Help with Oscar data newly diagnosed 55 AHI

[mmcf]

Help please! With my sincere thanks in advance.
• Definitely need assistance interpreting ResMed/Oscar data
• Home study shows a high (to me) number of minutes of "Invalid respiratory signals." Is this typical for a home study or is it indicative of a measurement problem (potentially invalidating results) or perhaps a health issue?

Attached AccuSom home study in May '19 showed severe OSA with 55.9 AHI, all OSA, none unclassified. I'm newly under the care of a Family Practice MD and unfortunately a mix-up at their office delayed transmitting the CPAP Rx to the DME until Oct '19 (yes, I'm guilty of not following up sooner.)
- sorry I had to break up the report due to size limitations

After 5 valid nights (out of 7 worn; first 2 skew historical averages) using the ResMed AirSense 10 AutoSet For Her with the AirFit P10 Nasal Pillow and ClimateLineAir Heated Tube I'm more confused than ever. Then again, confusion & inability to think clearly were primary drivers to my seeing a doctor in the first place!
Oscar screen shots attached. Anyone willing to help me decipher what this might mean?  Or what I might change?

Holy crap, why am I not breathing right?
I have more questions and comments about my possibly contributory health status and history but don't want to start off with a long overwhelming post.
And thanks again.
- Melissa

   

[attachment=16419]

[attachment=16420]

[attachment=16421]

[attachment=16422]

PS: I've frequently had the the flow rate and snore waveform graphs completely missing requiring a reload of data or closing and reopening Oscar; the pinning is based on troubleshooting I found online

[DeepBreathing]

Hi Melissa. Welcome to Apnea Board.

Your sleep test reports included your full name, date of birth and possibly other identifying material. To protect your privacy I've turned off access to these documents. Please let me know if you want them turned back on. Otherwise I'd recommend you redact the identifying stuff and reload your reports.

An initial look at your Oscar report indicates a pretty severe central apnea issue, which we'll need to get to the bottom of.

Edited to add: Could you post two more Oscar charts zoomed in on one of those periodic breathing episodes please? About 20 minutes starting at 05:40, and again at 08:00

[Gideon]

Welcome to the forum.

I would like to see a couple of 3 minute views of the charts below the green bar so that they can be evaluated.

[mmcf]

I'm grateful to the both of you.
I appreciate the concern and will attach copies of the sleep report without personally identifiable information to another post (attachment size max reached already here.)

20 minute intervals at approx 0540 and 0800:
   
   

3 minute intervals during probable Cheyne Stokes Respiration:
   
   

It's interesting no central apnea events were recorded on the home study although there a lot of "Invalid respiratory signal" minutes reported.
I'm somewhat relieved the study didn't show awful O2sats but this has been really disconcerting. No wonder my mind is shot and I've felt so lousy for so long.

Thank you!

[Sleeprider]

You really need to turn off the EPR function on your machine. If that does not resolve the central apnea, we will suggest a different solution. I'm certain you will experience a much better result if you change the settings to turn off EPR. Your settings are currently at the default 4-20 with EPR on full-time at 3. This is NOT working. It's possible turning off EPR will not resolve this problem, and if so you will need a clinical sleep study to verify your need for a more advanced therapy mode. Your problem does not appear to be obstructive sleep apnea, but turning off EPR will help us find out. Here is a link to show you how to change the EPR setting. https://www.apneaboard.com/resmed-airsen...setup-info

[mmcf]

Thanks Sleeprider. 
I will definitely turn off the EPR tonight and see how it goes.

I'm attaching only the summary page of the home sleep study... it doesn't seem at this point the charts would provide much.

I've been thinking the data shows my treatment needs may be better served by a board certified sleep physician than a family practice doctor. Bummer.

   

[Gideon]

I see SR has beat me to the punch, Turn off the EPR.

[mmcf]

No EPR dropped my AHI to 14.7!

Still all clear airway events and a short night of only 5.01 hours (typical for me.)
But another short 4.22 hour night with EPR on was all clear airway with a 60.2 AHI.
(this was the second night I attempted sleeping higher on my wedge pillow - after 2 nights higher on the pillow resulted in higher AHIs I've returned to a lower position. Unfortunately I've had to sleep on my back for the last 15 years.) 

AHI: 30.8/33.3/49.5*/69.2*/37.5/14.7 no EPR
*higher on wedge, others all lower

Without EPR I had my highest leak rate of 6 nights (excluding 1st 2 of 8 total.) I awoke at least 2-3 times feeling like there was no airflow from the nasal pillows and messed around with the mask until satisfied it was positioned well.

My sense occasionally, but particularly while falling asleep, was I wanted a higher pressure. I felt I wasn't getting adequate air unless I really concentrated on taking slow, deep breaths (not necessarily a bad thing to do!) but wished it didn't require being so cognizantly awake.

Turning off EPR seems to have helped significantly... Thank you!
Any further guidance would be greatly appreciated.

   

[SarcasticDave94]

The others will bring me in line if I stray too far off base, but I'm wondering if there are any known heart health problems you know about. This is possibly a Central Apnea issue, and if so this machine won't cut it.

You're likely needing to discuss this with whichever of your doctors you'd think would offer backing you, I'm thinking you're needing the actual lab sleep study to verify your status. Dependant on that sleep study report, if it shows a high central count, you might need what is called an ASV machine like mine. But to be clear, the sleep study will be needed for verification as it has the extra sensors to monitor better.

Best to your success and we'll help however we can.

PS in the meantime, I'd consider minimizing the pressure variations on your current machine.

[Sleeprider]

The level of central apnea you are experiencing does not usually resolve with time or adapting to CPAP. I think your sleep study found an AHI of about 41 per hour, so you are indeed getting a benefit from CPAP; however at 14 AHI it falls well short of our efficacy target. I agree with your conclusion that you will likely need a specialist, but more important than board certification, is experience with complex or central apnea. Far too many "board certified" sleep doctors see apnea and conclude it is always obstructive. The analogy of everything is a nail to a hammer. This is a cognitive bias on the part of many physicians that is reinforced by insurance policies and the prevalence of obstructive apnea in their practice. If you go looking for a professional, be sure they are open-minded about central apnea, and don't just dismiss this as "stupid machine data". You want someone willing to investigate and solve the problem.

If you are uninsured, you have the option to obtain an ASV machine on the used market. They are out there and work beautifully for people like you that appear to have an absence of obstructive apnea at low pressures. Typically, we find the lightly used Resmed Aircurve 10 ASV or S9 VPAP Adapt at prices from $800 to $1400 in the used marketplace, with the higher range being suppliers like Supplier #2, which offers services and warranty. I have heard of these machines being picked up on Craigslist and Offer-up as low as $300. So shop if you want to do it that way. Either way, the forum can support you and quickly help you to dial in the right settings to achieve near zero AHI.

To optimize your current results, I would like you to chage the settings to 5.0 minimum and 7.0 maximum pressure with EPR OFF.