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CAs, RERAs, APAP Machine
#1
CAs, RERAs, APAP Machine
I have been speaking with a woman who has gotten me a Lowenstein machine, Prisma20A, PrismaAqua.
I have run it for 2 nights so far and have seen some RERAs (probably there's way more than what is picked up) and many central apneas which were not present in my previous ASV treatment or my sleep study.

Currently my settings are min 6 max 10 with EPR of 2.

If anyone could advise as to steps forward please let me know. Below is the chart of my first night; in my second night there were many more CAs (10 total).


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#2
RE: CAs, RERAs, APAP Machine
What are your stats? By counting the events on this chart your OAHI is very low (0?) And your CAHI is 1 (5 events)

Your CAHI doubled to 10 events which assuming the same 5hr (too short) sleep night is a CAHI of 2. Centrals are consistently inconsistent non of which is significant.

That said you do know what happens when you assUme facts not in evidence.
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#3
RE: CAs, RERAs, APAP Machine
(05-28-2021, 03:25 AM)Gideon Wrote: What are your stats?  By counting the events on this chart your OAHI is very low (0?) And your CAHI is 1 (5 events)

Your CAHI doubled to 10 events which assuming the same 5hr (too short) sleep night is a CAHI  of 2.  Centrals are consistently inconsistent non of which is significant.

That said you do know what happens when you assUme facts not in evidence.

Yeah I mean sure but I would like to get it down to nearly zero. After all the diagnoses are arbitrarily set; the ideal is obviously zero.

My main concern, however, is eliminating RERA, but I don't necessarily think a PAP machine can pick that up. Is there a method which I could utilise to assess if RERAs are still present other than getting a sleep study (which btw isn't out of the question)?
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#4
RE: CAs, RERAs, APAP Machine
Zero events isn't a wise goal. You'll rob yourself of comfort.
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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#5
RE: CAs, RERAs, APAP Machine
If I'm correct, Your numbers you are at the point where you need to forget the numbers and focus on comfort. If not you go down the rabbit hole and never find the rabbit.
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#6
RE: CAs, RERAs, APAP Machine
I am going to be blunt. Chasing zero is stupid.

1) These machines don't even know when you are asleep. Lots of flagged events are at times when a person are not asleep. A name coined for this is sleep wake junk.

2) Everyone has flow limitations, hypopneas, obstructive apneas and central apneas. They are primarily only the problem when in high numbers. That is why AHI cutoff for mild apnea is 5, not 1.

3) In order to avoid all obstructive events you need high pressure. High pressure causes a number of other issues that negatively affect your sleep. Aerophagia, more difficult to breath out (you have to breath out against the pressure), nervous system sensitization and more.

4) In order to avoid all flow limitations and hypopneas you need high pressure support. High pressure support washes out CO2, causes central apnea, hypocapnia which can also cause metabolic acidosis.

5) In order to avoid all central events you need a machine with backup rate and often times variable PS to force your body to breath when it doesn't want to. Your body doesn't always like being forced to breath when it doesn't want to.

PAP treatment is a game of balance and minimums. The best treatment is the minimal treatment (lowest pressure, lowest PS, least invasive machine) that successfully treats your specific issue. As Gideon says don't fall down the PAP rabbit hole chasing 0, fairies and unicorns.

Frankly I can't help interpret this data because I don't know how to. I see what appears to be a minorly affected flow rate chart but I don't know if the breathing is being affected in a obstructive or central nature. I can't tell what your pressures or pressure support are and therefore can make no recommendations on how to improve settings. If these are obstructive events then this machine appears to have a low responsiveness. If they are central in nature I don't believe this machine can treat them.

To decipher this look at the flow rate chart preceding each spike. Those are the interruptions in your sleep and if they are caused by breathing the disrupted breathing in front of them should be obviously affected (by obstruction, flow limitation etc). If the flow chart doesn't have obvious breathing issues then breathing is not likely to be the cause of these sleep interruptions.
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#7
RE: CAs, RERAs, APAP Machine
(05-28-2021, 11:40 AM)SarcasticDave94 Wrote: Zero events isn't a wise goal. You'll rob yourself of comfort.

Fair enough. IMO zero is the only place you should be, can you imagine our ancestors choking in their sleep? No chance, they were breathing fine the entire time. Maybe an apnea once a week at worst.
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#8
RE: CAs, RERAs, APAP Machine
(05-28-2021, 02:27 PM)Geer1 Wrote: I am going to be blunt. Chasing zero is stupid.

1) These machines don't even know when you are asleep. Lots of flagged events are at times when a person are not asleep. A name coined for this is sleep wake junk.

