Clear airways on my OSCAR report

[mmorris9001]

I am relatively new to CPAP and have been really struggling with it. I only recently found a mask that allowed me to sleep through the night but I still feel tired in the morning no matter how much I sleep. When I looked at my OSCAR reports they have varying amounts of clear airways on my report. My AHI is almost never below five. Any advice you can give on what steps I should take next would be greatly appreciated.

I included two nights of my OSCAR reports and my sleep study since I always see them being asked for.

[Sleeprider]

Your diagnostic study shows you have predominately central apnea. The diagnosis of "pathological breathing disorder" is remarkable for not committing to obstructive or central apnea. Your AHI is still not below 5 per hour and everything is central, so I think we can conclude that the doctor prescribed CPAP with hopes that you would be treated adequately. This is a normal approach, and one that is actually required by insurance which will not reimburse for advanced positive air pressure devices until the patient fails CPAP. You have what is properly diagnosed as idiopathic central or complex sleep disordered breathing. I doubt you will achieve efficacy with CPAP or even bilevel (BiPAP). During this time you are demonstrating a commitment to use your equipment (compliance), and your doctor is evaluating the effectiveness of treatment, and probably has a follow-up scheduled.

The device used to treat central apnea is called an adaptive servo ventilator (ASV). It is a form of bilevel with a backup rate that provides a low pressure during exhale to keep your airway patent against obstructive apnea, and will provide pressure support during inhale to make inspiration easier and more comfortable. It's defining capability is to increase that pressure support if you don't spontaneously initiate a breath, and that increase in pressure can cause you to have a breath. Kind of like artificial respiration, the machine ensures your breath rate and volume stay the same as it was for the preceding 90 seconds. ASV is sophisticated and expensive, and insurance hates it and will make you and your doctor jump some hoops before it is approved. Read our wiki on Justifying Advanced PAP machines http://www.apneaboard.com/wiki/index.php...P_Machines

You can call your doctor and notify him you are not experiencing restful sleep, and that your AHI remains high and is all central apnea. I don't think he will be surprised. The next step for you is to have a titration evaluation for CPAP that progresses to ASV to determine if CPAP can be titrated to prevent apnea, and a trial to evaluate the efficacy of ASV. You can speed the process up a bit by communicating / complaining to your doctor. Keep using the CPAP therapy, but understand that it cannot treat your central apnea, and this is just a first-step for you.

[Gideon]

SR beat me to it.
Your diagnostic study was predominantly Central Apnea, your diagnosis should be idiopathic (meaning unknown cause) central Apnea. Your current machine cannot treat this. So you need to convince your doc that this isn't working.

Ask your doc when can we schedule a titration test with something that works.? Can you request that an ASV is included.

Expect to be titrated on a BiLevel and fail then on an ASV and succeed with an AHI approaching 0-1.

[SarcasticDave94]

Mmm ditto the above. I strongly suggest taking pen to paper and writing a symptom and complaint diary of all the things the current therapy is failing to do. Not well rested, not treated, etc. Tell the doctor this current AutoSet failure as often as needed. Request ASV titration. Accept ResMed AirCurve 10 ASV only when the ASV determination is finally approved.

[Ratchick]

What the others have said. You have predominantly central sleep apnea and unfortunately, APAP/CPAP isn't the answer for most of us. ASV is definitely the way to go.