[Diagnosis] Surprised newbie with CSA/OSA -- Any words of wisdom?

[SarcasticDave94]

The Central Apnea component, not with everyone, but a select few, like yourself, Central Apnea can be a tricky issue. I have them too, and regardless of cause, doctors typically are either reluctant to treat, or they lack the knowledge or competency to treat. Maybe both in some cases.

The head on aspect means they need direct treatment, the same way Obstructive Apnea are treated directly. The CA can be treated, but it must be with ASV therapy (Adaptive Servo Ventilator). Here, I specify the ResMed names, because that's what I've used, and it was successful by itself. That is, I say that because by themselves, CA were treated, but my over complex issues include the following: Obstructive and Central Apnea, and then GOLD 3 COPD along side the Apnea hindered eventually.

OK, what I mean for your Central Apnea treatment is that it needs actively addressed by the ASV. It cannot get better by avoiding, just like Obstructive Apnea can't get better if you ignore it. Doctors don't always know universally how to actually treat Central Apnea. They'd rather not treat in most cases, but not only avoid treatment but "treat" by avoiding. Sorry I'm in my weird description thing again.

Take what I've said in this case literally not figuratively. The CA need treated directly not by way of avoidance. To treat Central Apnea of your type, which likely they're an idiopathic cause, again meaning unknown medical cause, is force your doctor to recognize the CA are an issue to you. They will hinder good sleep. To treat only equals they likely will need a Titration including ASV mode. They then script to the ResMed AirCurve ASV, and be specific here.

PS, the time to request therapy change from the AutoSet to getting the ASV is set by your time not the doctor. If you can't accept the therapy as is now, then now is the time to demand CA treatment.

[CLCCW]

Thanks Dave ... I will definitely self-advocate. Will watch the scores and reach out to him next week. Yeah, dunno about cause (living at altitude). My heart is good except for mild regurgitation at the valves.

Question: if switching to ASV, will that also treat my less common OSA?

Cheryl

[paulag1955]

You could change to fixed pressure and probably eliminate some of the central events but you have so many that I don't think it would be enough.

[SarcasticDave94]

The ASV will address all Apnea, yes.

Correct, closer to static pressure might reduce CA at times.

[paulag1955]

It does reduce my CAs on average, but there are still nights where it doesn't seem to help at all.

[CLCCW]

Hey there. A new thing to the party: Cheyne Stokes breathing last night (two 20 min chunks 12%). Although the API went down largely due to decrease in CAs last night. AHI 15. CA 14% (93 episodes). OA 0.31% (2 episodes). I feel ok, but I have felt day-sleepy for so long (my whole life) I don't know what "better" might mean.
Oscar Summary:
Your device was on for 6 hours, 26 minutes and 0 seconds.
You had an AHI of 15.39, which is under your 7 day average of 16.44.
Your pressure was under 8 cmH2O for 95% of the time.
Your average leaks were 0.26 l/min, which is under your 7 day average of 0.44.

[paulag1955]

Can we see your chart for last night?

[CLCCW]

Sure... here it is.

[CLCCW]

Good morning! I am two weeks in. Getting used to the system/mask, etc. 

Have had 2 nights where I slept mostly through, but other nights have been broken up with wakefulness (no shortness of breath, etc.) due to stress from work, mask shifting a bit (magnet came undone on one side, strap loosened) or sliding down my nose a tad (I am still guarded rolling over, etc.), nose itching, general aggravation at using this device, etc.  But last night was fairly solid, and feel rested this morning.

However, OSCAR reveals my pesky CAs. I know some can be 'false', but I have so many and have not yet gotten API under 5. Sarcastic Dave, you've noted the likely ASV need, which I will push for. But if you or someone could look at last night's data and give me your two cents on "progress", that would be cool. Or setting issues, knowing I am a complex (mostly CSA) living at altitude (5300' many years) and no heart issues other than mild valve regurgitation (just tested). Sometimes CS breathing is noted, not last night.

       

[SarcasticDave94]

You may want to try static pressure or close to it. By static I mean, based on current auto adjusting, it'll have the max pressure 8 pretty much always so try putting 8 in both pressure settings. If you can tolerate it that is. Alternate is bump min to 6 from 5. Goal is trying to avoid CA, which unfortunately doesn't look successful honestly.

Next if it were me, make doctor appointment to discuss status. Insurance is involved or not? If yes, you'll probably request a bilevel, specifically ResMed AirCurve 10 or 11 VAuto. Here you'll attempt therapy, with 1 trick AutoSet lacks, Trigger in either High or Very High. This enhances the sensitivity to trigger inhale pressure, the attempt is to gain avoiding more CA. Failing that, demand ASV. Insurance aspect means you must prove cheaper options fail, leaving expensive as only answer.

If no insurance, go directly to buying ResMed AirCurve 10 or 11 ASV. Website DotMed is one place to look.