HenryECole81 - Therapy Thread

[Jay51]

Thank you very much for providing that link Narcil.  Those could be CSR, but with your Spo2 remaining high, they might be false.  By eyeballing them, they seem to fit the pattern of CSR.   When the Cardiologist and Pulmonologist have all of this data (and their own testing data), then they can draw more precise conclusions.

[HenryECole81]

Help with understanding and addressing CAs and CSRs :  Note, I originally posted this in other threads but readers had trouble with my attachments and rationale within the thread. 

 -- I regularly  see CSRs in my OSCAR daily reports, with lots of CAs, mostly at near the start of end of sleep or when I am having mask/breathing issues and "half asleep", but also in core of the night. I also have nights with no CSRs.  For 80 year old, I am strong competitive swimmer  with relatively heavy workouts. O2 levels always at 97-99 with CPAP even during CA and CSR, but O2 75-98 without CPAP. Working with cardiologist and electrophysiologist on seemingly asymptomatic AFIB but ok echocardiograms. It is my call whether to have an ablation. Still, I am concerned with CSRs and  have attached two files from OSCAR  F12 screen shots from a particularly bad night with 4 CSR OSCAR reports via Res Med: one shot of the entire night and the other of a selected 20 minute CSR segment. Not shown, but no leaks or snores, always on back (rotator cuff issues) but  no serious movement and wear cervical collar.

CPAP background: CPAP 2008- 2014. Start and stop based on pulmonologist sleep lab testing.   Restart based on A Flutter finding suggested prudent to re check on Apnea with pulmonologist home test. Mild + Apnea result.    Very difficult re start with masks and machine; after several subsequent pulmonologist Rx home tests, the pulmonologist decided  I was better off with just mandibular device than CPAP. Eventually using mandibular - mandibular and mask - and now just mask I have been having much better results in the AHI 2-8 range but also still mixed AHI 12-18 , as the attachment example shows. Lots of CSRs.  Still adjusting with poor second half of night, usually after waking to pee, often with mask adjustment issues after. 

       

[SarcasticDave94]

Normally our response to seeing CSR on OSCAR is they're false flags. That is, unless a person has a heart condition. AFib is a heart condition, so we can't just generally rule this out as false. It also doesn't automatically mean the CSR flags are true. Your best bet is talking to your cardiologist.

As for Central Apnea and high flow limits on OSCAR, there's a problem with treatment of both because it requires opposite actions.

Did you get your sleep study results? What were they? Did you post them redacted of personal info in the other thread? If Central Apnea were present in that study report, you're probably better off with an ASV. This is a guess until seeing report data.

2 suggestions, keep your therapy discussion in one location. Scattered all over and in other's threads is very hard to keep up with it all, and will miss important info and data. Second, OSCAR charts should have the most important charts first with others as second images. There's a way to reset the format within OSCAR.

I'll circle back to your sleep study. Since I don't see one being posted, you must act too request your own copy from the doctor, the detailed many pages version. Because of your complex situation and questions, I suggest you post that here redacted of personal info. We can't answer even somewhat definitive without the background info.

[HenryECole81]

Thanks, SarcasticDave 94.  As you saw by my post, I am already doing all the suggestions you gave.

[SarcasticDave94]

Sleep study report? I realize this thread has gone dormant, but you're posting elsewhere, asking about CA. We don't see new charts. Keep things in one of your threads please.

[OpalRose]

HenryECole81,

Three of your most previous threads have been merged with your latest thread to better reflect your Cpap journey and help others to see your previous history.

Going forward, please continue to use this thread.

Thanks!

[HenryECole81]

           

QUESTION: SHOULD I IGNORE MY CURRENT CAs AS EVENTS WITH NO CONSEQUENCE?
 
