Changed Machines. Lots of therapy Questions Now

[Croatoan]

Good Morning folks,

I'm a long time lurker first time poster. For the past ~4 years ive used a philips dreamstation. I can attach a summary page if needed to give you an idea of what the last 3 months look like. This last week I replaced the machine with a ResMed airsense 10 Auto and my oscar results have changed dramatically. My mostly obstructed apneas have all converted to clear airway Apneas on the same or similar settings. I'm sure there's a difference i how these machines work and log results but the difference is pretty confusing. I'm hoping to get a little light shed on my reports and maybe an idea of where to go from here. As you all have probably experienced, my doctors aren't very engaged in my treatment so its mostly been my own specialist on this. I've been unable in the past to reach the magical sub 5 AHI consistently but I did stay in the 6 AHI ballpark for a long time. Now I'm up around 9 or 10 with the bulk of them being central apneas and I'm a bit lost.

When I first got the machine i decided to keep it in Auto Cpap mode just to see what it decided to do for my treatment and then after seeing the apneas I put it back at the ~12.5 that i was using on the dreamstation and all nights were similar.

The attachments are 1 dreamstation, one auto cpap airsense and one fixed airsense.

Thank you so much for reading and looking!
           

[Gideon]

Welcome to the forum.

As you noted the prominent thing we need to work on are the Central Apneas. The proof here is in the details, and those details are a zoomed image, a 2 minute view of a couple of your Central Apneas. This will allow us to evaluate the nature of these centrals.

Your EPR = 0 / off, leave it there as an increase will likely increase your central apnea.

[Croatoan]

Here's a zoomed image of about a 6 minute window of a cluster of them. And a 2 minute subset of that same cluster.
       

[Gideon]

Good news, these appear to be CO2 induced which means we can influence them. The CPAP has reduced your blood CO2 concentration to where it is bouncing around your Apneic threshold. Unknown to many is the fact that our primary breathing mechanism is driven by high CO2 and not Low O2, and your CPAP is clearing the CO2 too efficiently. This makes you a candidate to use a technique called EERS http://www.apneaboard.com/wiki/index.php...ace_(EERS)

This is a mask and tube modification to allow you to rebreathe a little of you your exhaled air resulting in a higher CO2 level and the elimination of central apnea. ASV will also work.

[Croatoan]

Thank you!

I'm cobbling together the materials to make one of those EERS. I had figured it was something to do with co2 washout but I had no clue what could be done to combat it. Ill be sure to reply back once I get all the equipment and update you all on how its working. Until then I might try some of my other masks and see if any of them purge air with a little less zeal.

[Croatoan]

I had another predictably bad nights sleep consistent with the above screenshots. (Sorry, i forgot to return the SD card to the machine so i only have summary data).

This isn't really an urgent question but more of a follow up from the first. Have any of you experienced this sort of change in therapy quality when you change machines? It seems that all machines on the same setting should have similar results but clearly they haven't for me. And I don't mind doing some experimenting to get the new machine to work but I wish I understood better why the results are so different.

[Gideon]

I saw the same thing shifting from DV to ResMed. Different manufactures use different algorithms.

My original Rx was 19 fixed to treat OSA,
My EPAP is set at 11 and I rarely go over 11.5 with a 0.5 average AHI. What I was at 19 is anybodys guess as that machine had zero data, not even summary data.

[upsman]

Good news, these appear to be CO2 induced which means we can influence them.  The CPAP has reduced your blood CO2 concentration to where it is bouncing around your Apneic threshold.  

Pardon me for injecting this question here, but I'm curious. Bonjour, what specifically from these charts is indicating that the centrals are CO2 induced? I'm not questioning your expertise, but I have mostly centrals too, and would like to be able to determine if this is the issue with my treatment. 

My AHI is very low, usually less than .5, but almost always central apneas. Is this not worthy of my concern, or could it possibly be reduced further? I do have COPD, so that might factor in somehow.

I don't want to hijack this thread, but it seemed like a good place to ask while on the subject.

[Gideon]

Upsman post your charts in a separate thread, your thread.  That way we can look at your specific case.
In general, there are several indications
1. some indication of waxing and waning similar to what we see in CSR.  Must look at a zoomed view of flow rate to see this.
2. The reaction of Central events to EPR, PS, Pressure.  These all affect the efficiency of our breathing which indicates at least a likely, not guaranteed, CO2 driven component.
3. No indication of a central component in your diagnostic sleep study, which indicates treatment-emergent central apnea which almost always has a strong CO2 component.

Note that we have to try things to see if this holds up.  Also don't assume something will negatively impact central apneas, prove it then avoid it.

edit:
I'll test for a CO2 component just because central apneas are there, without any indication that they may be CO2 induced.  There is no risk and info to gain from this.
Titration is an experiment whether we do it ourselves or it is done in a sleep lab.  Make a change and see what happens, make another change and repeat, normally in an orderly pattern ie. increasing pressure.

[upsman]

Thanks Fred.

I doubt my centrals are anywhere near the point of worrying about right now. As I mentioned I probably average 2 or 3 a night right now, but I was just wondering what indicators the CO2 component had in the OSCAR data. 

I appreciate the explanation. I’ll keep an eye on it and if my centrals become an issue, I’ll be back with my own charts and post.