Help with new bilevel titration and TECSA

[ATeam91]

Hey Apnea Board Friends,

I am learning how to titrate my newly obtained bilevel machine to treat OSA. I have a few questions for you as you have been so helpful in this journey.

My sleep studies ranged from 5 to 24 AHI, all obstructive. I was started on CPAP for the first 18 days and struggled to fall asleep breathing against pressure, so I was moved to a bilevel (AirCurve 10). It is much much easier now to fall asleep and I can sleep all night.

Analyzing my data, my AHI is low, but it looks like I am having some treatment emergent central sleep apnea. I think there are events that are not being flagged as central apneas that are centrals and that my disturbances are actually higher. You can take a look in the attachment.

If you would really prefer the OSCAR report, I can upload that too. I am still learning but I think the data from SleepHQ is still helpful.

What do you think? Am I having waxing and waning flow followed by pauses indicating central apneas that are not being flagged by the machine? I am confused by the flow rate that spikes up and down periodically.

Secondly, based on your answers, how should I adjust my IPAP and EPAP settings to accommodate and have more regular breathing? I currently am trying 9 IPAP 5 EPAP with cycle and trigger set to very high. This feels the most comfortable.

Making things even more confusing, I am tracking sleep quality and breathing interruptions each night with the Wesper sensors in addition to the ResMed reports. The ResMed report said I had an AHI of .64 which is excellent, but my Wesper report (attached) says it was 24. This is a huge discrepancy and I am not sure how to interpret this as I did have desaturation events.

If I am missing the forest for the trees here and am off base, please chime in, and thank you for the help! 

[UnicornRider]

We are accustomed to working with OSCAR, This is my first time viewing sleepHQ. 

I get more useful data that is needed here from the OSCAR Report format.

Yes, if you desire assistance post an OSCAR Report. 

[SarcasticDave94]

Hi and welcome to Apnea Board,

Yes, given the sleep report has no CA, it appears correct the CA you mention are treatment emergent. Agreed it's helpful to include an OSCAR chart. I think there's a standard chart arrangement on there within the detailed tab in OSCAR. Also make mention of the VAuto settings you're running, which is the machine I'm guessing you're on. To deal with TECA you'll probably need to lower PS. Example: if PS is 4 you'll maybe try 3 or 3.Even number. I would also say try your best to limit this to one setting that's edited, to tie effect (chart stats) to cause (the setting that was changed).

[PeaceLoveAndPizza]

It is hard to follow with the SleepHQ output as it does not give the actual machine settings. You said you use 9 IPAP 5 EPAP, but SleepHQ looks to show 9 IPAP 6 EPAP.

There is so much we don’t know about the setup, post an OSCAR chart and we can go from there.