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Cheynes Stokes - is that what this screen shot shows?
#1
Cheynes Stokes - is that what this screen shot shows?
Hi Folks,


I'm really hoping someone can help me.  I've been using CPAP for almost 4 months. I can see in my data history in Oscar that I was having a few, what are reported as Cheynes Stokes, but more so in the last months. 8 of the last 19 days I've had them and am concerned. I've got Afib at 3-4%. I had an echo cardiogram last December and was told all was well - I am not diagnosed with any other heart ailments. I fell fine except for hip pain that can wake me up at night. I'm having a hip replacement next wee, and maybe should not have looked at my ResMed data, but I did and and would really appreciate an opinion. Images from last night are attached.

       
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#2
RE: Cheynes Stokes - is that what this screen shot shows?
Any chance you could do a screen capture rather than a phone picture? I am colour-blind and cannot see much due to the way the colours blended in the photos. Maybe others can see what is on the screen.

Also, please read the link in my signature on “Formatting OSCAR charts”. It may be correct as is, but as I cannot see it I figured I would mention it.
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#3
RE: Cheynes Stokes - is that what this screen shot shows?
Thank you. I can not find an option for a screen shot.  Do you mean a Print Screen saved to a file. I tried doing that in a Word doc and got a message that that type of file can't be uploaded. I also got the same message attempting to upload as a PDF.
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#4
RE: Cheynes Stokes - is that what this screen shot shows?
Nevermind, I got it. Wiill send along.
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#5
RE: Cheynes Stokes - is that what this screen shot shows?
Screen shots

   

   
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#6
RE: Cheynes Stokes - is that what this screen shot shows?
Do you have a history of heart issues, had a stroke, or live at high altitudes? If not, I think those are more likely periodic breathing being mischaracterised by the machine. If you do not know about PB, it is characterised by a waxing and waning breathing pattern, but is not typically CSR. Hence, the questions about your health and location.

Whilst you did not ask, if you want to get a better pressure range, consider trying the following. If you are happy where things stand, then leave it be.

Mode APAP
Min pressure 8
Max pressure 12
EPR 2 full-time
No ramp

That should help with the pressure swings and hopefully be more comfortable.
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#7
RE: Cheynes Stokes - is that what this screen shot shows?
No history of any heart issues besides occasional afib. Echo and bloodwork 6 months ago were all normal. No strokes. I live near sea level. 

When first put on cpap, they set ERP to 3, I believe. That caused an increase in CAs. Turning the ERP off brought my AH under 5. It’s been over the last 4 months that I’ve had nights like I posted with these clusters of CAs and PBs and AH in the teens to 30s.

Do you think turning on the ERP is likely to help given that?  I’ll. Give the pressure changes a try, but what is this APAP?  Sorry, I’m still on the learning curve. Curious if you think having these nights (8 in the last 19) might suggest I may need a different type of machine. I hope that’s not too many questions. I really appreciate your help.
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#8
RE: Cheynes Stokes - is that what this screen shot shows?
I am still learning about the impacts of certain heart conditions to CPAP, so I’ll defer to those more experienced to comment.

For the acronyms, CPAP is Continuous Positive Airway Pressure. APAP is Automatic Positive Airway pressure. CPAP is a fixed pressure with or without pressure support (EPR). APAP is an auto-adjusting pressure that adapts to the breathing of the patient to try and reduce apnoea, with or without pressure support (which you are using today).

The wiki linked in the bar above the thread has quite a bit of information on everything CPAP. Worth a perusal when you have time.

Based on what I see in the chart, I think there may be some positional apnoea going on as well. Positional as in chin-tucking, which is seen in the clusters of obstructive and hypopnoea events. A flatter pillow is a simple way to start, if you use a higher pillow today. You can also consider trying a soft cervical collar to help keep your neck straight and airway open.

If EPR is not working for you, possibly a fixed pressure or honing in the min/max pressures would be more comfortable. You have enough flow limitations to justify a wee bit of EPR.

Maybe give the following a try to see how it goes.

Mode APAP
Min pressure 9
Max pressure 12
EPR 1 full-time
No ramp

If that does not help, you can then turn off EPR and still use the pressure range. Less pressure swings may help with sleep quality. Based on what we see with those settings, trying a fixed pressure in CPAP mode may be the next thing to try.

I think a bilevel would definitely be a better choice based on everything you have said and what I see in your chart. Once you have exhausted the APAP options, you could go back to your doctor and request a bilevel. I do not know how your insurance would handle it, but if the current machine is not helping they should hopefully be willing to let you swap it out. Worst case if you can do so, you can buy a lightly used bilevel from one of our suppliers or on Facebook Marketplace.

I know there is a lot there to digest. One step at a time…
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#9
RE: Cheynes Stokes - is that what this screen shot shows?
Thank you. I hadn’t noticed the pap mode yet for some reason. I will try those things. The main concern is reducing these apneas given my afib. But also that I could be having CSR. Is there something in the charts that can rule that out? 

Unfortunately I was told I’d have to do a sleep clinic before changing machines and I won’t be able to do that for weeks after my hip replacement.
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#10
RE: Cheynes Stokes - is that what this screen shot shows?
I think PeaceLoveAndPizza is spot on about the positional apnea.  It looks like in your chart, you have a few OA just as you are going to sleep.  The pressure then increases a lot to compensate.  That pressure increase may be the cause of the CA's that follow.  Possibly.  

One test would be to try to stop the positional apnea, then see if the CA's decline.  Try sleeping on a flatter pillow, possibly side sleeping instead of back sleeping, and if those don't help, a soft cervical collar may help (like PeaceLoveAndPizza suggests).
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