2) Everyone has flow limitations, hypopneas, obstructive apneas and central apneas. They are primarily only the problem when in high numbers. That is why AHI cutoff for mild apnea is 5, not 1.

3) In order to avoid all obstructive events you need high pressure. High pressure causes a number of other issues that negatively affect your sleep. Aerophagia, more difficult to breath out (you have to breath out against the pressure), nervous system sensitization and more.

4) In order to avoid all flow limitations and hypopneas you need high pressure support. High pressure support washes out CO2, causes central apnea, hypocapnia which can also cause metabolic acidosis.

5) In order to avoid all central events you need a machine with backup rate and often times variable PS to force your body to breath when it doesn't want to. Your body doesn't always like being forced to breath when it doesn't want to.

PAP treatment is a game of balance and minimums. The best treatment is the minimal treatment (lowest pressure, lowest PS, least invasive machine) that successfully treats your specific issue. As Gideon says don't fall down the PAP rabbit hole chasing 0, fairies and unicorns.

Frankly I can't help interpret this data because I don't know how to. I see what appears to be a minorly affected flow rate chart but I don't know if the breathing is being affected in a obstructive or central nature. I can't tell what your pressures or pressure support are and therefore can make no recommendations on how to improve settings. If these are obstructive events then this machine appears to have a low responsiveness. If they are central in nature I don't believe this machine can treat them.

To decipher this look at the flow rate chart preceding each spike. Those are the interruptions in your sleep and if they are caused by breathing the disrupted breathing in front of them should be obviously affected (by obstruction, flow limitation etc). If the flow chart doesn't have obvious breathing issues then breathing is not likely to be the cause of these sleep interruptions.

Yeah I mean mild is 5 but when they analyse healthy populations they use an AHI < 1. If your AHI is 4 you're gonna tell me you're choking in your sleep more than 30 times per night and it's fine? No way!

My sleep test had more than 25 RERAs/hr. AHI low and no centrals. So this device is giving me centrals. Not sure how to reduce them...
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#9
RE: CAs, RERAs, APAP Machine
(05-28-2021, 08:46 PM)KingKongBingBong Wrote: Yeah I mean mild is 5 but when they analyse healthy populations they use an AHI < 1. If your AHI is 4 you're gonna tell me you're choking in your sleep more than 30 times per night and it's fine? No way!

My sleep test had more than 25 RERAs/hr. AHI low and no centrals. So this device is giving me centrals. Not sure how to reduce them...

How do you know those were central apneas? How do you even know you were asleep at those times? Put on your CPAP, hold your breath for 10 seconds and OMG you just had a central apnea!!!! There isn't a single person on this planet that you could hook up to a CPAP machine that would not have the odd central apnea. I do not have central apnea but I have them flagged almost every night because these machines are stupid. According to my most recent sleep study I don't even have apnea although my HEALTHY breathing triggers 1+ AHI most nights.


Apnea is only an issue if it is an issue. They don't recommend treating AHI less than 5 unless there is strong reason to believe breathing is an issue (UARS supported by RERA's like your diagnosis). They don't even recommend treating mild apnea (5-15 AHI) unless there are also symptoms present that suggest the apnea is an issue. Many people have apnea that does not need treating and does not influence their health or life significantly (1 in 4 male adults are believed to have apnea). Your recent claim that ancestors had maybe an apnea once a week is utterly ridiculous. Many of our living ancestors are living with heart problems etc because they had no way to treat the apnea when they were younger. Many of these people would be dead if it wasn't for PAP technology now. 

Your untreated RERA count is worth treating. It may already be treated at these settings (or when you were are on ASV). The only way to tell is with EEG so if you are that paranoid about this then get a titration study while using CPAP to confirm if your RERA's are treated. Once you find a treatment that works you need to stick with it for weeks/months while your body heals and adapts.
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#10
RE: CAs, RERAs, APAP Machine
You're assuming if you have zero Apnea then you'd have zero RERA and the rest. And that you'd also be comfortable. And you're assuming our ancestors had no Apnea at all, but our generation does. Quit assuming. You're setting yourself up for a huge letdown. You can't get a zero AHI and be comfortable.

For myself, a person that has complex Apnea, heavy on the Centrals, and then COPD, BTW my diagnostic in 2017 was 78 or so, when my ASV therapy was doing well, I slept 8 hours BEST when reported OSCAR AHI was about 3. I had some zero event nights and felt worse than the AHI 3.

Chasing AHI ZERO will drive you crazy. Maybe you need to stop looking at any chart and focus on the question "are you sleeping well or not?".
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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