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New CPAP User - Lofta Results & DreamStation Setup
#1
New CPAP User - Lofta Results & DreamStation Setup
Hello!

I am a 38M diagnosed with mild OSA just this week via Lofta.
Prescription: Auto-titrating CPAP machine at a range of 4-20 cwp with EPR of 3

Would love some assistance in looking at the OSCAR results.

Background
My complaints leading to get home tested are recent fatigue, morning dull headedness, and poor circulation in hands/feet (that I have had for much of my life).  Plus, my ex used to mentioned that I occasionally stopped breathing in my sleep.  I'm quite fit, not overweight.

Test Results (see attached)
Sleep Time: 6h 31m
AHI: 9.2 (60 total events)
RDI: 15.8 (103 total events)
O2 Sat Min: 88 / Mean: 93 / Max: 99

CPAP Setup & Trial
Our family has a DreamStation APAP that is not being used, so I set it up according to the Lofta prescription.
I've tested it for 2 nights so far using a full face mask.

It's definitely taking some getting used to.  I'm planning to meet with my PCP in a few weeks to discuss and perhaps meet with a sleep specialist, but I wanted to try this in the meantime to see if I could get some relief.  

I do notice more alertness in the daytime, but I also feel a bit off from disturbed sleep getting used to the device.

As I look at the results via OSCAR, one thing that is concerning to me is the number of CA events.  I've read that there can be an initial influx at the start of CPAP treatment, but that it could also be a sign of the pressure or EPR being too high.

Question
Since I'm brand new to this, and kind of flying solo at the moment, I'd love any feedback in regards to the CA events mentioned above.  Also my AHI using CPAP is higher than my Lofta test. Something to be concerned about?

OSCAR results attached.  Thank you!


Attached Files Thumbnail(s)
           
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#2
RE: New CPAP User - Lofta Results & DreamStation Setup
Welcome to Apnea Board,

A few items to consider, 1. Did you get your detailed sleep study report yet? There's too much Clear Airway/CA/Central Apnea reported here to be effective. We are wanting to find the info on these from that test, if available. If you do not have it yet, call the ordering physician and get it ASAP. HIPAA law gives you the right to request and receive it.

My opinion, you're going to want a ResMed AirSense 10 or 11 AutoSet, the 10 series preferable. The Philips Respironics machines are now banned for new sales in the US, and for most aren't as effective as ResMed.

There's a lot of untreated events the Philips Respironics is neglecting to help with. You're going to need to increase minimum pressure, starting at 7 for now.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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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#3
RE: New CPAP User - Lofta Results & DreamStation Setup
Thanks so much SarcasticDave94.  I didn't even know that I could request the detailed results from Lofta.
I have that attached here now!

I'm not able to discern if the Lofta Sleep Study shows indication of CA or not?

               

Wasn't able to attach a 4th image but the prescription says:
Diagnosis: Obstructive sleep apnea (G47.33)
DME Device: APAP

I'll certainly keep in mind that advice re devices.  Really appreciate the help.
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#4
RE: New CPAP User - Lofta Results & DreamStation Setup
Yep, there's some CA, first chart. It's called there pAHIc 3% with 11 counted. Translated, there obviously were some Central Apnea, but by itself not enough to require specific CA treatment.

I still say you'll want to request specifically a ResMed 10 or 11 machine, the AirSense AutoSet would be fine, even better will be the AirCurve VAuto. This VAuto is bilevel and can avoid more CA than the AutoSet. It's the High or Very High Trigger setting in the VAuto that helps avoid more CA, but it can't treat CA if they are extremely high.

My opinion also is with some CA on the test result is that you have a higher likelihood to have more treatment emergent CA than others. This can be an issue that is in want of addressing when you start therapy in earnest.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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: New CPAP User - Lofta Results & DreamStation Setup
Nice, thank you! Your feedback is very helpful.  I will explore those options, and discuss with my PCP (for insurance coverage).

In the meantime, if it were you.. do you think you would hold off on using the DreamStation and wait until switching devices to prevent an exacerbation of CA?
I have a side sleep positioner I can employ in the meantime to mitigate supine OSA events.
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#6
RE: New CPAP User - Lofta Results & DreamStation Setup
Using the DreamStation would be up to you to decide. I personally think that with it indicating this unit may need higher pressures, it may either become uncomfortable or it may increase the CA even more. However CA of any sort have a tricky side. They're proven to be consistently inconsistent, as in they're up, down, disappeared and returned later with no setting edits.

With a Philips Respironics machine, they are slower and reactionary in response compared to ResMed. This requires the DreamStation settings needing set higher because they leave less room for leeway, or it struggles to catch up. The ResMed allows more play but still catching events faster meaning more therapy and better comfort.

As with everything your mileage may vary.

If you did want to trial it, min probably gets dialed up to maybe 7, there should be a flex setting that you might try 1 or 2, setting 3 seemed more of a hindrance than help for most. Try not to set a Ramp, especially due to CA.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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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#7
RE: New CPAP User - Lofta Results & DreamStation Setup
Thank you so much.  As it turns out, I just found out that our family has a ResMed AirCurve 10 VAuto sitting in storage (it was used by my grandmother before she passed).  I'm hoping I can bring it somewhere to get cleaned up.  Any advice on where to go or what to ask for on that?

Right now I'm just weighing the options between going that route and then working backwards to get ongoing support via my PCP vs. purchasing new with Lofta + their ongoing care plan.

In any case.. what do you think would be a good starting point with settings on the AirCurve?
Do I just set the same Min/Max as the DreamStation and set the High/Very High trigger option to catch the CAs?
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