New to CPAP - have 3 instances of Cheyne-Stokes

[aussienana]

Hi  - I had a home sleep study done on 1 June and was diagnosed with severe obstructive sleep apnea-hypopnoea. Sleep study attached. 

I have had my cpap machine at home since 11 June, and after trialling several masks, seem to be on the right track with either the F30 or F30i ( although am waiting for the F40 to become available in Australia). My figures have been going down until last week when it was recorded I had 3 Cheyne-Stokes episodes on 26/06, 29/06 and 2/07. 

After reading several threads on here realised to be accurate I needed to have OSCAR downloaded and an SD card. Have purchased a computer and SD card today and will download Oscar later. 

Do I have to format my SD card or can I just insert it into my cpap machine?

[aussienana]

Oops - trying again with the attachment

[aussienana]

           

Hi - I managed to load last nights data into Oscar and have attached 3 thumbnails to this post.  Could someone please check this data to see if I had any Cheyne-Stokes incidents last night?  Also whether my settings could be improved? I had trouble falling asleep last night (still awake at 23.39) and had a lot of snoring events.  I think the most I've had since starting CPAP. 

For information I also wear a chinstrap

[PeaceLoveAndPizza]

A few questions first.

Do you have a history of heart conditions? 
Any family history of heart conditions?
Are you taking any medications?
Did any CSR show up during your sleep test?

Onto the charts. You have a lot of positional apnoea going on. Positional as in chin-tucking. The clusters of obstructive (OA) and hypopnoea (H) events suggest you are tucking your chin towards your chest and cutting off your airway. A flatter pillow may help, but most showing this use a soft cervical collar. I have attached a chart you can use to measure your chin-to-sternum distance and you will also measure the circumference of your neck. That should help find one that will meet your needs. I personally use a Caldera Releaf and have for years. Any that meet your measurement requirements will help. Read the following link for more details on positional apnoea. 

https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Before getting to deeply into the CSR issue, I suggest first dealing with the positional problem. It will give a better idea of what you are dealing with in your therapy.

I also suggest increasing your minimum pressure a bit, which should help with some of the flow limitations. Try the following:

Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
no ramp

Use that for a few nights with the soft cervical collar and post some charts.

[aussienana]

Hi - thanks for the quick reply.

No CSR’s recorded on my sleep study and these 3 CSR’s recorded above were after being on CPAP for 15 nights with no incidents.

I had an EEG in Feb prior to a hip replacement and no abnormalities were recorded. I am taking tablets for high blood pressure and high cholesterol and have been taking these for years.

I have ordered a cervical collar but it won’t be here until mid July. I’ll use a flatter pillow till it arrives and I’ll adjust the settings for tonight.

[aussienana]

Went into the clinician’s menu and selected the following
Mode: CPAP (other choices were Autoset or Autoset for her)
Pressure: set it to 8 (couldn’t see anyway to set max pressure)
EPR: was already set to 3 full time
Ramp time: was already set to off

[PeaceLoveAndPizza]

You need to be in APAP mode, not fixed pressure CPAP mode.

Mode APAP
Min pressure 8
Max pressure 15
EPR 3 full-time
No ramp

[aussienana]

Had another look at settings before I went to bed and put them on

Mode: Autosense for her (APAP)
Min: 8
Max: 15 (figured out how to do it )
EPR: 3 full time
Ramp: off

Will post data after a few nights sleep with these settings

[aussienana]

       

Have two nights sleep data with the new settings.  Could someone check my data and see how I'm going, whether I need to change anything etc.  MyAir informed me that I had large leaks over the last two nights although I used a thinner/flatter pillow.  Not sure what to do next 

Friday nights data:

---

       

Saturday nights data:

[Jay51]

You have several problems going on.  

1st:  leaks.  Way to many IMO.  Here are some tips:  Mask Primer

2nd:  You have positional apnea.  Here are some tips:  

• 5.3Positional Apnea
  

3.  Also, your pressure may be too low.  I would suggest increasing your max pressure slowly.  Do you have EPR turned on?  EPR can help your flow limitations (0.38 at 95% is way too high).  You can start with EPR 1.  Then try EPR 2.  Then EPR 3.  

These should be plenty of things to do to start with.