Pokey49 - Therapy Thread

[ejbpesca]

I will attempt to anwer your questions.

There is no average life expectancy of a mask cushion I can find.  Medicare advises changing them once a month.  Some people get several months out of them.  I change them once a month.  Yes, the life of a mask cushion depends on the individual.

Yes, EPR reduces exhale pressure by 1 cm for each EPR level.  Level 3 EPR = 3cm pressure reduction on exhale.  EPR 1 = 1 cm pressure reduction on exhale.  I remember it by thinking of the intials EPR as exhale pressure reduction.  It can give better breathing comfort during therapy.

You have only CAs on the most recent posted OSCAR report which means your apneas on the report were not caused by blockage of airways they were caused by an unknown reason from the brain.

Your OSCAR report shows only Clear Airway apneas which means your brain caused them, not an airway blockage.  Clear Airway apneas are also called Central Apneas. CAs can happen as a part of getting used to PAP therapy, a pressure change, an EPR change, medications, or reasons unknown.  If an apnea test (sleep study) finds apnea is due to CAs, a different type of PAP machine may be prescribed.

There are tutorials on this forum that will help to learn OSCAR.

[Pokey49]

Central apneas?? That’s a brain thing isn’t it?? My sleep study showed no indications of central apneas. I wonder if that’s why I sometimes awaken feeling so groggy or “thick headed” feeling?? Does CA’s have any specific symptoms?? Can meds cause them?? Or are they cpap induced due to EPR as u say??

[ejbpesca]

Yes, CAs are apneas caused by the brain.

Yes, they may be caused by medication, EPR change, pressure change, adapting to PAP therapy, or for some unknown reason.

[ejbpesca]

There are no symptoms I know of for CAs that set them apart from OAs, both are events when breathing stops.

Grogginess from apneas can occur from CAs, OAs, RERAs, UAs, and poor quality sleep from factors other than sleep apnea.   Looking up the meaning of each can help to understand OSCAR.

Taking a medication like a sleeping pill, antihistamine, alcohol, or anything that may suppress the nervous system is listed as a possible cause of CAs.

I have seen examples of CAs going up after someone increases their EPR level.  It has been said that with time the CAs will reduce as the brain gets accustomed to the changes.  OSCAR reports will tell the story.

[Pokey49]

Hummm. When I had my sleep study it showed no central apneas. Since then I was put on a modest dose of doxepin. Doxepin is a tricyclic antidepressant and is known to have anticholinergic affects. Don’t know if that means it can affect breathing but something I should do some research on. I need to go back and look at my sleep study and keep an eye on Oscar. I’ll lower my EPR to 2 tonight and see what that does.

[ejbpesca]

I did a search of your medication and the answer was yes it can suppress the nervous system.
Yes, doxepin is a tricyclic antidepressant that works by slowing down activity in the brain, which can suppress the nervous system and help with conditions like anxiety and insomnia.
Yes, doxepin is a tricyclic antidepressant that works by slowing down activity in the brain, which can suppress the nervous system and help with conditions like anxiety and insomnia.

[Pokey49]

Does it tell me anything that they saw no central apneas on any of my sleep studies. I’ve had several over the last 14 years and was finally diagnosed with moderate apnea 12/24.  So I hope they are due to adjusting to cpap. Hopefully dropping the EPR to 2 will help. I’m curious how does doing that help???

[super7pilot]

It tells you that your CA’s in OSCAR are treatment emergent clear airway events. They will very likely decrease as you get used to treatment and adjust your pressures. This can vary widely from person to person. Mine took a month-month and a half to settle down.

But they are still there to a very small degree.

[Pokey49]

Attached is my OSCAR report for last night. Ive taken 2 screen shots to show most of the graphs and summary. It appears I am having few obstructive apneas or hypopneas, mostly central apneas. None of the sleep studies that I have ever had ever mentioned having any CAs. Maybe I am more concerned about this than I should be, but its a brain thing which I find a bit worrisome.

Last night I reduced my EPR from 3 to 2. My therapy pressures are set at 8-20. I awoke about 1:30 feeling like I couldnt breath properly. Maybe a mistake but I set it back to an EPR of 3 and went back to sleep until about 530 and again awoke feeling SOB. I dont know what the hell is going on. My first 10 sessions of cpap I didnt have anything like this but OSCAR showed I was having some CAs

I am not sure I understand what is happening with changing my EPR. I tried to find an explanation on this site but was unsuccessful.  So my understanding is as follows. With my therapy pressure set at 8-20 with an EPR of 3 that would reduce my exhalation pressure to 5? If I change the EPR to 2 doesn't that change the exhalation pressure to 6, thus increasing the pressure I have to exhale against, making it more difficult to exhale rather than easier??? What if I set my therapy pressure back to 7-20 and set the EPR to 2, would that help, be the same, no help??

[ejbpesca]

I have never been continuously free of CAs in 18 years of treatment.  5 CA events were indicated last night.  I have severe apnea.  Reading about CAs, one article claims a few of them are common or normal as are apneas in general, in small amounts.

I can only guess that in a sleep study with multiple sensors stuck to one's head to detect brain waves, there may be some indication on screens/printouts of what is going on with the brain during a CA event, and even with that, it may not be known why the brain is behaving in such a way.

I have not made a serious record of it but I've seen CAs go up when I take an antihistamine for allergies, but this could be coincidental.