CPAP Trial .. still not sure

[Oompa]

Hi all,

Firstly its great to see the support that this forum brings, I was pleasantly surprised when I came across it

Was originally diagnosed with severe obstructive sleep apnea (AHI in trail of 44) about 5 weeks ago and commenced a trial using the Resmed 10 Autoset and Resmed N30i mask.  After the first few nights I was moved to a fixed pressure mode due to combination apneas but since haven't really had consistent results despite daily reviews and tweaks from the clinic

Its to the point now where I need to decide to purchase a machine and they're insisting fixed pressure is the way to go.  

I've attached a pile of sleepyhead screenshots which show some of the changes performed last week and then the recent 4 nights.  Not sure what happened last night but as you can see at some stage I removed my mask

Any suggestions? Is a fixed pressure machine really the way to go saving me $5000 or have they missed something?

Thanks in advance!

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[SarcasticDave94]

Oompa, a sincere

I'm not anywhere a chart reading guru, so I'm letting that to those with expertise in doing so. I will say this though, CA showing up which typically means central apnea events. Gurus would help ID if this is a real mixed apnea issue like mine or if it's the type some get when starting on CPAP. The second type, I forgot technical term (pressure induced?), will fade away after using a CPAP for a while.

You're off to a great start with knowledgeable chart postings. Gurus may suggest you tweak them a bit I guess. They almost always do that, but for good reason. Anyway a kudos padawan Oompa. Light saber training here we come!

Where were you told of the $5K price? Because that's highway robbery territory. I'm not bashing you, I really am curious who quoted that. That's about double, possibly more, than my ASV machine cost. And mine is probably the most expensive xPAP there is.

[Oompa]

Thank you for the warm welcome and after the congrats on doing a good post I'll now have to correct it as I added an extra 0 :

As per others this is suppose to be $500 more not $5k :O

[SarcasticDave94]

Thank you for the warm welcome and after the congrats on doing a good post I'll now have to correct it as I added an extra 0 :

As per others this is suppose to be $500 more not $5k :O

Oh that makes more sense. No worries, I'll just use a red challenge flag and you won't get any of my virtual coffee this month. Not a penalty really because this virtual coffee is nasty.  

OK on to a serious thing...exactly which CPAP do you have? Try to find the model number. Example: mine is ResMed 37043.

[Oompa]

OK on to a serious thing...exactly which CPAP do you have? Try to find the model number.

Model is a Resmed Airsense 10 Autoset (Air10)

[SarcasticDave94]

I think I'm right but the Autoset, when set-up correctly, will "tell" us great info to point you in the right direction in settings needed. I believe the Sleepyhead charts can reveal this after a night's usage. We can go by pressure info seen there to formulate some ideas.

Sorry my image on the model example didn't show, I got to get it smaller. Maybe a moot point anyway now.

[Oompa]

I think I'm right but the Autoset, when set-up correctly, will "tell" us great info to point you in the right direction in settings needed. I believe the Sleepyhead charts can reveal this after a night's usage. We can go by pressure info seen there to formulate some ideas.

Sorry my image on the model example didn't show, I got to get it smaller. Maybe a moot point anyway now.

Thanks for taking the time to respond, much appreciated

I think you're saying the machine set in auto mode might give more insight?  If this is the case I've attached the last screenshot for when the machine was set on auto.. hope this provides some insight

[Gideon]

Wellcome Oompa,

Do you have a copy of your sleep studies?  Can you post a full copy? not just the summaries.  They will tell us if you had Central apnea before your treatment.

With the mixed apnea that you are currently showing we tend to recommend a narrow range of pressure and a minimum or no EPR.

Frequent pressure changes, either way, tend to increase apnea, thus the narrow range or fixed pressure even with an auto CPAP, EPR changes pressure on every breath so tends to not help CA events.  Auto CPAPs are programmed to not change pressure for CA events.

Rule of Thumb for CA is to reduce pressure to eliminate Central events.
Rule of Thumb for OSA is to increase pressure to eliminate obstructive apneas.

As you can see this results in a compromise.  A basic Auto CPAP machine, you have the best of them, is NOT designed to treat central apneas.

How do we treat CA with an Auto CPAP?  By trying settings then seeing how you react.  If we were doing it for ourselves we would likely start by setting a range to your current setting +/- 2 so 8 - 12 cmw.  Note: this may make your apnea much worse but that is ok because then we know that those settings do not work well for you.

If this is as I call it Therapy-induced then it should go away after a period of several months.  If not a more advanced machine, the ASV Dave talked about, may be in your future.

Fred

[SarcasticDave94]

I know I'll sound like a broken record, but others are far better than I at chart reading. However, I see lots of CA, again typically central apnea.

Did you, and if not can you, post images of your sleep study and/or titration? Suggest redacting/blacking out personal info. BTW if you do not have these, I suggest getting copies of these and your scrip too. Nice to keep these on hand.

[Gideon]

Your auto example shows an increase in Central Apnea events and a decrease in Obstructive Apnea events as I suggested above.  IMHO I would favor OA over CA because in most OA you have some airflow while in CA you have none.  Thus I would call your 6 - 16 trial a successful test because we learned something, but it was a failure for your therapy.