[CPAP] Help needed to update settings

[OpalRose]

Gideon is correct in that the use of EPR didn't make too much of a difference. Your CA's rose from 12.43 to over 16.

You can leave it on for a night just to see what the results will be with the 7-7 setting.
It's always a good practice to make one change at a time.

Try it on for a night. We can always turn it off.

[Gideon]

When we see central apnea and EPR on we, most everyone here myself included, will either decrease or turn off EPR to see if it makes a significant difference simply because we are testing to see if your CA events are TECA and thus CO2 driven which is by far the most common case.

I looked at both cases and IMHO the increase you had in CA events was not significant. I also thought that some of your CA events are related to arousals from your obstructive events and are likely you just holding your breath when you tossed and settled in.

EPR is the best tool you have against all obstructive events except OA itself.

One of my thoughts which I haven't voiced yet is that you may have the wrong machine for your apnea, this is the reason for requesting sleep test results and the overview and summary screens which is very rarely look at. I was quietly evaluating you for an ASV machine.

The additional data I asked for please.

[Crimson Nape]

I based my recommendation on your first charts that showed a large incidence of CAs while not using any EPR. Using EPR may result in an increase of CAs. Since you weren't using EPR, the only other possibility to try and reduce your CAs, was to minimize pressure changes. That is why I wanted the same min and max pressure. If this doesn't help, then you will need to explore changing to an ASV model.

I subscribe to the idea of "too many cooks in the kitchen". Since you are getting confused, I'll refrain from any more posts.

Good luck!!!

- Red

[SteveC]

Hi,

Thanks for everyone's suggestions so far, I have a way to go.

Flow limit seems to be reported from my S9 irrespective of APAP or CPAP.

I forgot to put the SD card back in the machine last night, so no detailed data with EPR off, although it did show a CA of 9.8 which is an improvement over the previous night of 16.9

Grr...! There did seem to be a high leak (21, from the machine data, not the SD card) for some reason and as I am a mouth breather that can be quite uncomfortable. Sometimes that affects me, sometimes not. The mouth breathing was probably the cause of the high leak, although my wife mentioned a large noise coming from the mask, possibly a leak there due to it slipping.

I do have a chin strap which helps, but is not perfect. One thing I suspect with both the mask (N30I) and chin strap is if I let my hair grow to long the mask and chin strap slip around a fair bit. Got my haircut today so we'll see!

Looking over data going back a few years, it is mostly CA. Funnily enough, the ResScan s/w shows no data prior to 15 Feb, but Oscar does. Not sure why. 

I have done two sleep studies, one a home study in 2012, that showed mainly central. I do have data from that but not sure if it is still relevant or exactly what you need from that data. The recommendation from that was "not to use CPAP". 

I did an overnight sleep study in 2017, the recommendation from that was  "can use mask if wants to". I cannot find that report, which is unusual. Probably with my GP. The sleep specialist then told me it was 50/50 if I decided to use the mask.

Re oxygen levels and CO2, I was in hospital last week for a PE and while there after initial treatment on blood thinners and using the machine in APAP mode for the PE my oxygen levels were fine according to the staff, but my AHI's were high. As soon as I left hospital and came home they started to drop.

The specialist that looked after me on that occasion wants me to try and get the centrals down, but considering the previous reports about it is my choice to use the mask, I'm not sure why I should bother.

In reality, when I use the mask and have very low CA's, I really don't feel any different comapred to the days when I don't use the mask.

ATM, as the Resmed tech set the machine up to CPAP 10.2 and told me to come back in a week for review, I'll do that until he gives up.    

Regards,

Steve

[SteveC]

Hi all,

I have decided to put these screen shots in a separate post.

Note AHI on one is high, the other is low. Don't know why.

Also note flow rate graph is visible on 6th March but not the other two. Can anyone expalin why? It is not available in the graph selection. AFAIK, I did not change any settings between those dates.

Regards,

Steve

           

[quiescence at last]

yes, my guess is that on those nights when you did not see flow rate, it is because you scrolled the screen down to see how the snores were.

QAL

[SteveC]

Re the flow rate chart, no, that was not the case. I checked that as I thought that might be the case. I noticed that there were two extra entries in the summary for 6th March, one for insp. time and one for exp. time (inhaling and exhaling). The machine must be sensing something at a particular point in time and adding those as well as the flow graph. 

If you look at the graphs available at the bottom left you will notice that also changes.

[SteveC]

Ok,

Some updates. I changed the CPAP pressure from the clinician's setting of 10.2 to 8 and found that really reduced mouth breathing. Graph 1 shows AHI of 2.91 with a leak of 6 which is great.
I descided to drop the pressure further to 7 to see what happened. AHI at 3AM was high, so I reset it to 8. That resulted in an overall AHI of 9.28 for the night. The nest two nights showed and AHI of 34.58 and 49.05  respectively with a leak rate of less than 15.

I have included the graph also of the AHI at 49.05 with a pressure of 8. 

My question is, with very close to the same settings, why is the AHI so markedly different?
I have narrowed the graph time scale down to cover 1/2 hour so it might be a better indication. If you need a wider time scale on the chart i will provide.

An interesting note, if the pressure setting is changed after a night, the new setting is displayed in Oscar Device Settings, not the setting for the night, altough the correc t pressure is shown in statistics.

Regards,

Steve.  

       

[SteveC]

Another update.

Last night, pressure of 7, chin strap, leak of 4 and AHI of 5.2.

I'm happy with that, I'll see how it goes over the next few days.

Regards,

Steve