New to CPAP, just used OSCAR for the first time, should I be concerned?(Cheyne Stoke)

[breckenk]

I got my CPAP 4 nights ago, and just added an SD card last night so I could see the data for myself, as the myAir app was not enough information for my taste. I was concerned by by Cheyne Stokes respiration events that occurred a few times during the night. After doing some googling it does appear that this is a common thing and that the software tends to overproduce this event, so I wanted some confirmation that this is not a cause for concern. I'm attaching the overall data, and highlights of the "Cheyne Stokes" sections. I took the mask off at one point in the night to go use the bathroom, and put it on a little bit later after I decided I was still tired and wanted to go back to sleep, and after this is when a lot of the events occurred. I'm attaching photos of the time while I was asleep, and the time at the very end from after i had woken up and dozed back off.

   
   
   

[breckenk]

Some extra info, I had an at home sleeptest done which showed an AHI of 21.5, 14% of the time my O2 was <90%. I'll take any advice to improve my AHI because while it appears to be better, it's still incredibly high compared to some of the treated numbers I see here and I'd like to get down that low as well.

[breckenk]

More results from last night. Nothing labeled as CSR, but constant CA throughout the night. Could this be the result of starting CPAP therapy and it will go down over time, or is this indicative I may need an ASV and to check for cardiopathic issues? I'm a fairly healthy 24 year old man.

   
   

[Sleeprider]

I don't think you have CSR, but Resmed flags periodic breathing as that, so it is PB that you have due to being persistently at the apneic threshold for central apnea. Unfortunately you did not receive a clinical sleep test which would have more accurately identified central sleep apnea. We often see CSA can be relieved significantly by using less EPR. Your EPR setting is currently at 3, and while this promotes easier respiration and higher ventilation (tidal volume), it also purges CO2 from your respiration. I think you will see a significant reduction in central events and periodic breathing if we move EPR back to a setting of 1 or off. Let's try minimum pressure 5.0, maximum pressure 9.0 and EPR at 1. Turn off ramp.

[breckenk]

Will do, thanks! Will update with results tomorrow. I went ahead and scheduled a cardiologist appointment just to rule out any other issues for my own mental satisfaction.

[breckenk]

I forgot to plug my SD card back into my CPAP, so I don't have the detailed data, but I had a CA of 11.2/hr last night, OA of .4 and AHI of 12.1. The changes didn't seem to affect the CAs.

[Sleeprider]

Let's get a picture with Oscar. Turn EPR off. It appears you have central sleep apnea, and it would help to obtain a more detailed report of your sleep study. With the large number of central apnea events, you will probably need to request an in-clinic titration test to evaluate your CPAP pressure and potential efficacy of ASV. The adaptive servo ventilator is nearly 100% effective in treating the type of apnea and periodic breathing we are seeing in your results. Insurance hates paying for it. This wiki article describes the hoops you may need to jump through to obtain ASV https://www.apneaboard.com/wiki/index.ph...P_Machines

It is possible to self-fund ASV and it can be less expensive than going through the doctor and insurance if your coverage is not great. If you're interested in trying ASV, I can suggest some ways to obtain a machine inexpensively.

[breckenk]

Attaching my sleep study with personal info removed. My insurance is not awful, and getting them to cough up an ASV machine may be possible. I'll mention it to my sleep medicine doctor as soon as I can. I'm not scheduled to follow up with them on the CPAP for 2 months, but I'll see if they can do something sooner with these CA results.

   
   
   

[breckenk]

I've turned EPR off and have my SD card in the machine so I'll have OSCAR results for that tomorrow.

[Sleeprider]

Based on the sleep study, you did not have central events. or they were sim-characterized. Your age and weight do not suggest a high likelihood of obstructive sleep apnea. Events in your study were mainly during supine sleep and are clustered, suggesting possible positional apnea (chin-tucking), which may be the majority of your events when not using CPAP. There is no reason to suspect central sleep apnea, so this is likely therapy onset CSA. I'm a bit conflicted on just holding the course with low-pressure CPAP and looking for some positional apnea issues or trying more advanced stuff. I think for the moment the evidence points to continuing with CPAP and optimizing for at least the first 30 days. Our wiki on positional apnea might be helpful to read so we are on the same page. https://www.apneaboard.com/wiki/index.ph...onal_Apnea