA that is pretty impressive. This is not CSR, but is your obstructed breathing creating a periodic pattern.

That was a short but intense ride. I googled it then searched the forum. I went from "congestive heart failure" to "that ain't really CSR" in a matter of minutes. Wink

Thanks,

Dave



RE: A new wrinkle--big CSR event - Sleeprider - 08-16-2016

I just want to reassure you that there is nothing complicated about your OSA. It is purely obstructive, and obstructive apnea responds to pressure. The clustering of events simply indicates a need for changes in your pressure through the night as sleep stage or body position changes. You have apparently normal tidal volume, and breathing patterns, so once the flow limitation, hypopnea and obstructive apnea are resolved, you're basically done.

The only other thing to consider is adding in some EPR (exhale pressure relief), if the exhalation pressure begins to feel uncomfortable at higher pressure needed to resolve OSA. You can see the mask pressure is a thin line suggesting no pressure relief. Your machine offers up to 3.0 cm pressure relief in exhale. So, if it turns out you need a pressure as high as 14, your exhale pressure cans still be 11.0. We can deal with that later. Good luck with the auto settings! I think they will work well for you.

RE: A new wrinkle--big CSR event - dclaryjr - 08-16-2016

[attachment=2768]
(08-16-2016, 09:00 AM)Sleeprider Wrote: I just want to reassure you that there is nothing complicated about your OSA.

Thanks--assurance is welcome at this stage.

Quote:The only other thing to consider is adding in some EPR (exhale pressure relief), if the exhalation pressure begins to feel uncomfortable at higher pressure needed to resolve OSA. You can see the mask pressure is a thin line suggesting no pressure relief. Your machine offers up to 3.0 cm pressure relief in exhale. So, if it turns out you need a pressure as high as 14, your exhale pressure cans still be 11.0. We can deal with that later. Good luck with the auto settings! I think they will work well for you.

It looks like I had EPR originally but it was turned off. I didn't do it--guessing the DME did it remotely??







RE: A new wrinkle--big CSR event - PoolQ - 08-16-2016

Pretty much what has already been said. You have a lot of flow limit activity going on, I checked my graphs to make sure the scale was the same-and it is.

Sometimes a lab will go for plain CPAP fixed pressure because the client cannot tolerate the pressure changes or the pressure changes are triggering central apneas. look at your plots from when you used APAP and see what your centrals were doing.

Labs and Doctors, I have found, do not like looking at sleepyhead graphs for several reasons:
1. they mostly know nothing about it and it is in no way certified by anyone, a sleep professional that can be sued cannot depend on sleephead.
2. if is quite complex and hitting them with it during a visit will not give them enough time to figure it out and respond even if they wanted to.

I would bring one printout, with notes attached telling the Doctor what my concern was, what date the plot was for and what time the concerning event happened. During the same visit I would bring my memory card in so they could down load the data, find the same sleep window in the "approved" software that they are used to before they came into see me. They tended to respond better this way.

Very few clients look at the data and the Doctor have gotten used to just talking with the client about what they are feeling and looking at the AHI number. The problem is that what we are feeling is totally new and we don't always have the words to tell them what is going on.

If you change your settings and are not getting the results you would like, bring us some plots so we can help fine tune the settings. You should have some plots of when you changed to APAP and got the same AHI, lets see one of them.

If you already posted them in another thread, let me know and I will go look there. One long thread to build up a history is not a bad thing.