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New to CPAP, sleep apnea, this forum. etc. Was diagnosed with OSA just over 1 year ago with an AHI of 6.6. While there was some day time sleepiness, the primary reason that I decided to use a CPAP was due to my partner complaining of snoring.
Have been using my CPAP machine for 1 month now. Since I have historically been a mouth breather when I sleep, my choices relative to a mask were to either use a full-face mask or some sort of nasal mask with a chin strap. I chose to try the nasal cushions with the chin strap.
My partner said that she no longer hears me snoring, so that is progress. However, when I look at the OSCAR data which I have collected since the 1st night, my average AHI is 6.76, and on a nightly basis its all over the place with no discernible (to me) pattern. The low being 1.14 and the high being 19.15.
So on the surface, it would appear from an AHI perspective I have not made any progress. I have attached the last 3 nights of data. I would welcome any insight others can offer as to what the data means, and welcome any and all recommendations.
I think things could be better with increased minimum pressure at 7.0 and EPR at 2. The CA events are going to be consistently inconsistent, but might improve with lower EPR and the higher pressure may take out some OA and H and reduce pressure variations. Give that a try, and if need be we can look closer at remaining events.
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.
Hi, and welcome. I will give you my take based on my personal experience and peoples comments here on the forum.
I would love to see the snore chart and see if you snore with the ramp on (and if the snoring goes away when the pressure reaches 6 or higher).
All the experts here told me to turn the ramp function off and also reduce the EPR to 1 (some even recommend turning EPR off). They will advise you as they have far more experience in this than I do.
You look like you have a combination of Obstructive and Clear Airway apneas (like myself). I eventually had to switch from the A10 Autoset to the A10 ASV (I could not reduce my inconsistent central apneas).
Mask leaks and mouth leaks are an issue for me. I tried Somnifix and am trying the Knightsbridge chin strap (it's a little warm to wear in the summer for me). I also use the Resmed Airfit p10 nasal pillows which I think is a terrfic mask.
I am sure Bonjour, Sleeprider or JasWilliams will chime in on this one.
Attached are the same 3 charts including the snore data. Ramp is off. I am still snoring. However, what do the values on the Y-axis mean? Is any amount of snoring relevant? Is snoring a trigger or correlated with CA's?
(07-22-2020, 01:59 PM)Sleeprider Wrote: I think things could be better with increased minimum pressure at 7.0 and EPR at 2. The CA events are going to be consistently inconsistent, but might improve with lower EPR and the higher pressure may take out some OA and H and reduce pressure variations. Give that a try, and if need be we can look closer at remaining events.
Thanks for the feedback. Relative to the change to a min pressure of 7.0, I assume you are recommending that because I am quickly going over that level anyway. Correct?
Relative to CA events, can you explain why I should expect CA events to be "consistently inconsistent" (as I am)? If there is a wiki page or a thread somewhere that explains this, feel free to direct me to the right place.
In any case, will try the changes that you recommend.
Head injury, Strokes, Seizures, Meds especially opiates, idiopathic (Don't know). I'll add another later.
How do you treat Central Apnea from a Head Injury? Possibly Meds, not at our disposal, and your doc likely didn't prescribe anything. ASV works, or You could always time travel and prevent the injury.
How do you treat Central Apnea from a stroke? pretty much the same as the head injury.
How do you treat Central Apnea from Seizures? Depends on the cause of the seizure, meds come into play, genetics too. In the future, you may be able to be genetically modified to make you not susceptible to some types of seizures. Or ASV
Opiates are known to cause centrals, obvious solution is to get off opiates, or there is always ASV
Idiopathic, if you don't know the cause you can't fix it. ASV is there again.
The bottom line is your CPAP machine has no mechanism to treat any of these forms of central apneas. Because we can't control the cause we can't treat central apnea with either a CPAP or a BiLevel without backup. It simply is not designed to do so. The end result of not being able to control all these different or even just one of the causes results in a sporadic and irregular central events. It happens so often we call it consistently inconsistent, meaning expect it to change.
An ASV, adaptive servo ventilator, is designed to treat Central Apnea, and the newer models treat OSA as well.
Another form of Central Apnea we see quite a bit of is Treatment-Emergent Central Apnea. To a certain degree, we can at least have an impact on this form. This form is caused by having too little CO2 in your blood. Since we know the cause we can influence it.
