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pierrecohenmusic - Therapy Thread
#1
pierrecohenmusic - Therapy Thread
Hi all,

I started to have insomnia issues in Feb 2024 due to chronic anxiety and decided to get an at home sleep study with a company called Lofta using the WATCH PAT One device at the end of May 2024. I was diagnosed with OSA with an AHI of 19.5 and then purchased an Aircurve 11 Bipap machine. (I can provide my sleep study results if needed).

I've been checking my OSCAR results since June 4 and have pretty much 0 OSA and only Centrals. Here is my OSCAR from last night. I removed the mask for about an hour but put it back after gasping for air.
   

This weird feeling happens when I fall where I stop breathing right as I fall asleep, and then I jolt myself awake with a burst of adrenaline. And this happens every 5-15 minutes many times throughout the night. I bought a Sleep Oximeter and tracked my data from last night. You can see right as my Sp02 drops (from not breathing I presume), my BPM jumps up to wake me up.
   

This whole situation is really frightening. I scheduled an appt with an ENT to hopefully get more concrete answers.

Could anxiety be causing this? Please help... this is really scaring me and is making my anxiety even worse.

Thanks in advance for your support!
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#2
RE: Was my OSA a misdiagnosis? Is it CA?
The Lofta WatchPAT is not an accurate diagnostic for anything other than obstructive sleep apnea. If apnea occur, it is assumed to be obstructive. Without a more accurate diagnostic test, we can't assume you do or don't have central sleep apnea or complications of anxiety. There is very little obstructive apnea here, so I'm gong to suggest you try a pressure of 6.0 to 9.0 with EPR at 1. If this is a therapy onset CA problem, the lower EPR may help reduce events. Your leak rate is high and can contribute to increased sensing of CA.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Was my OSA a misdiagnosis? Is it CA?
Thanks so much Sleeprider!

I used your suggested settings and here are my results (I forgot to put my SD in my machine last night SMH):

Total AHI: 3.1
OA: 0.0
Central AI: 3.0
Spont Cycle: 92.5 %
I:E: 50
Tl: 1s
MV: 4.8L/min
RR: 13.2
Vt 340 ml
Leak 29L/min
Exp. pressure 7.3
Insp. Pressure 8.2
Used Hours 8.2

Is there a way I can further tweak my settings to reduce centrals even more?

If the data I provided isn't sufficient, I can use the same settings you suggested yesterday and make sure I upload tonights data into Oscar.

Does this mean I don't even have OSA?

Thanks!

Pierre
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#4
RE: Was my OSA a misdiagnosis? Is it CA?
OSCAR charts are based on post treatment, so this cannot replace a sleep study. The absence of Obstructive Apnea may mean they're treated well.

I don't recall seeing your sleep study report, but if there was no data involving Central Apnea, we can't help you know about them.

You might need to chat with the prescribing doctor and request an in lab PSG sleep study.

I can't pull much out of the text for your last night. Charts help for context.

It does appear your leaks are high, 29 L/Min is over the ResMed redline indicating you need to fix it. This can throw off therapy responses from the CPAP, disturbing you as well.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Was my OSA a misdiagnosis? Is it CA?
Here is my initial sleep study... according to their website Watch Pat One says they can distinguish between OSA and CA but I'm not sure if its true or not. Is there anything in this study that you see that pinpoints  to me having CA?

           

I will set the same settings as SleepRider suggested again (Ipap:9 / Epap:6 / PS: 1) and will post my OSCAR data tomorrow. 

I plan on meeting my ENT Thursday and look to get a legit sleep study if you think the data I provided above is insufficient.

Thanks for your help and support!

Pierre
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#6
RE: Was my OSA a misdiagnosis? Is it CA?
(06-18-2024, 11:56 AM)pierrecohenmusic Wrote: Thanks so much Sleeprider!

I used your suggested settings and here are my results (I forgot to put my SD in my machine last night SMH):


Is there a way I can further tweak my settings to reduce centrals even more?

Pierre

I have a completely different approach I'd like to try.  I really want to see the charts on this.  You have an Aircurve 11, and we had pretty good success at reducing  your CA events by using less pressure support.  Now, we're going to put the pressure support back in but use a very-high trigger setting.  New settings are:
Mode: Vauto
EPAP min: 5.0
Max IPAP: 10.0
PS: 3.0
TiMax: 2.7
TiMin: 0.3
Trigger Sensitivity: Very-High

I know this is kind of a 180 for therapy, but I really want to give your Aircurve 11 Vauto the best chance to resolve this.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Was my OSA a misdiagnosis? Is it CA?
You roughly had 1 CA to 10 OA, or 13 CA to 136 OA as I'm seeing it.

Let's see what your OSCAR charts look like next, especially if you edit to Sleeprider's settings suggested.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Was my OSA a misdiagnosis? Is it CA?
Having such a leaky mask situation would make me gasp for air and want to rip my mask off. The noise of a leak alone wakes me up. IMO it’s hard to hard to evaluate your sleep experience unless you get that under control. I would address that pronto: it might take quite a bit of work, since it’s a trial and error thing.
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#9
RE: Was my OSA a misdiagnosis? Is it CA?
Thanks Sleeprider!

I tried a PS of 3 and trigger sensitivity set to very high but as I was falling asleep I kept getting shortness of breath.

I returned to your original suggestions (Ipap:9 / Epap:6 / PS: 1) but set the trigger sensitivity to high

Here is my OSCAR data from last night and its already looking a lot better... although there are leaks I didnt really notice them (maybe its because my mouth is opening and the air is escaping my mouth)?

   

My pulse and heart rate also look a lot better:

   

What do you think these improved number are due to? the higher trigger sensitivity?

How can I resolve the leak issues and maximize these already much better looking number. 

Youre the man!
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#10
RE: Was my OSA a misdiagnosis? Is it CA?
This looks to me to be a combination mouth and mask leaks, all within too high to accept in my opinion.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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