APAP optimization assistance

[jayed53]

Hello,

I recently was diagnosed with OSA with an AHI of 82.2.   It's been 4 nights so far on APAP and My AHI went from a high of 45 the first night to 8 after adjusting the pressure based on doing some research.  Any insight into how I can further optimize my therapy would be much appreciated.

   
   
   

[jayed53]

so decided to experiment and change the min pressure to 9.6 leaving max pressure at 11 to try to get under 5 AHI.  For some reason, oscar isn't showing the change but I changed the EPR to 2 full time from off and had a terrible night sleep. My AHI went from 8 from the night before to 40, so looks like that didn't work.  Any idea what I should change to get rid of the stubborn centrals?

   
   

[Phaleronic]

You likely need a soft cervical collar to clear up the multitude of CA events-are you sleeping on your back at all that you notice?

[jayed53]

Thanks for the reply.  I usually start on my side and end up on my back.

[jayed53]

Aside from suspected positional apneas, can the pressures be optimized further?

[Phaleronic]

Since your %99 pressure is 10.7 you could try a night on straight cpap mode set to 11.5 with EPR set to 2 and see if it helps-it helped me when I moved off apap to cpap (with my CAs).  Maybe give this a try for 30 minutes or so before the full night to see what you think of the pressure and mode.

[Sleeprider]

Jayed, if you have a copy of your sleep diagnostic report, please post a copy with the personal information redacted. This is central apnea not obstructive, and we need to see if this is treatment onset, or if it was present in your diagnostic test. I don't see significant evidence of obstruction or flow limitation but we could verify by looking at some zoomed images of about 3-4 minutes in length, so we can see how these event arise. If you provide a zoomed chart, try to get a minute or so before the events start. If this is central apnea, we're going to focus on how you need to proceed to get an adaptive servo ventilator (ASV) class PAP device.

[jayed53]

Thanks for your help.  

From my sleep study:

 Obstructive Sleep Apnea (G47.33) - Severe based on pAHI=82.2 and O2 nadir of 75% Central Sleep Apnea (G47.31) - Moderate based on pAHIc=19.9

   
   

[Sleeprider]

Okay, you are a candidate for ASV. You already have a complex apnea / CSA diagnosis. It is typical for individuals to be started on a CPAP trial, because it is a less expensive therapy, therefore insurance generally requires that CPAP be failed before more advanced PAP therapies will be compensated. All you need is for your doctor to determine that you have failed CPAP (and you have) due to efficacy and to prescribe ASV. It is not required that you take a titration test or demonstrated ASV is effective until you have used the device. Many sleep doctors prefer to give you a titration because that's how they make their living, but ASV is nearly always set up at default settings of EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 15.0, and the machine just works. Given your obstructive sleep apnea component you may need a higher minimum EPAP pressure, but the machine is fully automatic. The point is, you need to be in your doctor's face with the fact CPAP is ineffective at stopping central sleep apnea although the obstructive component has resolved. Specifically start asking for a prescription for ASV HCPCS Code E0471 (respiratory assist device with backup rate).

Your zoomed image shows central apnea, and chaotic respiration without any evidence of obstructive flow limitation.

[jayed53]

Thanks for your response. I’m currently living at an altitude of over 7500 ft above sea level. I was reading this can be a major factor in central
Apneas. Is there any change that I can make with my existing machine to improve my condition or is getting an ASV my only recommendation at this stage. So far it’s been a week of being on the machine and have had one night with less than 10 ahi. Was thinking on addition to altitude it could be me just not being able to get comfortable on this setup yet as it’s so new. Going to a new , much more expensive machine when I just bought this one hurts.