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This is my first time posting here, I hope that I am posting my chart data correctly. This is the first nights data from my machine. I know it may be too early to give some input but I was wondering if anyone could look at this and give me some advice on what you see.
Welcome. If you could post some zoomed in screenshots of the periods where the apneas are being tagged it would help a lot.
Those appear to be some pretty severe centrals. As opposed to obstructive apneas and hypopneas where your airway is being physically blocked off by tissue in your throat/airway, central apneas occur when your body is literally not trying to breathe at all, or barely trying to breathe. This can happen for many reasons, but it's not that uncommon for new users of CPAP to experience something like this. It is commonly called TECSA (treatment emergent central sleep apnea).
One of the reasons this can happen is because CPAP has a slight ventilatory effect, meaning it changes the CO2/O2 balance within your body, and causes you to breathe out more CO2 at any given time. It is the buildup of CO2 within our bodies that trigger the drive to breathe, and if more of it is being expelled the drive can go away for a period of time, where you stop breathing completely. Also called central apneas.
Which is potentially what we're seeing here in your data, with that waxing and waning pattern. Large, deep breaths followed by very shallow breaths, or no breaths at all. One thing that could potentially be causing this is something called EPR, which you have set to the highest level, 3. EPR stands for expiratory pressure relief, and it aims to make it more comfortable to breathe out against the pressure, by physically lowering it every time it senses you exhale. So if your pressure is set at 8 with EPR on level 3, you will be inhaling at 8, but only exhaling against a pressure level of 5. All it does is subtract the difference. So if you're on 8 with EPR level 2, you'll be exhaling against 6. And so on.
The reason this is important and I'm explaining it is because EPR increases the ventilatory effect of CPAP, by allowing you to expel more CO2 at any given time. Which is my guess for what's causing the back to back central apneas you're seeing, that are absolutely disturbing your sleep. My recommendation for now would be to turn EPR off entirely, and see if the centrals go away. If you don't know how to change EPR or your pressure settings, there are videos on YouTube that tell you how to access your clinical menu on the AirSense 11.
I have more recommendations, but I don't want to overwhelm you with too much information. I like to explain everything to make sure people understand what they're changing and exactly why they're changing it, so for now just consider giving this a try and post your data afterwards to see if it helps.
(09-26-2024, 02:05 AM)coutherino Wrote: Welcome. If you could post some zoomed in screenshots of the periods where the apneas are being tagged it would help a lot.
Those appear to be some pretty severe centrals. As opposed to obstructive apneas and hypopneas where your airway is being physically blocked off by tissue in your throat/airway, central apneas occur when your body is literally not trying to breathe at all, or barely trying to breathe. This can happen for many reasons, but it's not that uncommon for new users of CPAP to experience something like this. It is commonly called TECSA (treatment emergent central sleep apnea).
One of the reasons this can happen is because CPAP has a slight ventilatory effect, meaning it changes the CO2/O2 balance within your body, and causes you to breathe out more CO2 at any given time. It is the buildup of CO2 within our bodies that trigger the drive to breathe, and if more of it is being expelled the drive can go away for a period of time, where you stop breathing completely. Also called central apneas.
Which is potentially what we're seeing here in your data, with that waxing and waning pattern. Large, deep breaths followed by very shallow breaths, or no breaths at all. One thing that could potentially be causing this is something called EPR, which you have set to the highest level, 3. EPR stands for expiratory pressure relief, and it aims to make it more comfortable to breathe out against the pressure, by physically lowering it every time it senses you exhale. So if your pressure is set at 8 with EPR on level 3, you will be inhaling at 8, but only exhaling against a pressure level of 5. All it does is subtract the difference. So if you're on 8 with EPR level 2, you'll be exhaling against 6. And so on.
The reason this is important and I'm explaining it is because EPR increases the ventilatory effect of CPAP, by allowing you to expel more CO2 at any given time. Which is my guess for what's causing the back to back central apneas you're seeing, that are absolutely disturbing your sleep. My recommendation for now would be to turn EPR off entirely, and see if the centrals go away. If you don't know how to change EPR or your pressure settings, there are videos on YouTube that tell you how to access your clinical menu on the AirSense 11.
I have more recommendations, but I don't want to overwhelm you with too much information. I like to explain everything to make sure people understand what they're changing and exactly why they're changing it, so for now just consider giving this a try and post your data afterwards to see if it helps.