When CO2 levels drop below the apneic threshold a central apnea will occur. This happens because a CPAP or BiLevel has increased the efficiency of your breathing improving your oxygen exchange and increasing the removal of CO2 from your body. The trick is to make it somewhat less efficient so the CO2 does not drop below the apneic threshold and cause a central apnea.
Gideon - Project Manager Emeritus for OSCAR - Open Source CPAP Analysis Reporter
(07-22-2020, 07:06 PM)bonjour Wrote: What causes Central Apnea?
Head injury, Strokes, Seizures, Meds especially opiates, idiopathic (Don't know). I'll add another later.
How do you treat Central Apnea from a Head Injury? Possibly Meds, not at our disposal, and your doc likely didn't prescribe anything. ASV works, or You could always time travel and prevent the injury.
How do you treat Central Apnea from a stroke? pretty much the same as the head injury.
How do you treat Central Apnea from Seizures? Depends on the cause of the seizure, meds come into play, genetics too. In the future, you may be able to be genetically modified to make you not susceptible to some types of seizures. Or ASV
Opiates are known to cause centrals, obvious solution is to get off opiates, or there is always ASV
Idiopathic, if you don't know the cause you can't fix it. ASV is there again.
The bottom line is your CPAP machine has no mechanism to treat any of these forms of central apneas. Because we can't control the cause we can't treat central apnea with either a CPAP or a BiLevel without backup. It simply is not designed to do so. The end result of not being able to control all these different or even just one of the causes results in a sporadic and irregular central events. It happens so often we call it consistently inconsistent, meaning expect it to change.
An ASV, adaptive servo ventilator, is designed to treat Central Apnea, and the newer models treat OSA as well.
Another form of Central Apnea we see quite a bit of is Treatment-Emergent Central Apnea. To a certain degree, we can at least have an impact on this form. This form is caused by having too little CO2 in your blood. Since we know the cause we can influence it.
When CO2 levels drop below the apneic threshold a central apnea will occur. This happens because a CPAP or BiLevel has increased the efficiency of your breathing improving your oxygen exchange and increasing the removal of CO2 from your body. The trick is to make it somewhat less efficient so the CO2 does not drop below the apneic threshold and cause a central apnea.
Thanks for the detailed explanation. Much appreciated.
So I made the changes recommended above, namely set min pressure to 7.0 and EPR to 2. I do not know if this can be considered a "trend", but based on 4 nights worth of data my number seem to be consistently better. My AHI is consistently below 3 and the CA's seem to be more stable. You can see the last 3 nights in the attachments.
So what should I do now? Should I keep these settings for a few more nights to see if this is a trend, or make additional adjustments to see if the numbers can be further improved?
Additionally, I would be interested in any thoughts on the leak data? As mentioned above, before I started using my CPAP I was a mouth breather. To control this, I am using a chin strap with my nasal mask. Is this being effective enough? Does the data show any mouth leak? Are the numbers so low, i.e. way below the threshold, that any leaks do not matter? I would like to get rid of the chin strap if possible. Is it reasonable to try a few nights without it and see what happens? Any insight here would be appreciated.
Also, would be interested in any comments that can be provided on the snore data as prior to starting my device snoring was the big problem. My partner is no longer complaining about my snoring. However, are the numbers high enough to be relevant relative to my sleep quality? How can they be improved? What do the numbers on the y-axis mean?
As you can see, by increasing the minimum pressure to 7.0 your pressure is actually lower than when you started at 6.0. Your CA events have been reduced, mostly because your pressure is much more steady, resulting in fewer sleep disruptions. There are still some OA events, and we could probably knock those off with an increase in minimum pressure to 8.0. Assuming you are comfortable with current pressure, I think it may be worth trying that change.
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.
I actually found it easier to breath with the new settings of min pressure = 7.0 and EPR=2 than with 6.0 and 3. However, for some reason I seem to be waking up after less sleep, but maybe that is not related to the changes. In any case, I will try min pressure = 8.0 tonight. Thanks for the recommendation.
What about the leak and snore data? Is there anything relevant there or should I just ignore it? I have a bunch of questions as listed above. As always any insight is welcomed.
