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(07-18-2022, 09:01 AM)Sleeprider Wrote: Jonno, welcome to Apnea Board. Your results with the Autoset are interesting with all events being central. Your pattern of sleep disorder is fairly common. Shortly after going to sleep your pressure rises from your ramp of 5.0 to a higher pressure. You seem to have 6.4 as a maximum pressure and EPR that keeps your exhale pressure at 4.0. It will help if you minimize the monthly calendar so we can see more respiratory statistics and settings. While the event rate is low, you find it disruptive to sleep. Your previous sleep results do not indicate a problem that would normally qualify for medical intervention or insurance reimbursement.
We need to get a better look at normal respiration where you are sleeping but not experiencing events so we can evaluate what the flow looks like, and we may want to evaluate what your therapy looks like without EPR to see if that helps. Let's consider this an evaluation period of your response to some different CPAP variables, that we hope will lend some insights to your problem/needs. I would like to see you try a night of fixed pressure with EPR and ramp off, and a fixed pressure of 6.0. You can still use Autoset mode with a minimum pressure of 6 and maximum pressure of 6 and the device will record flow limitation. If you change to CPAP mode it will disable flow limitation scoring. This should provide a look at your baseline respiration without the influence of bilevel (IPAP/EPAP) pressures. Your respiratory flow seems to vary from breath to breath and in addition to seeing the full night, I'd like to sample some zoomed screenshots of 3-4 minute duration where we can clearly see the flow wave shape. Remember to swichoff the calendar by clicking the triangle or F9.
I managed to stick it out on these settings. Was difficult initially but managed to get through the night and it got more comfortable as the night went on. I have attached 2 screen shots. AHI is low but still getting the centrals.
It Seems the fixed pressure was causing more hypopneas and disturbed sleep. I set it back to EPR with Ramp Auto half way through he night. I struggle to fall asleep with ramp off and fixed pressure. Im not sure what to try next for the centrals.
If we were working with the Vauto or VPAP S we could use some pressure support and set the trigger sensitivity on high. This seems to help queue your spontaneous respiration to create a breath, when a CA might normally be recorded. We're kind of out of options on CPAP.
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Thanks for the help sleep rider. I’ll see if I could trial a different machine. The only other option I could get hold of is an AirCurve 10 CS pacewave. Might only be in a few weeks though.
One additional question I have is, prior to quite a number of the CA events I notice an arousal, does this mean I’m awake.
And on others there seems to be a build up of a waxing and waning pattern where it looks like I’m asleep.
Hi Jonno12,
Others who are commenting have far greater expertise, but want to share a few things. I'm 77 and have been in CPAP therapy for 2.5 years. Overnight full sleep lab study showed 101AHI primarily centrals. Sleep doctor got me ResMed ASV which from the little I've researched is the preferred machine for primarily centrals. While I'd be happy to have some of the numbers in your posted data, you are smart in both researching things, addressing it, and getting forum help. It seems that your doctor who seemingly dismissed your concern (intuitive insight about centrals) is a "fool" as while central sleep apnea is less common it does I believe account for about 15% of all apnea.
You are correct in being concerned about the duration of central events as duration seems to have some correlation with the likely drop in oxygen level, and drops (especially if sustained) below 90% particularly below 88% are not a supportive environment for your brain and body. While good that you are addressing this at a comparatively young age (I was not aware of things and diagnosed til 75), the potential cummulative impact for you over the next 50 years could be significant.
While I have some cognitive decline it is less than the preponderance of my peers, and assuming my apnea has gone for a while and since at least upon testing is far, far more severe than your own, my conjecture is that while you should address it, it is probably not causing super serious damage. If I were you, I'd be hopeful.
While medicare covered most of my REsmed ASV machine cost, I did also buy a used machine as back up and for travel. There are several websites that you could find selling used equipment.
Since it seems that no one else had responded to your OP in a broad and encouraging context as I read the comments, I wanted to offer the above and hope that it is of some comfort and help. Keep motivated and learning and experimenting and I expect that you will gain mastery fairly easily. As you probably know there are various ways of evaluating the effectiveness of sleep and its healing and restorative powers that all of us are after. I don't think you need good luck as it seems like you have a solid approach in working with and managing your life.
Hi Liteheart1
Thanks for your encouragement. I eventually could not deal with the sleep disturbance that I got hold of an AirCure ASV after seeing a cardiologist to check my LVEF. On good nights I’m getting my AHI below 2 but I’m averaging between 2 and 3. I’m no longer waking up gasping for air which is great. My sleep report also shows that I have not had a single central event since I started it. I am however experiencing hypopneas usually during the ramp period (I struggle to fall sleep without ramp), associated with a leak and post arousal so I disregard most of them.
My sleep is still quite fragmented and disturbed due to rainout (I have a climateLine tube, I can feel it heats up as I start the machine but then seems to stop heating and it cools down) and my nose itching. Using a nasal mask I need to remove it to scratch my nose. Hopefully I’ll get over this. When the pressure ramps up I’m also having a lot of leakage which I think occurs when I roll onto my side. I’ll probably return for some assistance if I’m not able to tweak the settings successfully on my own.
Glad things are somewhat improving for you. Do forum search on rainout and you will find numerous threads with good suggestions. I also use same heated hose, and in winter use wrap on hose to insulate it as many suggest. Mini-arousals//fragmented sleep is not restful - I know from my own experience. Suggest keep updating forum and provide detailed description(s) of what issue(s) you might be having and I expect you will get some excellent input from others with experience and solutions that have worked for them.
Perhaps proving info on your typical/preferred sleep position would be important info to share as the physics of mask/face structure/ sleep position/ movement or lack of it/ position of head on pillow/ type of sleeping pillow/ where hose is/ etc. all can contribute to mask stability and therefore possible leaks. If you haven't already elevated your hose by attaching to headboard on a loose swivel that might be an experiment to consider. I use an inexpensive <$15 hose support to accomplish this available at many of the cpap vendors noted on the website. Glad you have ASV machine as I believe that might be the better tool for you. Most people who pay for their own supplies find that the mfg/vendor recommended replacement schedule is far far too conservative and that the suggested time frames can be (greatly) extended - obviously a money saver for you.
Hi Liteheart, I’ve done quite a bit of reading about rain out on the forum. I could probably e doing more about it. I’ve tried increasing the room temp. I did notice that it was at its worst when it’s very cold. Next I think I’ll try elevate the hose on the headboard. I’ve been trying to figure out if the hose remains heated. I can definitely feel it is slightly warm to touch as I turn it on but when I wake up because of moisture build up, I can’t feel the warmth anymore, so I’m not sure that it remains heated. I’ve gone through manual settings. Currently have humidity on 6 otherwise my nose dries out.
I’ll shortly share my experience and challenges and also ask for advice. Thanks for your tips.
Hi Clownbell. The Hose is new and it definitely warms up when I start the machine, but it does not feel like it stays warm. Only once did it fully rainout where water collected in the heated section of the tube, now it seems to be the end section that attaches to the mask. It also has the notification that appears when the machine senses the hoses is connected.
