easy breath - Therapy Thread

[SarcasticDave94]

Note your OSCAR chart had high CA, but at only just over 1 hour, it's worse than it looks.

You need to eliminate or reduce pressure changes in therapy to help avoid CA. Ramp needs to be turned Off. Your minimum pressure needs to be about 8 cmH20 as this is your median. This also reduces the pressure changes that can induce CA.

EPR will not work at the start with Min pressure 4. The AutoSet physically cannot reduce below 4, so this cancels EPR until events force pressure up.

The math:
EPR 1 requires Min pressure 5...
EPR 2 required Min pressure 6...
EPR 3 requires Min pressure 7...

If you want EPR to work fully from the beginning, those minimum pressures are required.

Example Min pressure 5 minus EPR 1 equals 4. Min 4 is for the child that uses CPAP, and it appears your device may not stay at 4 very long.

Try the higher, reduced range a full night if possible. 3 sections totaling 1 hour won't give much help to Apnea. I would try wearing the mask with CPAP running during times you're not trying to sleep to get used to CPAP and mask.

I've noticed your test result text says what I'm seeing as 7.x CA but overall maybe 9 Apnea total... Correct me if I got it wrong, but if that's accurate, you have a high sensitivity to Central Apnea, and are possibly predominant Central Apnea.

Is there ANY way you create an image of that sleep study to post it attached just like you do OSCAR charts? Text only sometimes loses the true meaning behind the test results.

If what I'm suspecting, your AutoSet might not be the best answer. But let's get the test results posted so we really know what you're working with.

[Dormeo]

Dave, I think the OP posted that there's no mention of central apneas in his sleep report. I'm curious: can you figure out why the OP had fewer CAs while sleeping on a recliner? (The Oscar chart for that part of the night isn't posted.)

Easybreath, you've gotten some good suggestions here. My own instinct is to change just one thing at a time, so that it's effect can be isolated, but if you'd like to make several changes at once, here are my suggestions:

ramp off
min = 6
max = 6
EPR = 2.

This will eliminate any pressure changes that might be bothering you and allow the EPR to work full-time. A pressure of 7 would be better (head off more OAs), but only if it doesn't bother you.

[SarcasticDave94]

A guess might be these flags on OSCAR might be really something like Positional Apnea based but mimicking CA. If it is something to with PAs, might there be a head position on the recliner that blocks those PAs?

PS I misread them saying 7.x CA as being in the test but in actuality getting the info from the CPAP report.

[easy breath]

        Your responses mean a lot to me, I really feel touched. Your support is doing a lot of good for me, besides the practical information and suggestions.

The Report. I am located in Israel, and standard practices might be different that in USA. I have every reason to suspect that the machine that was used for home sleep study was not capable of detecting CA, and certainly did not. The report is in Hebrew, with only text and no charts, so do not think it will help to post it. 

OSA and Reclining. Today I found on the Internet that sleeping reclining can help reduce OSA, for reasons similar to sleeping on side (gravity helps).

My Reclining History. I usually sleep in a reclining chair; it is easier for me to breath. Until recently I thought the breathing problem was from post nasal drip, so sitting up makes sense, like when you have a cold. Now I realize that it was reducing OSA. However, since getting the CPAP I have slept every night on my bed. Last night, I felt so miserable sleeping in bed with CPAP, I decided to move to the recliner, to see if that might be better. And it was MUCH better.

Pressure and CA. I have looked over charts from 5 nights, I see that the CA is almost entirely when pressure is highest, like when it reaches 7.5 and more.

CA to OCA ratio. I am prone to think that the AHI of 44 on lab test (which was done while reclining) was all or mostly OSA and not CA. I believe that the CPAP has almost eliminated the OSA, but is cause CA when pressure is highest. When I snore, the pressure goes up, and then the CA starts.

Current Trial. Now that I see that sleeping reclining seems to improve the situation and that the CA is happening when the pressure is highest (and I feel comfortable exhaling at 4-5 without EPR doing anything at that range, I plan to try a few nights sleeping in recliner. Min set at 4 and EPR at 2. Let’s see what happens.

SarcasticDave9: I have noted your suspicion that AutoSet is not the best answer, and that might be right (or at least, it might pay to set Max and Min closer together), yet I want to experiment first in a different direction.

Dormeo: Oh my, I meant to post the Oscar of the whole night, I will now post it. 

BTW I tend to think that high pressure is what is causing the CA and not the changes themselves.

Thank so much!

[SarcasticDave94]

Your leaks are getting too high.

You're in a difficult place where EPR might be adding to CA, but not enough EPR won't address Flow Limits.

Typically low pressure of 4 will not give you therapy. Typically variable pressures may induce Central Apnea. 7 is not a high pressure, and by itself might not be why you have CA.

[Deborah K.]

You had your worst AHI by far when sleeping in a recliner. I suggest that you go back to bed. Also, anything you achieve in the recliner would mean you'd have to sleep in a recliner for the rest of your life. Do you really want that?

Also, moving your starting pressure back to 4 was not a good idea. Those very low settings are for children and leave adults air-starved. I suggest moving it back to 7 for now, and maybe higher later.

[easy breath]

    Deborah and others, here is the two and half hours in the recliner. AHI 2.1. That is far better than any other session. If I can sleep like that for a whole night, I will be doing very well.

At this point, I want first to find a way to sleep well, even in the recliner.
Then once I get used to the CPAP, we can look at what to do to sleep in a bed.
Sleeping in bed has other problems for me anyway, it is hard to get comfortable because of neck and upper back problems.
So tonight I will see what happens sleeping all night in recliner.

[easy breath]

IMPORTANT NOTE: The chart on post #10 was the WRONG chart! I have now deleted it.

Everyone, please update your understanding of my case.

Thank you.

[easy breath]

[attachment=78949]A few weeks ago, I was diagnosed as having OSA base on an at home sleep sample.
The Sleep Doctor called the sleep sample "very interesting" and recommened "trying" a CPAP, perhaps hints at uncertainty about the Dx but did not openly mention doubt. I have used a CPAP for about a week now.

While I clearly have a form of Apnea, the data I am viewing from the CPAP has given me to doubt that there is any real problem with obstruction. Rather I thinking that I my have Central Apnea (not mixed), likely caused by a problems I have of Heart Insufficiency. 

That would mean a different treatment approach, perhaps using a ASV machine (or other therapies using O2 or CO2.)

I am planning to see my GP tommorow and afterwards my Cardiologist to discuss the issues. 

However, I am interested in presenting why I doubt OSA and to hear if my reasoning sounds correct.

Here is a clip from last night, similar to other nights. The flow limit is usually zero or low. There seems to be little connections between when it is somewhat higher and Apneas or Hypopneas. Both what is recorded as OA as well as CA have the same pattern, increased flow rate followed by a break in breathing of a few seconds (recorded as OA) or 10 seconds or so recorded as CA. I note that for all 6-7 nights my hourly OA has been recorded between 0.5 and 4.98, and as I noted, even the OAs do not look like they are from obstruction so possibly also are from Central Apnea.

   

[easy breath]

I posted a new thread: https://www.apneaboard.com/forums/Thread...-diagnosis