New to CPAP. Could you review my data?

[jingles55]

Hello All, I am a new CPAP user and was wondering if you could review the attached Oscar screen shot and give me your thoughts on current machine settings?

Background:
I have been battling migraines and sleep issues for many years. For me it has always seemed that migraine frequency correlated with sleep problems. Over the last year I began to notice that I was waking up each night with a choking sensation which resulted in gasping and high heart rate. Most nights I could never fall back to sleep after the choking episodes. This led me to see a pulmonologist who ordered a sleep study (attached) which led to a mild OSA diagnosis. I had a very restless sleep the night of the sleep study (no choking episodes) but the study results were enough to get me started on CPAP. The pulmonologist's prescription was min pressure 6 max pressure 20 but I dialed those numbers down as the pressure seemed too high when I started.

I feel pretty good now. Sleep has improved and I feel like I'm adjusting well to the CPAP therapy. I no longer wake up with the choking episodes.

Questions:
1. I have a follow-up appointment scheduled with the pulmonologist in early Feb 2022. In the meantime, could you review my Oscar data and machine settings and tell me if there are any adjustments that could be made to optimize the therapy?
2. I see a large number of CA events in the Oscar data. There were no central apneas recorded in my sleep study. Is this any cause for concern and/or are there setting adjustments that could improve or eliminate the CA events?

Thank you so much for your time and feedback!

           

[staceyburke]

Welcome to the board. Let me explain on how your pressure setting works. 

Min - that is your inhale and exhale pressure IF THERE IS NO EPR. (Exhale pressure relief)

EPR subtracts from the min for the exhale while the min is still the inhale. 

The absolute lowest the pap machine can go is 4 

So your settings of min 5.4 Minus the EPR 3 can’t happen because the minimum the machine can go is 4 (5.4 - 3 can’t be 2.4 again the lowest is 4). So you are getting half of the pressure relief you should use. 

I would set your
Min7
EPR 3. FULL TIme

[SarcasticDave94]

The Central events are treatment emergent, due to the higher flushing out of CO2. These will diminish within 3 months. If they really become severe, settings edits can attempt to lower them. These CA aren't really at a high level. Yes there are some now while on the test there weren't any.

As Stacey mentioned your pressures aren't doing you any favors by robbing you of the benefit of EPR. Keep EPR 3 full time, but you need to get your Min pressure out of pediatric territory which is below 6 like yours. To allow EPR 3 full time the ability to help, your pressure needs to go up to 7. I understand you're not used to CPAP, but this pressure is really low.

You seem to describe there were high pressure spikes. This was likely from flow limits. To combat FL your EPR needs to work correctly and with full available pressure room to do its job.

Ramp isn't doing you favors either at 4. You're barely getting any breath of air down there. With your somewhat elevated CA, Ramp needs to go as this adds to the likelihood you'll have CA.

I'm going to suggest some getting used to PAP and mask sessions. You need to sit calmly reading or watching TV while the CPAP is running and your mask is on.

[jingles55]

Dave/Stacey, thanks so much for the feedback. I will try min pressure of 7, EPR of 3 and no ramp. Really appreciate your help.

[jingles55]

Dave, your profile says you are no longer on CPAP therapy. Could I ask how you accomplished that?

[SarcasticDave94]

I should be on therapy, it's that my ASV I was on isn't the correct therapy any longer due COPD being stacked on top of my high Central Apnea. The quack doctors in my area excuse away the need for a higher level machine, because they're too lazy to fight for what's best for this patient. So I'm stuck flapping in the breeze without correct machine that's needed as therapy.

[jingles55]

Dave, sorry to hear that... hope things work out for you soon.

[SarcasticDave94]

Thanks. Till then I'll have roast duck.

Try the suggestions at least a night and follow-up with how you feel about the changes with an OSCAR shot. We're looking for trends, but feel free to post after one night if it's drastically changed, better or worse.