Should I be concerned with this type pattern

[adrift]

Hi,
I have been using CPAP for a couple of months. I see similar flow rate patterns as depicted in my attachment a few times throughout the night. I am using a AirSence11 and an AirTouch Full mask. 10-13 pressure and EPR Level 3 cmH2O. Should I be concerned about what I am seeing? thank you

[adrift]

I've attached another image

[Apnea23]

I may be wrong but it looks like the massive leaks set off the reaction.

I would probably look in to resolving the leaks and seeing how that changes your data.

[adrift]

Thanks for your reply. I see what you mean. There are some very brief leaks just prior to first apneas. I am attaching a new image that shows the same patterns with no leaks as far as I can tell. I'm thinking the leaks on the first images occurred after an arousal when maybe I changed sleeping positions or woke up. My main concern is what type of apnea is happening and is it related to some type of heart disease. The ResMed 11 manual I have describes this pattern as periodic breathing due to frequent apneas and it is a typical OSA period. This part of the manual is in the Cheyne-Stokes respiration detection section. I am not clear if they[attachment=50246] put this in there to contrast Cheyne-Stokes respiration patterns compared to typical OSA or if this typical OSA is a form of Cheyne-Stokes respiration. thanks

[esleepie]

The brief leak followed by a slew of incidents is probably a change in sleep position that causes positional apnea. You also seem to be hitting your MAX pressure often enough that it may warrant raising it to 14.

[adrift]

Hi,
Thanks for your responses. I reached out to my doctor and received a new type mask which I used last night for the first time. F&P Brevida. I imported my data into oscar and now for the first time I see a Cheyne Stokes Respiration event. In addition the patterns looks the same to me as what I have posted previously but previously the events were mostly labeled OA with no CRS at all and now I have one that is labeled mostly CA with CRS. Now I am even more concerned and would appreciate other people's comments on whether this is actually Cheyne Stokes Respiration. The breathing pattern goes straight up and tapers down followed by an apnea and then straight up again. It's not a taper up - taper down breathing followed by an apnea that I see when I look at other people's data that are described as Cheyne Stokes Respiration. thank you

[Apnea23]

What was you diagnosed with exactly? As it's the Airsense I assume OHA?

Have you ever used less pressure, or no EPR?

How did you arrive at 10-13?

The overwhelming consensus is reduce or turn EPR off completely if you're seeing centrals and/or too much periodic breathing.

Did you jump straight in to 10-13 with EPR 3 from the doctors prescription?

Let's not forget you've gone from a full face to nasal, you'll probably be getting more pressure and there was some minor leaking around those times for whatever reason. Perhaps it was too much, your mouth had to open in an attempt for your brain to remedy the chaos and the EPR aggregated the situation, and your machine raised pressure in response to what it believed what an OHA event, which then caused the cascade of CAs.

Did your doctor advise to reduce pressure with the nasal mask, or suggest lowering EPR or turning off, or both?

I find with leaks, the waxing and waning can quickly get out of control especially with EPR.

I'm no expert but would expect with mouth tape, 6cm - 10cm pressure (with no EPR) you won't see this sort of thing.

[adrift]

Hi, thank you for your help,

From Sleep Study:

Diagnosis Summary:
Moderate OSA
No significant CSA
ECG showed no cardiac abnormalities

Diagnostic AHI: 16 events/hr
Diagnostic RDI 39 events/hr
SpO2 Nadir: 84%
Total Sleep Time 117 min

Suggested RX:
APAP therapy 10-13 cm H2O with EPR or equivalent: 3 Ramp: Auto
Mask: Large F&P Eson2

A month after my sleep study, my primary care physician asked me if I wanted him to send me a CPAP device. I asked if I could speak with the Sleep Specialist MD about my Sleep Study but was brushed off and asked again if I wanted him to send me a CPAP device. This was through my health care providers messaging app. I didn't get a prescription or any follow up at that point just a phone appointment with him in 3 months if I accepted the device.

When I got the device, I tried different settings and was using Oscar and reading this forum. I couldn't find my sleep study or prescription in my health care providers app so I formally requested my medical records and got the report. This was about 10 weeks after getting the device.

My primary care physician helped me change to a full face mask AirTouch when I requested it because I was experiencing Aerophagia. It didn't help with that and I found that I drooled a lot with it which was nasty with the memory foam seal. It is a great mask I think however and seals perfectly for me.

After my 3 month phone appointment with my primary MD he had the sleep center call me about trying different masks. They sent me a NuancePro and a Brvida. My doctor did not advised me to reduce any pressures, or lower or turn off EPR. I really don't think he knows specifics about the therapy.

(I think my doctor is over loaded with patients and it's not his fault they make him do sleep patient work instead of giving me access to a sleep specialist doctor.)

I have lowered my setting to 6-10, with no EPR like you recommended. I am experimenting with different masks now with those settings. I have ordered mouth tape.

Thanks for you help!

[adrift]

Hi,
I've been using the mouth tape the last few night with settings 6-10, no epr. I changed back to my full face mask, AirTouch, because I get very low leakage with it.
I am attaching an image of a session last night were the pattern is still there. It is labeled as OA but is it actually CA? I am concerned about this pattern of breathing and am wondering what condition might be causing it? Thank you

[Gideon]

Very obviously obstructive, the the cause is most likely positional! Possibly fixable with a pillow adjustment, think 1 vs 2, flatter, less firm, if that doesn't work look into a soft cervical collar.

Of course if this is a one off then forget about it.