New Resmed Autoset user - high central / no-low obstructive?

[mchuhn]

Hello,
Great source of info here. Thanks to all who support and provide information and help educate!

I have been using this APAP for 2 weeks.
I was giving a 'sleep study' by my primary doc, which showed 46.6 AHI.  I felt like the 'study' seemed kind of low information. It was only a thumb ring that looked at pulse and oxygenation. From this site, I am now realizing that this may not have been a thorough study to understand what type of apnea I have?

The Resmed was telling me I had pretty much zero obstructive and high central.
I found Oscar and started looking at the data.  I am seeing that I seem to be in Cheyne-Stokes quite often ... 25-50% of the time.

I raised my low end pressure to 8, due to feeling insufficient air while trying to fall asleep. I have played around with between 11 and 15 on the high end. The charts were showing a 95th percentile high of around 11-12 ... however if it got to 13 it would wake me up or cause me to start opening my mouth and having large leaks.

Based on the attached screen captures - is the Resmed 11 Autoset the right equipment? It doesn't seem to do anything for the CSA??

Thanks for any information!
-Mike

   

   

   

[SarcasticDave94]

Welcome to Apnea Board,

The thumb ring test might have been a bit lacking. Request a proper diagnostic lab PSG sleep study.

CSR flags may be false, and triggered by variable breathing. Do you have any heart conditions, like Congestive Heart Failure or other? If no, the probability of the CSR flags is likely to be accurate.

The CA looks to be an issue for you. Is there any actual test report you were given via that thumb ring test? No, then request it. It might be skimpy though.

You need to get likely a more thorough diagnostic sleep study with proper EEG. You need to get data recorded via that test on the Central Apnea. The CA are more tricky as they're consistently inconsistent.

For now you may want to remove Ramp entirely.

Your EPR is Ramp only for now.

Your minimum pressure might need to be 7.

Your leaks are of concern somewhat. There's a bit of large leaks involved. It's possible there's a mix between mouth and mask leaks showing in the leak trace graph.

You might need to leave EPR off now as well. The reason is you need to get to a more static CPAP pressure to reduce/avoid a lot of those CA. That's nowhere near acceptable now.

[Jay51]

That is an absolutely massive amount of CA's!!!

The most purple I think I have ever seen in an OSCAR chart.  

The first suggestion would be to completely turn EPR off for now.  This should reduce your CA's.

[super7pilot]

Personal opinion is that far too many (most) home studies are absolute rubbish. They should only be used to determine if a “real” study should take place.

I would suggest getting back with your Dr. and discuss getting a proper polysomnography sleep study.

[mchuhn]

Thanks for the comments.

The EPR is on only during the 10 minute ramp time. That shouldn't affect the next 8 hours of time with no EPR, would it?

[mchuhn]

CSR flags may be false, and triggered by variable breathing. Do you have any heart conditions, like Congestive Heart Failure or other? If no, the probability of the CSR flags is likely to be accurate.

Your minimum pressure might need to be 7.

No heart conditions. I have had an EKG recently.  
Zooming in on the flow graph, there is very cyclical breathing, with a crescendo and then 25+ seconds of no breath.  This pattern occurs for 45 minutes plus. I sometimes wake when I feel what seems like an oscillation of 'pressure puffs' ... I think that is the test for OSA vs CSA?

I will try lowering the minimum to 7.  8 just felt best while falling asleep.

If I have only Central Apneas, is the APAP helpful at all?  Or would that be treated by something else?
Thank you.

[super7pilot]

With that low/no info sleep study. It will be harder to tell what to do. If you had that many CA’s in your study. You would need an ASV machine.

It might be worth while to switch to cpap mode at your median pressure with 0 EPR then report back. If you still have CA’s with no OA’s. Then lower the pressure.

So in effect. YOU, with the forums help, have to do a sleep study via a cpap machine and OSCAR. And that can be a bit slow and frustrating.

[mchuhn]

Understood. I would be willing to do that.
However, I am also concerned about muddying the waters with trying to work with my physician (it is my general family practice physician).

Is it worth finding a specialist? Not sure where to start as looking at 'sleep specialty' clinics on the web seems like it is a bit sketchy.
I am in Colorado.

[super7pilot]

Working with your GP is fine. You just need to be a strong advocate for your self. Such as asking how a ring can tell if a low o2 level was a result of an hypopnea, obstructive, positional or central apnea. It can’t.

All apnea’s lead to low o2 levels. But if it’s from central apnea’s being the predominant apnea. The treatment for a mostly central apnea diagnosis is very different from H’s & OA’s.

[Jay51]

Living at high altitude (you say you live in Colorado) can contribute somewhat to the increase in CA's as well.  Thinner air contains less O2.