Thank you for this in depth comment. I don’t feel overwhelmed at all. I prefer to have things explained in a detailed method when it comes to health related things. It helps me understand things better. Because sleep apnea is new to me, I am trying to learn all I can.
Machine: Remediated Dreamstation APAP-CPAP Mode Mask Type: Full face mask Mask Make & Model: Airfit F20 Humidifier: Built In CPAP Pressure: CPAP 15cmH2O CPAP Software: OSCAR
09-26-2024, 03:33 PM (This post was last modified: 09-26-2024, 03:35 PM by Phaleronic. Edited 1 time in total.)
RE: OSCAR Data Review
Welcome to the forum Mcca21.
I'm in the middle of the suggestions on these last two posts to help you figure this out
ERP on fulltime at 3 does soften the transition from inspiration to expiration and also inserts a delay in expiratory pressure when compared to any other vendor's form of exhalation pressure relief (this is also part of the reason why CAs crop up more with folks running fulltime @ 3, unless they are running high pressure). Apnea control is also lost when EPR is set to 3 without raising pressure (as the airway is not being kept open with both the delay and the -3cm of pressure).
I would suggest turning EPR off (as you're at a very low minimum pressure to begin with @ 5cm) and setting max pressure to 15cm).
I would also like to see a zoomed graph of the waveform around a cluster of the CAs please to see if it's valid cheyne stokes respiration (and also if you had CSA reported/diagnosed in your sleep study-if it was a type 2).
Yesterday, 11:00 AM (This post was last modified: Yesterday, 11:03 AM by Mcca21.)
OSCAR Results
Hi everyone,
Second time posting here. My AHI still seems to be high. Even with trying different masks and various mask adjustments. Ive been told on here previously that I seem to be having more central events than obstructive events. My initial at home sleep study, both central and obstructive were lumped together because the effort belt wasn't working properly. Can anyone here give me any insight as to what you are seeing here? I think this will be the 12th day of therapy or so. I have a follow up appointment later this month to see how things are progressing. The equipment company suggested there may be a possibility of needing a bipap st machine because I seem to be having a lot of central events still. Please let me know if I need to include anymore specific data here.
Machine: Remediated Dreamstation APAP-CPAP Mode Mask Type: Full face mask Mask Make & Model: Airfit F20 Humidifier: Built In CPAP Pressure: CPAP 15cmH2O CPAP Software: OSCAR
11 hours ago (This post was last modified: 10 hours ago by Phaleronic. Edited 6 times in total.)
RE: OSCAR Results
Welcome to the forum Mcca21
They have you on inappropriate pressure, please set min pressure to 6.6cm, set max pressure to 12cm and turn EPR down to 1, set ramp to off. You will need more minimum pressure but this is just the first three steps Lowering EPR helps with the CA events you're seeing, but also please sleep as much as you can on your sides using a flat pillow, as well as a second flat pillow to grab and wedge under your head and between your chest/chin and shoulder to help you from chin tucking. Your AHI is high because of this (and the hypopneas) and you're also having quite a few hypopneas. Also please go to the daily tab and hit F12 to save a screeshot, open it and attach it here please as these are all cutup.
We want it to look more like this (the waveform should be flatter on the top and bottom:
I'm not sure all of your centrals and centrals. Using the machine to determine central apnea is not nearly as accurate as a sleep study. All the machine does is give several puffs of air and if it is returned it is classified as an obstruction and if is not returned it is a central. Sleep labs have wires hooked up all over your head and body along with a chest strap to see if you are trying to breathe.
But some of these apnea show as position apnea. You can see positional apnea where either H or Oa events are clustered together. Getting rid of as many as you can will lower your AHI. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
Mcca21 - Your 2 threads were related to your therapy. For this reason, I have merged them. This provides the reader a history of your past settings and results. Having the ability to see past attempts and their results will help to form better recommendations. Please use this thread for all your therapy related posts. I have changed the thread title to, "Mcca21 - OSCAR Data Review" to be more inclusive.
- Red
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Phaleronic, thanks for this advice. I am still in the compliance stage with my device through Medicaid. I have a Resmed Airsense 11, will they be able to tell I changed my settings and will this void my compliance? I just want to make sure I don’t make a mess of things if I change it. I’m not sure why I can’t because the doctor has is setup for APAP with a range of 5-20. I will try to get a proper screenshot of my results, thanks for this.
