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[Symptoms] New User Resmed Auto 10 Her - Not sure what is going on?
New User Resmed Auto 10 Her - Not sure what is going on?
Hi Everyone, 

I was diagnosed with OSA with a G47.33, AHI 21.57.  I have started using the Resmed Auto 10 Her for 4 days.  I downloaded the report via Oscars but i am not certain what is going on.  My pressure was set at 4 to 11 but my AHI remain at 20+.  I need some helps to look into my therapy.  

This is my first time to this forum hence i apologies if i did not post appropriately or use the features correctly here.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
Welcome to the Apnea Board.

I'm not sure if you have a bad case of treatment emergent or pre-dominant Central Apnea. Pre-dominant CA will show something typically in a diagnostic sleep study. For either type, for now you'll need to turn back EPR 3. If you're using a Ramp, it will need to be minimized or better is turned off. Both those items add pressure swings and increase CA, of which you've got a Central AHI of about 18 with PAP.

Secondary, your leaks are sometimes a bit high. This can diminish therapy but hindering the effectiveness and by adding disruptions.

If you have access to your diagnosic report, you can post a redacted version here so we can look at it. CA info will in part be found in the event count and type area.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
To add to what Dave said -- you have an utter train wreck of central apnea. There are two kinds of apneas. Obstructive means that you are struggling to breath through a partially or totally collapsed airway. A cpap machine provides some extra pressure to hold your airway open. A central or "clear airway" event is where you simply stop trying to breathe for awhile. Centrals can come from various lung diseases or neurological problems, but they can also be CAUSED by cpap therapy. When they are caused by the therapy it's because a person has spent years struggling to breathe all night through obstructions and you adapt to getting the most air as you can through all of the physical barriers. Then you strap on this mask and the machine helps you to breathe more easily, and you are still breathing really efficiently because you've been doing it for years, so you move a lot more oxygen in and CO2 out in a much smaller amount of time. Then you get ahead of your body's needs, so you just stop breathing while the CO2 builds up as your body plays catch-up, you hyperventilate again, pause again, lather/rinse/repeat.

When the centrals are caused by the therapy being so effective that you breathe "too well" eventually over some months your body will realize that it can turn down the "master volume control" on your respiration and relax and slow down. It's like if you've always had to run in the sand and all of a sudden you are running on pavement -- you need to slow down to a walk to get the same speed as before.

Since this is all happening while you are unconscious, it takes a lot longer for your hindbrain to figure all this out because it's not like your unconscious reads apneaboard postings!

You clearly do have obstructive sleep apnea because you have lots of flow limits, so you need the pressure and need the machine's help.

Now if this central apnea is treatment emergent, then you just need to play a balancing act between the pressure to clear the obstructions, while not getting too much help because then your body just keeps stopping breathing because it doesn't realize that you need to keep breathing.

The other possibility is that you have something else -- like COPD, or a neurological quirkyness, or a full-blown neurological disease like myesthenia gravis, etc -- and that was already causing you to repeatedly shut down your breathing even before cpap. You can tell this from your sleep study measuring lots of centrals even before you ever get on therapy.

If you have both kinds of apnea it is a balancing act -- more pressure cures obstructives but causes centrals, less pressure doesn't cause centrals but it doesn't help you breathe through the obstructions.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
[attachment removed per member request]

Dear Dave,

Thank you so much for your reply.  I am attaching my Sleep Test Diagnostic Report here.  I appreciate your valuable comments.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
Dear Cathyf,

Thank you so much for your comments.  Oh my, how can i perform this "balancing act" now. Unsure I totally no clue how to start with!  Reading the report is already a challenge to me.  Oh-jeez
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
OK your sleep report clearly shows that you have predominantly central and mixed apneas versus obstructive ones, and they haven't differentiated between central and obstructive hypopneas - but assuming that they're of a similar split, you shouldn't be on APAP. You need to be on ASV.

Unfortunately, doctors often simply put us onto APAP even though it's not going to help central events or mixed events. They may well insist on putting you through to "fail" CPAP, and maybe even to "fail" BiPAP before they even consider ASV. But ASV is specifically designed for central events and can manage the obstructive part too.

The first thing I would suggest is to (for now) turn off EPR. That can sometimes make centrals go crazy. The other option might be to drop down your max pressure, maybe to 8 or 9... that might help reduce the centrals a little too, but it might also mean you start to have a few more obstructive events too. You can see on the chart that the big clusters of centrals happen with the highest pressures, so if you can keep the pressure below that point, hopefully your centrals will be a little lower.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
Dear Ratchick,

I appreciate your comment.  Let me try out tonight your recommended setting - Switch Off ERP, Reduce Max Pressure to 9 to see whether it become better.

I am not certain what will happen to my therapy.  As the doctor has never mentioned to me to be treated with ASV and he only talked about my OSA and my narrow airway and nothing else  Huh
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
That doesn't surprise me. My own (first) doctor diagnosed me with central sleep apnea 10, nearly 11 years ago now. I had no therapy for that until I finally kicked up enough trouble to have a second sleep study done this time last year, and the results showed that I was having 80+ centrals a night. And the doctor insisted I start CPAP and I swear was more concerned about the literal handful of obstructive events I had than the 800 or so centrals I have on a normal night without therapy. It took until the last week for me to finally get onto ASV, too. It's all too prevalent, sadly.
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
Dear Ratchick,

Your doctor did not treated you appropriately really perplex me.  In deep, it is very troubling.  It took me a while to gather my courage to hook on to a machine to seek improvement to my sleep and now I will need to figure out how to deal with the situation.  I truly appreciate all the supports in this forum hence I can gather all the relevant information to speak to my doctor and the polysomnographic technologist.  Bother were telling me, my central Apnea is temporary when i last questioned them.   Huh  but after 4 days with CPAP, the central apnea did not seems to come down neither was the OSA. 

Let me observe my data tonight and i will share.  Thanks!
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RE: New User Resmed Auto 10 Her - Not sure what is going on?
I hate it when they say that to patients who have more than the odd central on their sleep study.

Hopefully tonight will be a little better but the thing about centrals is they tend to be nothing if not contrary. Best described as consistently inconsistent, they can vary dramatically from one day to the next. So if tonight looks bad for centrals, maybe give it another night or so, and if it looks good, keep your fingers crossed that it persists!
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