[Diagnosis] Round 2 Sleep Test

[pearlpearl]

See...this is the kind of stuff I want someone to do with mine. Posting a screenshot or two is one thing but having you actually look at the data is entirely different. I need to figure out how to get mine so you can look at it if you want.
You guys are doing great work here.

Hi David, I totally agree they are doing a great work here.  I think just need a bit of patience there are a lot of kind and knowledgeable people here.  Good Luck and Take Care!

[pearlpearl]

I would give 6/EPR3 another shot.  The 3/11 study was a 11/EPR3 night and breathing instability only started to rear it's ugly head, so let's try to differentiate between sleep and apnea.

I forgot to mention, CSR came back to the chart with setting 6/EPR3.

[Geer1]

Absolutely not periodic.  Doesn't even look like sleep.  SWJ.

That isn't the same day... If you are going to post data on behalf of the patient please post the full OSCAR screenshots so all of the necessary information (date, settings etc) is known to all members. 

Interesting looking data though. Some of it would be hard to replicate if you tried, part of me wonders about some ugly rem sleep breathing mixed in with some arousals/SWJ/central apnea aspect. Does the breathing only look like that for that short period or is a lot of that central apnea ugly like that?

[Rubicon]

That isn't the same day... 

That's the same day from my previous post.

What day are you talking about?

[Rubicon]

Besides, you just told me

"95% of beginner patients will not grasp the details you are trying to convey especially in tricky situations like this"

so what difference does it make as long as pearl2 knows what I'm talking about?

At any rate, pearl2 initially, and inadvertently, left out that file so I had to make a fake settings file in order to make it work.

Imagine the excitement when she thought she was on ASV all this time!

[pearlpearl]

My understanding is that you have tried different settings in the past so lets see a screenshot from your statistics page scrolled down to the "Changes to Prescription Settings" section. This section shows us the pressure and epr settings you have used and average ahi at each setting. Depending on what settings you have tried in the past it may help confirm what has worked better or worse for you. I still think you should use a progressive, systematic approach to find ideal settings but I feel this data may help confirm that EPR of 3 makes things worse. If you have already extensively tried numerous settings it may confirm that nothing has consistently worked.

Hi Geer1, please find attached the Prescription Settings at my goggle drive from 12 Jan (my first day CPAP) to 6 Feb.  12 Jan to 15 Jan was set by the Sleep Technologist.  I secretly changed the setting to EPR 1 or zero from 16 Jan to 6 Feb.  I got caught on the 7 Feb hence no more EPR 1 or none.  Do also note i had LARGE LEAK during those settings.

https://docs.google.com/document/d/1mvcQ...ue&sd=true

[Rubicon]

For 3.29.2022:

1.  If you were to rate your quality/continuity of sleep that night on a scale from 10 (best ever) to 1 (worst ever) how would you rate that night?

2.  Again, we're trying to do desensitization with some focus on reducing leaks, so while this isn't quite as bad as some of the past, it's still a little disappointing:



3.  IMO a lot of the centrals are again from SWJ, but there is some periodicity in the CSR-tagged area.



An arousal leads to chain central stuff.  This may have enhanced by the leaks and CO2 washout (the air blowing by your face removes CO2)(there's a whole arm of therapy devoted to CO2 manipulation called EERS which can be fun, but with only about 30 minutes each on a couple of days way to early to go down that road).

4.  There's a little more flow-limitation, and they look a little more significant in waveforms than what is reflected in the graph:

[pearlpearl]

For 3.29.2022:

1.  If you were to rate your quality/continuity of sleep that night on a scale from 10 (best ever) to 1 (worst ever) how would you rate that night?

2.  Again, we're trying to do desensitization with some focus on reducing leaks, so while this isn't quite as bad as some of the past, it's still a little disappointing:



3.  IMO a lot of the centrals are again from SWJ, but there is some periodicity in the CSR-tagged area.



An arousal leads to chain central stuff.  This may have enhanced by the leaks and CO2 washout (the air blowing by your face removes CO2)(there's a whole arm of therapy devoted to CO2 manipulation called EERS which can be fun, but with only about 30 minutes each on a couple of days way to early to go down that road).

4.  There's a little more flow-limitation, and they look a little more significant in waveforms than what is reflected in the graph:

For 3.29.2022:

1. 6, I felt a slight headache last night.  Didn't feel quite rested and not into that deep sleep mode.  When to pee around 415am though, couldn't get back into sleep again.  However didn't feel restless or tired during the day.  I am still quite awake typing here at 10:50pm Singapore Time.  I am going to bed now with 6/EPR3, last night hahaha and maybe switch to something else tomorrow night    Thanks!

[Geer1]

Pearlpearl if you look at those initial tests you will see that during the first 4 nights with 3 EPR your AHI was the worst of the bunch at 20-22 most nights (I am guessing first night was only lower due to being awake a bunch at the beginning of the night). The first days of data aren't very relevant right now though and what is more important is seeing your recent 3 EPR results. Posting your OSCAR settings tab including the "Changes to Prescription Settings" section would help interpret recent averages quickly. Here is a screenshot of the section I am mentioning.

   

On Jan 16th you tried one day of 1 EPR at a lower pressure and you had your best results of the bunch, these results were also similar to your recent 1 EPR results. 

Then you tried EPR 0 with a few pressure settings but your flow limitations (I am assuming FL but potentially could be snore, can't see the data) kept maxing out pressure so all you effectively tried was fixed pressures from 9-12 cm with 0 EPR. You suffered with leaks, 0 EPR makes it harder to breath out and you were most likely opening your mouth because it was difficult to breath out against the pressure and then leaking out mouth. AHI was mediocre (better than 3 EPR though) and I am not a fan of the flow limitations/snore driving pressure up.

Then you tried EPR 1 for a couple more nights at higher pressure (13 cm) and had moderate results (better than 3 EPR and 0 EPR data but not as good as lower pressure 1 EPR). You still had leak issues for the same reason (high exhalation pressure of 12 cm causing discomfort). 


In summary your 3 EPR data is riddled with central apnea and if it hasn't improved since then you are arguably making your sleep quality worse not better with those settings. Treatment emergent central apnea can get better with time but it can take up to 6 months. You are only 2.5 months in so it is still possible it could improve but both of your sleep studies indicated central apnea without CPAP so not all of your central apnea is treatment emergent. I expect you will always have central apnea present unless you use an ASV to treat it, the question is if we can we keep it to an acceptable level without ASV. 0 EPR doesn't get along with you and 1 EPR was the golden spot in January/February and also recently. Higher pressure doesn't obviously help but 13 cm with 1 EPR wasn't as bad as I would have thought it might be. I am sticking with my previous prediction that your best results will come with a fixed pressure somewhere between 6 and 9 cm with 1 EPR. There is also a chance a small range like 6-9 cm with 1 EPR might be best but I would try slowly increasing fixed pressures first to get an idea of how your apnea responds to pressure before considering a range.

[Rubicon]

Treatment emergent central apnea can get better with time but it can take up to 6 months. You are only 2.5 months in so it is still possible it could improve but both of your sleep studies indicated central apnea without CPAP so not all of your central apnea is treatment emergent.

Can you post some examples of pearl2 having treatment emergent sleep apnea?  I've reviewed about 345,000 breaths so far, and other than a few areas 
of waxing and waning, examples of which I've presented, I haven't come across any, so in my haste I must have missed them.

TIA.