Help with treatment and upstanding data- High occurrences of Clear Airway events

[amunozar]

I've completed three days of wearing my AirCurve 10 Auto Bi-PAP with an AirFit N20 mask, but I'm still feeling fatigued and haven't noticed any improvement in my AHI. Although I was recently diagnosed on 7/24/2024, I've been experiencing extreme fatigue and cognitive impairments for the past two years. While Day 1 was challenging due to acclimating to the mask and air pressure, I've since been able to fall asleep without issues. Upon reviewing the OSCAR data, I noticed a high occurrence of clear airway (CA) events. If I’m understanding this correctly, this aligns with my at-home sleep study results from Lofta using WatchPat One device, which indicated severe OSA  and moderate CSA with Cheyne-Stokes respirations present in 42.8% of my total sleep time. I'm also awaiting the results of my recent thyroid tests, as I suspect I may have hypothyroidism (my mother has it). In the meantime, I'm wondering if I should adjust the settings on my Bi-PAP machine to better address my sleep apnea. Are there any specific changes I should consider making to the device, mask, or other recommendations/tips? 

Given my high-deductible insurance ($5,000) with lousy coverage after meeting the deductible, I'm looking for any helpful tips or advice on adjusting my Bi-PAP settings to better address my sleep apnea. Any help is greatly appreciated! 

Sleep Study Results:
Summary & Diagnosis
Obstructive Sleep Apnea (G47.33) - Severe, based on pAHIo= 47.6 and O2 nadir of 77%. 
Central Sleep Apnea (G47.31) - Moderate, based on pAHIc= 24.3.
Cheyne-Stokes Respirations present in 42.8% of total sleep time.
RDI 48.8 per hour
Snoring 61.6% of sleep time > 40 dB
Oxygen Saturation 77% Min 02 Sat; 94% Ave 02 Sat


           

[staceyburke]

We have had success with the VAUTO using trigger setting to high or very high with centrals.  Give high a try for a night or 2 and then try very high and see if that will lessen the central apnea.

[SarcasticDave94]

Hmmm, this is a case where the treatment is as bad for you as the health condition. That's a lot of purple ink.

Do you have the sleep study results with the event table to post?

[amunozar]

       
Hello there! I appreciate your help. Here you go!

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Hmmm, this is a case where the treatment is as bad for you as the health condition. That's a lot of purple ink.

Do you have the sleep study results with the event table to post?

Apologies for the repeat reply. I am still learning how to use the apnea board. Here you go! Thanks for the help.
       

[SarcasticDave94]

OK, yes thanks for the posting. My math stinks but the pAHIc 3% 144 count, these are Central Apnea, like what you're seeing in OSCAR. They're roughly half your study events. You had the Central Apnea on the test, and for all that I've seen, your CPAP isn't helping with these. Realistically, it's not expected to help with CA or Central Apnea. I think you're going to be best served going to ResMed AirCurve 10 ASV due to the fact the sleep study CA were about half your overall events. ASV is specifically built to combat CA while addressing the rest too.

You might be better somewhat with a VAuto and very high trigger, but I'm not sure it's enough help for you in CA reduction.

Talk with the doctor, highlight this CA aspect.

[amunozar]

We have had success with the VAUTO using trigger setting to high or very high with centrals.  Give high a try for a night or 2 and then try very high and see if that will lessen the central apnea.

Thank you! I will try this tonight. Crossing my fingers.

[Deborah K.]

You would do better at very high trigger as Dave suggested.

[amunozar]

Hello all!

I’m happy to report that changing the trigger to very high has significantly reduced my CA events. Previously, there was a lot of pink ink due to CA events, but things have improved. Over the past 24 consecutive days of using the AirCurve 10VAuto, my AHI has ranged from 2.28 to 6.83 on seven nights. However, on the other nights, my nightly AHI has ranged from 9.79 to 26.45. I’ve added screenshots from 5 different days displaying my sleep data. 

As I review my data, I’ve noticed that on the nights with minimal AHI, my leak rate was below 4-5 L/min. Is it realistic to maintain such a low leak rate, as I can only assume the are an inevitable part of CPAP therapy?
Are there any adjustments I can make to the machine to compensate when the leak rate exceeds this but stays below the acceptable level of 24 L/min? I’m also considering whether adjusting the TiMin settings to ensure an inhalation time of 1 second (or more) instead of the default 0.3 seconds would be beneficial, or other settings I should look at?

I’ve tried using chin straps, but I haven’t noticed a clear correlation between low events and wearing them. Maybe the strap wasn’t tight enough, but I also know I drool when I sleep, so switching to a full face mask is my next step. I will have to problem solve  how to manage the drool within the mask. I plan to order the full face mask AirFit F30i since I’m a very active side sleeper, and this mask would help prevent saliva from going down the tube.

I appreciate any advice as I continue on my sleep apnea journey. Thank you!
           

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[SarcasticDave94]

It seems you're getting the consistently inconsistent attitude treatment from your Central Apnea. This means CA count will be down one night, up the next despite no edits to settings, etc. Due to this inconsistent attribute, this will hinder therapy progress.

You'll have to decide how much CA you're willing to accept dealing with frequently. You may want to keep a scorecard so to speak, and track how many high CA nights vs low CA nights per 7 days. Whatever that is, will that be acceptable going forward? If no, then it's going to be time to press the doctor on machine change. This is a decision for you to make, possibly you're armed with suitable data already.

Lower leaks are acceptable, and in fact welcomed. If the price is over tight mask, then you'll need to redo mask size or adjustment method. Regarding what is acceptable leak rates, your ResMed has a formulated threshold leak redline of 24 L/Min, and looking on OSCAR leak graph, is represented by a red line. Anything above that redline is utterly uncontrolled leaks that the ResMed cannot compensate for. On the low end it certainly can compensate, but as the leaks go into the teens the more likely you'll get sleep disruption, and the CPAP begins to lose accurate tracking of breathing and restrictions. The lower you keep the leaks with minimal fuss, the better you'll be.