Continuing earlier posts. Apologies for the delay and return to previously raised issues. I am trying to be  better and more thorough this time.
BACKGROUND: CPAP from 2009 - 2016, when pulmonologist and tests said results ok and to discontinue. More recent pulmonologist  lab and home Rx tests interpreted as Moderate but OSCAR results terrible. After many rounds, pulmonologist said they cannot overcome CPAP issues to improve. During this I received new  CPAPs via Medicare and also Phillips litigation continues over the past year to adjust (self-titrate) CPAP mask pressures, cushion, cervical collar and include wearing comfortably a pulmonologist dental Rx mandibular device litigation. With these combinations together,  I am relatively comfortable going to sleep but real  CONCERNS:  I get uneven but relatively satisfactory results (for me) but consistently worse after middle of  sleep awakening due to BPH. and LOTS of CAs. I sleep and rest very comfortably and peacefully on my back ---  learned and well-practiced in response to rotator cuff issues. My breathing passage appears very clear with the above CPAP-plus combination. I tried but have not been successful switching to APAP. I wear an O2 ring that shows O2 levels at 97%, 98% almost always one hundred percent of the time overnight,  with occasional nights with one or two  3% or 4% O2 drops. The pulse rate stays at 60bpm  for ninety-nine percent + of the time with variance from  55bpm to 70bpm. I always compare OSCAR and O2/ pulse against OSCAR reported Events but stopped digitally syncing/linking the O2 into OSCAR -- time consuming for little perceived benefit. I have permeant,   asymptomatic AFIB, that is  electrophysiologist  and cardiologist treated/managed resulting eventually in a recent LEADLESS AV2 pacemaker (Excellent!!!). I have for my age typical  but mild CAD from a wide variety of ECHO, EKG, and other tests. I do Masters Swimming competitively with national ranking results but certainly slower and more challenging now at 80. In workouts my heart rate goes to 150+ in swim sets but recovers to 80 over 10 minutes, with repeat sets mostly below 100bpm .
 
CONCERNS:  Attached are three OSCAR shots of last night's ( Sept 21 ) sleep. Lots more pics available beyond the three limits. These may indicate other issues or prompt treatment change suggestions (welcomed), but my focus questions remain the volume and frequency of CAs. They contribute 90% or more of most Apnea events and score levels. I see that these CAs  often occur during lying awake or light off-and-on sleep periods after  BPH - peeing pressure (CA?) awakening, and these CAs increase after reconnection the  CPAP, some likely  based on various life related induced anxieties. Also occurring  particularly after I am awake and have not yet disconnected the CPAP to pee or to get up in the morning, or just after reconnecting and am clearly not yet asleep. Generally, if I subtract off the number of times when such CAs show up when I am aware of being off-and-on dozing and mentally aware, my Apnea score and Event levels dramatically shrink. My Apneas scores can drop from 15-20 to 3 after subtracting off just what appears to be light or pre sleep. Such periods could sometimes be as long as 1-1.5 hours. My O2 readings and Pulse bpm do not appear to show any response to the CA events. I am pretty sure  that my throat remains totally open during the CAs, and my full-face mask means the CPAP air must be circulating more than just a bit into the lungs. >>>>SHOULD I IGNORE THE CURRENT CAs AS EVENTS WITH NO CONSEQUENCE? <<<<   NOTE that previous to the pacemaker insertion, I was having occasional CSRs instead of CAs, and these certainly looked like the textbook CSRs. My pulmonologist was not particularly concerned, but then he was without info on the AFIB, but had other good cardiology reports. I will discuss  with the pulmonologist the several current CAs that have similarity to CSRs but now are  not flagged as such CSR events. However,  I do not expect much response from him, especially with my AFIB affects but  otherwise ok-for-my-age cardiology reports.
 
Sorry for the length, but hope the detail sparks some useful response. 

[SarcasticDave94]

HenryECole81 I'm asking the monitors and moderators to split your posts into your thread. You need to keep your info on your own for best support.

Thanks mods for all your work. Delete this post if you so choose.

[Crimson Nape]

HenryECole81  -  Your post has been moved to your therapy thread.  Please use this thread for all your therapy related posts.
- Red

[SarcasticDave94]

It's not that your CA are not a concern, it's that at least the numbers aren't too bad from what's shown.

You mention you had CSR events before the implant I think, and now they're showing CA. What did the most recent sleep study data say?

This is likely something both Pulmonary and Cardiology need consulted to address the Central Apnea content. You may need to pursue a bilevel or maybe ASV for better therapy.

However, here's what you can do now to maybe lower CA, reduce EPR to 2 and see if it helps the CA. It will probably make the other events go up though.