New member optimizing question

[raylock1]

  IMG_20200206_0001.pdf (Size: 558.86 KB / Downloads: 69)
  IMG_20200206_0001.pdf (Size: 558.86 KB / Downloads: 69)
  IMG_20200206_0001.pdf (Size: 558.86 KB / Downloads: 69)
Quote from another thread:

"I am 100% convinced that your therapy, once optimized, and ALL machines need to be optimized,"

I am new to this process and am wondering how one goes about optimizing my machine.  I have attached a copy of my sleep study and a copy of the Oscar report from last night (attached to the reply).  FWIW, it appears that the preponderance of apneas seem to be "Central apneas".  I just started using this machine a few days ago so I will not be seeing the sleep doctor again for about a month.  Any guidance or links to where I could find guidance would be appreciated. I am currently using the nose pillow but will be picking us a mask next week.  I am somewhat overwelmed by the amount of information that is included on this site.  


  IMG_20200206_0001.pdf (Size: 558.86 KB / Downloads: 69)
  IMG_20200206_0002.pdf (Size: 578.34 KB / Downloads: 24)
  IMG_20200206_0003.pdf (Size: 569.51 KB / Downloads: 13)

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Here is an Oscar page.  I was awake from about 3:30 on..

[raylock1]

Sorry, I guess I didn't understand the instructions for attachments.  Didn't mean to send page 2 four times

[SarcasticDave94]

Hi raylock1 and welcome to Apnea Board. Your sleep study has lots of central events to some obstructive, 28 vs 8 I think is the counts. It can be difficult to impossible to treat central events with a standard CPAP. Our medical insurance system will typically expect you to fail CPAP, BPAP, and maybe ST machines before you get to the one that kills centrals the ASV. The best way a standard CPAP can help is to reduce pressure swings as best as we can. We'll have to advise you on how best to limit those swings in pressure, that is things like Ramp and EPR should be minimized or turned off and a need to optimize pressure by reducing the range. Let's see what our pressure gurus say, and we can try to assist using that CPAP but be aware it most likely will offer limited effective therapy.

Best wishes for the success to be found quick.

[Gideon]

Welcome to the forum.

Optimizing.  The first step is understanding what you have.

So What do you have?
1. A Diagnostic Sleep Study.  This is important because it shows the state of your apnea before CPAP.
2. The above is backed up with your OSCAR chart.  You need to change what shows so we can make better decisions.  More on this later
3. You have per the diagnostic sleep study
AHI: 8.5
OAI: 1.5
CAI:  5.3 The largest component.  
HI:   1.5
Mixed: 0.2
so Mild Central Sleep Apnea (5-14) with CAI > 5

OSCAR shows an AutoSet 5-18 EPR = 1
        Now   Study
AHI: 10.99   8.5
OAI: 0.94    1.5
CAI: 8.63     5.3 The largest component.  
HI:   0.94    1.5
Mixed: NA   0.2

so your apnea is currently worse

Understand that NO CPAP, APAP, BiLevel without backup has a chance of treating Central Apnea.
Your Central Apnea existed before CPAP so it is unlikely to be Treatment-Emergent Central Apnea.
Your Central Apnea is the only thing that went up when you started CPAP so we need to change some parameters.

Set min pressure = 6 for comfort.
Set EPR =0 or OFF to attempt to reduce your Central Apnea.
Try these settings and post the results.

OSCAR Charts 
Read the Optimize links in my signature.  Make your charts show that info.  Turning the pie chart off will allow more important info to show.
Flow Limits are very important to pressure with ResMed.

[raylock1]

I made the suggested changes, increasing pressure to 6 and turning off EPR.  Central apnea seems to have increased even more. I guess the next step rests with my sleep doctor.


   

[Osiris357]

Fred just a thought here. I had 25 centrals in my sleep study but I’ve come to learn that they were almost all post arousal centrals. Now that I’ve acclimated to therapy I only get at most 8 centrals  if I have a very restless night and they are very short duration being about 11 or 12 seconds. I average about 3.5 now.

At first I thought I needed ASV especially since in the beginning they were causing me high anxiety. But since I realized I needed to wear a collar to control my flow limitations, most nights are very restful and calm with minimal tossing and turning. Which in turn dropped my central index drastically. 

Just something to chew on before the OP goes on a mission he may not have to go on.

[raylock1]

Thank you for that information.  Could you explain what you mean by collar.  What kind of collar is this?

[Dormeo]

Raylock1, to follow up on these comments, you might want to post a couple of zoomed-in views of one or more centrals.

Before you do that, please make sure your pressure and flow-rate graphs are visible. Grab the horizontal gray line that separates the graphs and scrunch them until you get all of these visible in one screen shot:

Events
Flow rate
Pressure
Leaks
Flow limitations
Snores.

Then select an area with centrals and hit the up arrow on your keyboard until you have about 10 minutes showing, ideally with several centrals displayed. You can hit the right and left arrows if you need to move forward or backward.

This will enable the experts to assess whether your centrals are or are not "sleep-wake junk," i.e., events associated with a bit of a wake-up. Of course, even if they are SWJ, the frequency of the arousals would be a problem -- but a different problem from centrals that are not SWJ.

[harrywr2]

Could you explain what you mean by collar.  What kind of collar is this?

Many people find wearing a soft cervical collar(available at most pharmacies for $10-$20) helps with keeping their neck/spine/airway straight which reduces various problems.

[Gideon]

Well, that demonstrated what I expected to see, not what I hoped to see.  These are not, as expected, Treatment-Emergent Central Apneas.


Please set EPR = 2, since the higher EPR had better results, let's see if an even higher EPR will provide even better results.

With the lower EPR I can see that you are, in fact, tucking your chin, which means that either a soft cervical collar or a version without foam on the back called an anti-snoring or sleep collar should fix that.  The purpose we use them for is to prevent the chin from tucking, or in medical talk, preserve your cervical alignment. See the Cervical Collar link in my signature.

This Central Apnea is not based on your CO2 Levels going low, which makes treatment a bit harder.  The only way your Central Apnea can be treated is with an ASV machine.  Without that we are going to try to reduce your central apnea to less than what you had pre-CPAP.  If that fails the effort has to be in getting an ASV.