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I was diagnosed with mild OSA and was prescribed APAP therapy configured for 5-12 cmH2O. I started using a Resmed Airsense 11 Autoset machine on June 15, 2022 and have not missed a night of use. I installed OSCAR and have been collecting APAP data since July 5th. I also bought a WellUe O2Ring in July and have been importing that data into OSCAR as well.
I have a couple of issues that I would like to get some advice on. The first, and foremost, problem that I'm having is with swallowing air. Over the last couple of weeks, I have been waking up feeling gassy/bloated and the symptoms usually last most of the day.
The second issue is with Clear Airway apneas. Some nights I get one or two large groups of CA events. Looking back at my OSCAR overview tab, I see that the majority of my events have been CA's since I first began therapy.
I have attached a few screenshots from OSCAR and greatly appreciate any advice on these issues. Thanks in advance for the help!
Welcome! Do you happen to know whether you had CAs during your sleep test? Ideally you could provide the breakdown of your AHI into obstructive, hypopnea, and central.
You have some flow limitations, not huge amounts, but enough for me to suggest you raise your minimum to 7 so you can get the full benefits of EPR all night.
For the aerophagia, I'd suggest experimenting with a lower maximum, given how relatively few obstructive events you're having. Maybe 9? Give it a try -- if you get a lot of OAs and Hs, you can always inch it back up. If you don't get a lot of OAs and Hs, but still have aerophagia, you can drop it further.
Clusters of CAs often signal a transition from waking to sleeping or vice versa, though it isn't clear to me whether that's what's going on with your cluster. Can you zoom in to about a 15-minute interval that includes a group of those CAs?
Sometimes (but not always) centrals can be lessened by a tight bad between max and min pressures. This is another reason why max can be lowered, and 9 sounds like a good trial.
I'm not at all convinced you were asleep during this bout of CAs. The segment opened with two OAs that roused you from sleep, and I don't see clear signs you fell back asleep after that. (In general, awake breathing is less regular-looking that sleep breathing.)
Our cue to breathe in comes from the build-up of CO2 in the blood between breaths. So after an exhale, which blows off CO2, there's a pause while CO2 builds back up, and then we inhale. Deeper breaths blow off more CO2, and the pause needed to build enough CO2 back up can exceed 10 seconds. Voila, a CA. And it's fairly common to take deeper breaths after a longer pause, and that means the pattern can repeat itself. That's what you're seeing here.
Using a PAP machine increases the efficiency of our breathing, meaning that we clear a bit more CO2 when we exhale. For that reason, people sometimes experience CAs toward the beginning of their PAP treatment. The body has a way of adjusting over time, though, and the CAs abate. Having a few during the night is quite normal, and I suspect you'll get to that point with time.
I've been thinking some more about your pressure settings. You're getting aerophagia even when the machine doesn't travel to the higher end of your pressure range, so you might want to try dropping the maximum even more than I suggested. And, unrelated to aerophagia, you might want to bring your minimum up to 7 so you can get the full benefit of your EPR all night. Maybe a tight range of min 7 and max 8? Can't hurt to try. I'll be curious how it goes.
Thanks for the response. Earlier today, I changed the pressure range to 7-9 cmH20. I'll try this for a few days and see if the CA's lessen and aerophagia improves. If no improvement, I'll try bringing the max setting down to 8 cmH2O and see what happens. How long should I wait after making a change before making another adjustment?
Attached is the data from last night at the new pressure settings. Overall, I think it looks much better than the screenshot that I posted a few days ago. What do you think? Should I leave it this way for a week or so and see how things go?
The minimum pressure of 7.0 is allowing EPR 3 to work as intended and has resulted in a much less variable pressure and lower event rate. I think maintaining these settings for a while will let you get a baseline against which you can compare any future changes. If you can tolerate no ramp, then turn it off, otherwise, set to the highest starting pressure you do tolerate.
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You’re not at therapeutic pressure during ramp, and on some machines you won’t get records of events during ramp. With your settings, you also don’t get full EPR. But if you need ramp to fall asleep, by all means use it.
Good to see your current results. I’d say try staying with these settings for a week.
