Help! High CAs, not sure if I'm dialing settings right.

[azntaiji]

Hello!

I've been trialing my APAP for 40+ days now, and it appears that central apneas have been representing the majority of my events.

Below is OSCAR data from 3 nights with initial settings.

   

   

   

After day 28 I changed my settings, based on a video tutorial that recommended I adjust my max APAP to my P95 level, and min APAP close to my average pressure levels. I will attach OSCAR data from 3 of those nights in the next post...

[azntaiji]

Below is OSCAR data from 3 nights after I changed my settings. I'm not sure if I'm doing it right, and could really use some help identifying what the main issues are, especially regarding the central apneas.

   

   

   

Below is data from my polysomnography that I had done prior to starting CPAP, if it helps to have background. Thank you!! 

   

   

   

[SarcasticDave94]

Welcome to Apnea Board,

Regarding Central Apnea, you have what looks to me like predominant CA. Here's why I think that:

Your report says this 11 Obstructive Apnea, 18 Central Apnea, 248 Hypopnea. What it doesn't say is what mixture the Hypopnea are, because that could be a mix of Obstructive and Central. So let's go back to the first 2, 11 OA to 18 CA. You had 7 more CA than OA, not being sarcastic when I say this is more than half the Apnea, but not necessarily half the overall events.

What to do?

Step 1
I think you'll want to edit your AutoSet, make sure to minimize pressure swings by no Ramp, mentioned because you might try it, EPR possibly needs to be turned off but it'll affect all other events unfortunately. Maybe round up your min pressure to 8, keep 11 as Max. We might need to trial static single pressure, but maybe not just yet.

Step 2

Contact the prescribing physician. Ask what treatment plan there is for your higher level Centrals showing in the sleep study. Intentionally not saying OSCAR for now. Include legitimate complaints that therapy isn't x (include uncomfortable, not well rested, feel worse, machine says high CA, basically what you FEEL), between you and myself you probably don't have much positive to tell doctor about your AutoSet therapy. Why does Dave say this?

Answer, you very likely need another machine than AutoSet. I think with the CA component you'll need ASV to treat CA. But you may be held to the doctor/insurance plan to progressively fail CPAP, Bilevel, even ST which by then I'd put the foot down and refuse the ST. Final stop is ASV.

If me, I would complain about the CA, request the next machine, go for a ResMed AirCurve 10 VAuto. It does have more tools to help you than AutoSet, but not as much as ASV when dealing with CA.

The VAuto has timing controls but not breath backup rate, while ResMed ASV has auto only timing controls but includes breath backup rate, important for CA control.

That's my take.