New member, help analyzing SS and Oscar

[Sleepcycle]

Hi I have just joined after finding this forum. There are some great resources here and I would like to post my own story and see what people recommend. Its been an overwhelming few weeks and trying to get my head around everything.

I'm 35, fit and healthy, I ride road and mountain bikes 3 times a week for fitness. 

I went to the dentist two months ago with a tooth complaint and he suggested I should get a sleep study as I was mouth breathing and had narrow nasal passages. After seeing my GP who didn't think I needed a sleep study and thought it would show nothing I ended up with a referral and had a home sleep study. the results are attached. The GP was shocked at the results as it said I have severe obstructive sleep apnea, AHI of 38/hr. I was shocked too as I didn't even know what sleep apnea was. yes I'm always tired but I think if you asked most people they would say they were. I don't fall asleep during the day watching tv etc but I can nap, I also probably feel like I don't recover like I used to after exercise. I really wonder how long I have had this for, I'm guessing the last 10 years at least.  

The GP sent me to an ENT who said nose was slightly deviated but not enough to operate on, the main issue was my throat was closing over due to back of tongue relaxing causing the obstruction, he said there is no fix for this and a CPAP is the treatment I needed.  Back to the sleep lab and I have picked up a Resmed Airsense 10 auto CPAP and a number of masks for a three week trial. The sleep tech was good and explained my sleep study and was confident this was the right machine for me. 

One week in and I have adjusted better than I thought, I cant say I feel any different and the nasal pillows have been the best masks for me. The sleep tech only wanted me to use the MyAir app but I have downloaded Oscar after seeing this forum. so much informaiton its a bit overwhelming what to look at and make sense of.  

My questions are, does anyone have any feedback on the following for me:
- Should I be aiming for 0 AHI events each night? my sleep study is attached and I will attach OSCAR screen shots in the next post as you can only attach 3 images

- can you still be tired and not recovering if you are having 5 AHI events every hr on average

- it looks like the CPAP is working and AHI events are down on sleep study but I am still having a few CA events, can i reduce this with the CPAP or at what point do I need to look at a different machine like the ASV ones I have come across in this forum. the sleep tech has been happy with my results and said under 5 AHI is good and isn't concerned with having that many. also thinks this is the right machine for me.

- can we breakdown why I'm having apnea events from OSCAR data?

- is there any other analysis you can see that is worth pointing out, I'm very new to this and still learning

thanks in advance

   
   
   

[Sleepcycle]

a few nights OSCAR data, also wanted to ask, I'm not sleeping through the nights, waking up 3 - 4 times. not sure if its getting used to the mask or if I shouldn't worry about it.

   
   
   

[SarcasticDave94]

Welcome to the Apnea Board,

3 important things, the least first. Your PAP is on default 4-20 pressures meaning your therapy isn't set specifically to you. All PAP therapy devices need set for the individual.

Second, your diagnosic report states you have a higher level of Central Apnea/CA than Obstructive. Total events are as follows on the test: 37 CA 12 OA 18 mixed 133 Hypopnea. You need a different PAP called ASV, specifically the ResMed AirCurve 10 ASV. This is designed to treat CA.

Third, your CA will be consistently inconsistent with this current PAP therapy because it cannot treat Centrals but only avoid.

[Sleepcycle]

Thanks SarcasticDave94

I will talk to the sleep tech, i have a three week trial and will see if they have an ASV machine. I will also ask about custom settings

are you basing the CA and needing a ASV on the sleep study results alone or also what's happening in the OSCAR reports i posted?

[Gideon]

By the numbers, your numbers, you don't/will not qualify for an ASV as your overall AHI is under 5. The case needs to be made based on your symptoms, with the numbers only in the background.

On your Sleep test, about 75% of your events were Central.

Keep a journal of what issues you have and when.

Most importantly is how do you feel?

[Sleeprider]

Sleepcycle, the charts you posted show you are using settings of 4.0 to 20.0 and it appears you have EPR (exhale pressure relief) on full time at 3. Your pressure rarely exceeds 7.0 so we don't see your EPR show up very often. There is a strong relationship between higher pressure and higher CA events, and we especially see this on Nov 17 from 03:15 to 04:15. I would like you to try turning your EPR down from 3 to a setting of 1. This will retain the comfort of some pressure relief during exhale, but will limit the amount of pressure relief to 1-cm which will avoid washing out as much CO2 when pressure gets higher. Finally, I'd like you to try a fixed pressure of 6.0. You do not have much obstructive apnea at your current pressure range, and we have often found a more steady pressure can reduce the number of CA events. This will also help us to more accurately titrate your therapeutic needs. I believe you will find these settings comfortable and less disruptive to your sleep.

In summary, in Autoset mode, Minimum pressure 6.0, Maximum pressure 6.0, EPR On Setting 1.

[SarcasticDave94]

Agreed with the others, and as for what I based my comments on at my earlier post, mostly from test results on event type and count and some on OSCAR with variable CA.

And yes I should have mentioned, getting an ASV will need be based on symptoms.

[Sleepcycle]

Thanks Gideon

I spoke to sleep tech today and they don't have an ASV I can trial and also said current machine and treatment is working based on AHI under 5. will keep pushing and see what the next two weeks of my trial shows.

[Sleepcycle]

thanks Sleeprider

some good suggestions, i spoke with the sleep tech who is looking after me for the three week trial (currently 1 week in)
they wouldn't let me change settings and I also cant on the machine, it doesn't have the normal settings which they said is because its a trial device. they will assess again after another weeks worth of data. They seem fairly dismissive of the CA events which is frustrating and they don't have any ASV machines to trial. 

I will keep pushing and have also asked to make an appointment with the Sleep specialist Dr next week to discuss results from the two weeks of CPAP use. 

There seems to be a gap in the system for CA.

Id like to get it dialed in before I buy a machine, I called a few other sleep clinics but no one seems to hire the ASV machines which isn't making a lot of sense to me. surly we should be aiming to get AHI to 0.

Based on symptoms I'm not sure I have noticed feeling any different as yet, but if I have had sever obstructive sleep apnea, i imagine it could take a while for the body to adjust to CPAP and different sleep. hopefully AHI under 5/hr give my body more REM and deep sleep that it wasn't getting before.  Before i had my sleep study I had ordered an Oura ring which I'm interested to see what it says about the sleep stages I get each night in conjunction with the CPAP results.

[Sleeprider]

You have a Resmed Airsense 10 Autoset, and regardless of what the tech told you, there is access to the settings. It's a nice story, but it doesn't let you troubleshoot and optimize therapy. To access the settings try this: https://www.apneaboard.com/resmed-airsen...setup-info

Let me be clear. The use of high EPR like you have set is known to make central apnea worse. The use of automatic pressure with EPR at 3 and minimum pressure less than 7.0 means the exhale pressure does not move in unison with the inspiratory pressure, and this can make the machine less responsive to obstruction, and worse for central. Finally, the tech lied to you about both efficacy and the functionality of your machine.