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CSR Concerns
#1
CSR Concerns
Am a cancer patient. Have had significant fatigue, in trying to sort out what it was, finally ended up with a pulmonologist over a year ago. Prescribed ResMed 10 with EPAP for severe apnea.

Tried to use the CPAP/EPAP for a week and could not. So gave up on it. Wife reports no gasping breathing EVER but snoring worse over the years (in my 60's, and overweight but not obese) and my heart rate has always been stable. Mitral Valve repair years ago and wear a Garmin. HR is steady in the 45 avg. range all night WITH NO panic breathing and HR NEVER really goes above 60 or so at night. Continued to have fatigue problems so saw ENT to see if could breathe better to use CPAP as still could not find cause other than compounded issue with the chemo/immuno drugs. ENT said deviated septum was as bad as ever seen. Had the surgery. Tried the CPAP and could tolerate it all night.

Have used it faithfully for 6 months. Have NO or just a few (1-2) OSA on Oscar reports, ALL CSA generally 1.0 to 3.0 AHI -- however past month or so, have had nights with CSR but I notice that the LEAK rate is high on the majority of them BUT NOT ALL, and my heart rate does not change. I have never had an elevated HR. Initial pressure was 9 to 15. I have reduced to 5 to 10 (min. 4) as the EPAP only did about the 8  or so range and my eyes were getting extremely dry. helped some. but wondering if that is causing more CSR although had prior month as well -- generally 4 to 6 days a month showing up.

I have a new pulmonologist that has me scheduled for a new sleep apnea test. Recent Heart monitor for 14 days, showed no problems and my blood pressure with meds is a steady 110-130 over 70-85. 

DOES THE RESMED false report CSR?  OR is it accurate.  Read that in other threads that it does report CSR. I thought CSR was truly you are in the last few weeks of life?

I am inclined to wonder if the ResMed 10 is even necessary.  am trying to get back in with the NEW pulmonologist to review data but she had never seen OSCAR reports.  Am concerned about CSR but wondering if bogus.
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#2
RE: CSR Concerns
Firstly, Godspeed on your cancer journey. That is enough stress on one without dealing with apnoea.

Any possibility of posting some OSCAR charts? The instructions for downloading, installing, and chart formatting is linked in my signature.

I think getting a second sleep test makes sense. Whether at-home or in the lab, it will provide data needed to make decisions going forward.

Does ResMed misreport CSR? Frequently, periodic breathing is reported as CSR on ResMed devices. Does that mean that they are all incorrect? No, some could be true CSR, but we need to see OSCAR data to determine that. Some of the folks here are well-schooled on identifying CSR, so seeing OSCAR data would be a tremendous help to them.

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#3
RE: CSR Concerns
PeaceLoveAndPizza - First, thanks for the comment on Cancer - it is indeed a journey. Very very fortunate after 3.5 years, I'm cancer - non-detectable with Multiple Myeloma. I've attached 2 recent Oscar Daily reports. one with the CSR event shown and my somewhat normal. I still have days where the AHI is 3 to 6 but 50% of the time it's a 1.0-ish.

As a result of those cancer treatments, I've had SEVERE fatigue. As stated in search of ways to reduce, ended up with a pulmonologist who was of dubious character and skill. With a deviated septum, the pressure setting and consistent sinus drainage, I was unable to use the CPAP and put it aside for over a year until sinus surgery.

With correction of dev. septum (used CPAP now for everyday for 5+ months) and a new pulmonologist, am scheduled for a new sleep test but when I restarted, I decided to self-evaluate and found Oscar, the SD card, etc. Sleep with steroids for 3.5 years was always challenging. Dosage was initially very high (40mg of Dex) which is like taking 240mg of Prednisone. Reduced to 6 mg for last year but still disrupted sleep. I reduced pressure to 5 to 10 from 9 to 15 due to dry eyes but am still having that issue. 

