[Health] Another CSR Scare

[ataylor830]

Hi Everyone,

First time poster here. I have had my cpap (resmed airsense 10 auto) since mid February, so about 2 months. I haven't had any followups w/ my sleep Dr yet due to COVID. 

I have slowly gotten used to sleeping with cpap. Based on things I've learned here, I increased min pressure to 6 from 4 because I felt like I wasn't getting enough air while going to sleep. My AHI is generally under 1 and I'm grateful I'm off to a good start! Last night my AHI was actually 0 for the first time.

I have 2 concerns but will start first with CSR.  Quick info: I'm 42, F and definitely have a higher BMI than I'd like to admit.  While I am overweight, I don't have any heart issues, high BP, diabetes, or any lung issues that I'm aware of. 

3 times now I have been flagged for CSR: my 6th, 8th, and 30th night on cpap.  
6th night was ~12 minutes of CSR, 8th night was ~22 minutes, and 30th night was also ~22 minutes.

I haven't been flagged at all since March 13th, but I do notice the CSR pattern quite a bit.

I've read the criticism of how sensitive resmed is when it comes to flagging CSR but don't understand it enough to know if I fall into the "false positive" category. I have a link with some screenshots but can't post it yet.  Can someone help understand what to look for in a false positive? Is it the length of time this pattern lasts? The lenght of time the low/flat flow rate lasts between the higher flow rate? I generally see patterns of larger flow rates followed by super small or flat flow rates. I see the pattern most nights for anywhere from 5-10 minutes at a time, even though they're not flagged.  

Thank you all for your time spent with those of us looking to take our sleep health into our own hands!

[Gideon]

CSR, IMHO the only change ResMed should make is to change the name from CSR to PB (periodic breathing). When ResMed flags CSR it is ALWAYS PB, and very rarely CSR. When it is not actually CSR it is a lot less concerning.

[ataylor830]

Thanks for the response, Bonjur. I sure hope that’s the case. I’ll get my posts knocked out and then I’d love for you to take a peek at my graphs.

Since I need to post... I was wondering if there an “average” flow rate. I have noticed others tend to go between positive and negative 40 or 60.. mine average 20, maybe 25. Does that mean I’m a shallow breather? And is that bad?

[jaswilliams]

No need for lots of posts anyone can attach an image to their email see details in my signature

[ataylor830]

Oops, Thanks Jaswilliams. When I couldn't insert a link, I assumed I coudln't attach either.. bad assumption on my part.

Here are my 2 images. The one in green is a 20+ minute segment that was flagged for CSR.  The other is a 5ish minute segment that I thought had a similar pattern as the CSR even and that I see very frequently -- most every night in the last 3rd of my sleep.

Is this something I should bring up with the doctor? Or will he just roll his eyes at me?

[attachment=22277]

[attachment=22278]

Also, still wondering if flow rate of +/- 20 is too low?

[jaswilliams]

These graphs are periodic breathing rather than classic CSR they aren’t regular enough in my mind certainly not enough to worry about and will likely diminish over time as you get used to the machine

[ataylor830]

Thanks, makes me fee a little better. I will try to learn more about periodic breathing.  I was afraid just seeing that pattern may not be good.

My other concern has to do with low o2.  I just got a summary from my Dr. (I learned reading here that he owes me the full report if I request it, so I plan to do so).  I haven't had a follow up, but while the results indicated "moderate OSA" with ~25 AHI, he said "Your oxygen dipped down to 65% at one point. That's not the LOWEST we've seen, but it's close" ... so of course, that freaked me out. 

I recently got a fitbit that shows oxygen variation.. it gives very little info, but shows some high variation. I have an oximeter on order as we speak. I have no idea how to interpret resp rate, tidal volume, etc, to understand if I'm not getting a deep enough breath, etc.

My flow rate seems to average +/- ~20 and that seems low compared to other graphs I've seen.. so wondering if I have a shallow breathing problem. Here are last night's stats.

[attachment=22284]

[Sleeprider]

The best way to post a chart is to follow the Organizing Your Oscar Chart Linked in my signature. Your tidal volume and minute vent suggest you might be a small individual. You have nearly no flow limitations so airway restriction or obstruction do not seem to be in play. If you are concerned about oxygen saturation, a recording odometer is a relatively inexpensive device to accurately evaluate any issues to discuss with your doctor. Some work with OSCAR. Fit Bit watches are a bit sketchy as an evaluation tool.

[ataylor830]

While I wish I could be considered a small individual, that's definitely not the case. I'm 5'8 which is on the tall side for a woman and I'm quite overweight.

Last night's chart attached.  While I am glad this looks pretty darn good overall, I do see many events not getting flagged because they're not quite 10 seconds.  And I continue to worry about o2 (oximeter is on order and should be in Monday) and worried I have shallow breathing contributing to the low o2.

[attachment=22287]

[Sleeprider]

Well, a couple ideas to consider. Your AHI is low but your pressure is absolutely mired at the lowest default pressure the machine offers at 4.0 cm because you are using EPR full time at 3. If you want to use exhale pressure relief, then I would suggest the minimum pressure CPAP pressure should be the at least the machine minimum pressure plus the EPR setting. This creates better ventilation and allows exhale pressure to rise at the same rate as CPAP pressure as needed. For EPR at 3 that means a minimum pressure of 7.0, which results in a starting pressure of 7.0/4.0 (IPAP/EPAP). If you reduce EPR to 2, the minimum pressure should be 6. Your EPAP pressure does go above 4.0 at the end of the night. My recommendation is to increase your minimum pressure to 7.0 with EPR at 3 and your pressure will be more consistent, you will improve tidal volume, and it should feel better.

Secondly, you have ramp on for 30 minutes...why? Turn off ramp. Your machine is starting at minimum pressure anyway, and that just prevents it from recording events and responding to respiratory inputs. Turn off ramp, and increase minimum pressure to 7.0. This should stabilize respiration and pressure. If we need to reduce EPR we can do that after observing results.