Help with CA Clusters

[ZipZap]

Hello!

I was recently diagnosed with severe OSA and started on a CPAP trial a month ago.

The sleep study showed central and mixed apneas and I continue to see CA events in the data, I also understand that CPAP doesn't treat CA's.

Some nights are better then others, with the AHI of the CA's ranging from ~2-15. The resmed also flags CSR's but not every night. I also wake with headaches, these seem to go along with the days when the AHI is higher.

I track my SpO2 and can see that it still dips below 90% (83% is the lowest i have seen) when I have these CA clusters.

Currently on fixed pressure of 8cm with EPR of 1, I have also tried turning the EPR off for a few nights but didn't notice a difference in the CA's.

I had a follow up with the Doctor just the other day and they don't think it is anything to worry about and should improve in the next 3-6 months but I am not so sure. They also said I should expect an AHI of less than 10 on CPAP which worried me.

I am currently renting the CPAP machine as a "trial" and will need to purchase one out of pocket but don't want to get into a situation where I purchase a CPAP then after 6 months the CA's are still there and they turn around and say a ASV is would be better for me.

I would really appreciate it if someone could take a look at my data and provide some feedback.

I will attach last nights data from Oscar and also the original sleep study

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Sleep Study results

[SarcasticDave94]

If me, there's a few thoughts about your situation. 1. I don't think the CPAP will be able to help. The 42 Central and 116 mixed are to me pointing to the ASV to treat. The CPAP AutoSet or bilevel VAuto just aren't likely to get this down to a treated state.

BTW here in the US at least, CPAP therapy needs to get you down to 5 AHI to be called a success by the medicals. Baloney on accepting 10 AHI. No go.

For now, I think you need to get rid of the Ramp if possible. It's possibly adding to the CA by way of the variable pressures a bit.

Have you called out the Central and Mixed content on the test, requiring the doctor to admit they're on the test, and then ask bluntly "Will we attempt to treat these, or do you plan on ignoring these?" Then if me, I'd state I cannot ignore the test results. I need a proper therapy machine. Welcome to the ResMed AirCurve ASV. I think your side of the pond will be a ResMed Pacewave ASV or similar.

This ASV is bilevel but it's programmed to combat CA, yet takes the rest down as well. This bilevel has a backup breath rate that the algorithm controls. You just plug in Mode likely ASV Auto to get EPAP Min/Max and PS Min/Max. IPAP is the sum of EPAP and PS, whatever is active per that moment.

You may try VAuto and the Trigger setting at High or Very High, but my opinion is that's not going to be able to avoid enough.

[ZipZap]

Thank you!

This gives me confidence that I am not overacting or misreading what is in the sleep report and CPAP data. I was honestly super frustrated after leaving the doctors but was starting to think I must be wrong.

I have called out the Central and Mixed content on the test and was told the CPAP should reduce these over time which I find hard to believe.

I will disable the Ramp tonight.

I think I need to have another chat with the doc or maybe find a new one.

[SarcasticDave94]

Yes, sometimes firing and replacing doctors is needed. Best wishes you get what's needed. And keep us updated.

[ZipZap]

It took a few attempts but I was able to convince them to trial me on a ASV.


Settings that have been prescribed:
EPAP min 4

EPAP Max 8
PS min 3
PS Max 8

Just had my first night, it did take a bit to get use to as I had just gotten use to the constant pressure from the CPAP but overall I do feel much better this morning. AHI is by far the lowest I have ever seen at 0.36!!! Comparing that to the night before on CPAP which was 9.72.

Sp02 minimum was 92% which I am happy about, on CPAP this was dropping to 83-85% with the central events and periodic breathing.

The Flow limit seems to be higher?

[SarcasticDave94]

When on the ASV, flow limits will likely look bad. You'll want to ignore them in this case. They're basically an artifact of the ASV therapy.