Am only concerned about the CSR pending getting back in to see the pulmonologist. Liked her, good reputation, but wanted to see what is said here first. I found these type of forums to be AWESOME when I had lots of trouble with the new "idea" by Porsche to get into cars/suvs vs. just sportscars, the best place for REAL info.


** tried to copy paste report - did not work -- will follow procedure you said and repost after a meeting.
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#4
RE: CSR Concerns
Normal

Possible CSR


Attached Files Thumbnail(s)
                       
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#5
RE: CSR Concerns
Right now, you're not able to get the full benefit of EPR 2 with a minimum pressure of 5. There's possibilities of several things maybe going on. Yes, Central Apnea is flagged, but is it real? Not certain. What did your sleep study report? Maybe Positional Apnea based issues, how thick is your pillow?

You likely need to update OSCAR to a new version. There's data missing from the left panel summary that is needful. We only need the OSCAR graphs Events, Flow Rate, Pressure, Flow Limits, Leaks as standard info along with left panel minus pie chart and calendar. F12 will take screenshots in OSCAR.
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: CSR Concerns
Here's as requested. I changed the settings from 9 to 15 to 5 to 10, as was just too strong and eyes got extremely dry. Have been messing around somewhat with various "masks". the "in the nostrils" pillow and the type that just rests against the bottom or the nose. The "in" chafe and generally wake more but the rest against leaks at times and dries eyes at times. Generally do not open mouth and the leaks and the CSR seem to be when on back/position changing or the nose leaks some due to movement while in light sleep but not awake.

panel cont.

one point I forgot to mention is that my HR is consistently in the 40 to 50 range ALL night. I'm using a viacom oxipulsemeter and a garmin. both show that consistent. i.e. I do not starve myself of so much o2 that my HR goes to 100 or more beats per minute.


Attached Files Thumbnail(s)
               
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#7
RE: CSR Concerns
   

This is what a close up zoom of CSR looks like.  If you provide a 3 minute close up from OSCAR and upload it, that would help.  Just start in the middle of the CA cluster that is flagged as CSR and click and drag left for 3 minutes.  Try to get as many CA's in that 3 minute zoom as you can.  

The plan would be to show your 1st chart and a 3 minute close up zoom chart to your Pulmonologist for interpretation.
Download OSCAR
OSCAR Chart Organization
Attaching Files

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Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.  
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#8
RE: CSR Concerns
Of note, current pillows masks aren't designed to be inserted in the nostrils. They are to rest in the nares only. This indicates a size issue.

Agreed with the pulmonologist contact necessity.
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: CSR Concerns
Thanks @SarcasticDave94  @PeaceLoveAndPizza  and @Jay51 

Like most here, takes time to get into over-busy Pulmonologists so I sought my own solutions. Found Oscar and now have found this forum.

**** I took your advice and have forwarded this info to my pulmonologist's RN and asked for input.

What if frustrating is I'm not sure what is going on. My wife has said that I never have gasped for air or that she has noticed not breathing in 40+ years. What I do know is that chemo and immunotherapy have absolutely impacted my nervous system (neuropathy) and as they say you also get "chemo-brain".  Difficulty remembering things could include some impact on the autonomous systems too ... I would guess. But I'm also 30 pounds up due to steroids for the past 3 years.

THANKS AGAIN. This is/was very helpful. I do think positional apnea and am going to look at the collar.
MadFox
SE USA
ResMed 10
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#10
RE: CSR Concerns
One thing to consider is that most times when we hear "gasping for air', it invariably means the members minimum pressure is not high enough. 

If you are open to an experiment, try the following settings:

Min pressure 8
Max pressure 10
EPR 3 full-time (2 would work as well for the test if you prefer it)
No ramp

The reason for more pressure is to avoid the swings from low to high and back. The extra EPR is for comfort. Both changes should hopefully remove the air starvation feeling and still be comfortable. Worth a go anyway...

Note that if you CA's go up dramatically that is likely from the extra EPR. You can always cut to back to 2 or even 1 if desired.
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