Newbie here - Could you help me interpret data please?

[Unkikonki]

Hi everyone,

I've been trialing a ResMed AirSense 10 Auto-set for the last 3 months almost unsupervised (long story short, the Clinic I did the sleep study with were extremely slow so I decided to hire a machine from another company). I cannot say I've noticed much of an improvement so far unfortunately.

As you can tell, I progressively increased the minimum pressure until I set it 10 cmH2O on 18/09/2023. I've also been using EPR at 3 cmH2O most of the time (someone on another post suggested this could be the reason behind so many CA events so I disabled it).

Last Monday, I went to see one of the specialists from the company providing the machine, who said the minimum pressure was too high for someone like me, so he set it down to MIN 5 - MAX 10 (I then changed it to 7-12 as I was feeling like crap with those settings). For reference, I'm 1,70 meters tall and weigh 75 kg. Neck circumference is 38 cm.

I've noticed a few things: the vast majority of events are CA, followed by Hypopnea. Barely any OA at all. Also, Hypopneas were below 1 while the pressure was set to 10 Min - 18.6 Max (EPR 3). However, they have tripled since reducing pressure and EPR. CAs have slightly increased.

When analyzing CA, the same patterns seems to repeat: flow rate becomes erratic then flattens, leaking stops, tidal volume rises and drops sharply (see links graphs below. Sorry for the messy links, the forum won't allow me to post images or links yet).

SUMMARY: ibb.co/x8TK5ym
CA1: ibb.co/mvtP2rJ
CA2: ibb.co/wh24w7f
HYPOPNEA1: ibb.co/0jxWkQq
HYPOPNEA2: ibb.co/MMpbHvB
ALL NIGHT1: ibb.co/GF63psr
ALL NIGHT2: ibb.co/CQyQsV9

Could you help me make sense of the data I've collected so far please? Anything you notice?

[UnicornRider]

Welcome aboard,  Until we get you totally settled in do not start another thread, stay on this thread.

     By staying with this thread, we can follow your progress better.

     Have you installed OSCAR? 

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

      Your links did not come through, You should be able to post an OSCAR Report.

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

         We are accustomed to reading information from the OSCAR Reports, it works better than other formats for our purpose,

         If you need additional information please post back.

      


.

[Unkikonki]

Are these data enough? Would you prefer me to provide data from a longer night? (I barely slept last night). Please, let me know if you need more.

SUMMARY



CA 1



CA 2:



HYPOPNEA 1:



HYPOPNEA 2:



ALL NIGHT 1:



ALL NIGHT 2:

[SarcasticDave94]

Welcome to Apnea Board.
The home site for all those that get treated the same by their doctor. By that I mean bad.

OK a few questions to help us dig in to the assist.

Was there any sleep diagnostic test? What were the details, such as diagnosis, event types, doctor recommended actions?

I'm not sure just yet whether the events are really Central based or not. Some have a cluster pattern which can indicate what we call here positional apnea. This isn't back versus side sleeping like docs discuss. This is meaning your airway gets restricted when one chin tucks while sleeping.

For now, you might consider a few actions to combat both scenarios, easy and free.

On the CPAP, I'd say kill off the ramp. I don't recall if EPR was on but if so reduce it. See if these have an affect on lowering CA. However this may make hypopnea increase. In that case, you'll have to choose the best balance between comfort and low events.

For possible chin tucking, you may want to get a flatter pillow if you can, or reduce to one versus two. You may want to tuck a corner of the pillow under your chin to reduce tucking, or a rolled small towel might do.

They're only possible things. Best answer is finding out what you're really treating, because there's a teeter totter situation where centrals are on one side and obstructive events are on the other. Pushing either side down (reduced events) by CPAP settings will very likely make the opposing side go up (more events).

If these are in fact Central based, the AutoSet may be ok, a bilevel will probably be worse, unless it's a CA combat specific machine.

[UnicornRider]

CA could be due to the fact that you  are new to PAP.

Post your Sleep Study Report, redact your name, address, etc.

"I went to see one of the specialists from the company providing the machine, who said the minimum pressure was too high for someone like me, so he set it down to MIN 5 - MAX 10"  

What did the specialist know about "someone like you"? Do you have any known medical conditions that would result in something bad happening?

Put the settings where you were most comfortable and had a better AHI report. include EPR 2 or 3, if you were comfortable with EPR. We can address CA's later.

Turn off Ramp. You get no therapy from ramp.

Leave your settings at that pressure while you work on getting a good mask seal. Read the Mask Primer:

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


   Be sure to read all the way down to include  "How to achieve the perfect mask fit - GUARANTEED! by Jeffy1958"  


  

[Unkikonki]

Welcome to Apnea Board.
The home site for all those that get treated the same by their doctor. By that I mean bad.

OK a few questions to help us dig in to the assist.

Was there any sleep diagnostic test? What were the details, such as diagnosis, event types, doctor recommended actions?

They're only possible things. Best answer is finding out what you're really treating, because there's a teeter totter situation where centrals are on one side and obstructive events are on the other. Pushing either side down (reduced events) by CPAP settings will very likely make the opposing side go up (more events).

If these are in fact Central based, the AutoSet may be ok, a bilevel will probably be worse, unless it's a CA combat specific machine.

Apologies for the lack of information, I didn't want my post to be too tedious (getting help from people I don't know for free is already a big ask. Hopefully one day I'll be informed enough to return the favor to others).

I had Level 2 PSG test done on 20/03/2023 that concluded "Moderate OSA, worse in supine and REM sleep":
Total Sleep Time: 397 minutes
AHI: 26.6 (Supine 32.1, Non-Supine 23.2, REM 41.8, Non-REM 21.3)
Apnea: 14.2 (Obstructive 13.4, Mixed 0.3, Central 0.5)
SpO2:
ODI: 26.7
Average SpO2: 94.8%
Minimum SpO2: 86%
Average Desaturation: 4.4%

Recommended Treatment: oral splint (MAD). I tried the SnoreRx for a couple of nights; my teeth hurt so much that I couldn't keep it for more than a couple of hours. Is this a good option at all?

I'm not sure just yet whether the events are really Central based or not. Some have a cluster pattern which can indicate what we call here positional apnea. This isn't back versus side sleeping like docs discuss. This is meaning your airway gets restricted when one chin tucks while sleeping.

For possible chin tucking, you may want to get a flatter pillow if you can, or reduce to one versus two. You may want to tuck a corner of the pillow under your chin to reduce tucking, or a rolled small towel might do.

Yes, I read about it on the OSCAR guide yesterday. One of the recommendations was getting a soft cervical collar. I was also considering buying a mattress incline elevator (https://www.avanacomfort.com/mattress-elevator.html). I also just bought this pillow: https://shop.edensleep.co.nz/collections...1415652642 (the best I can get in New Zealand unfortunately).

For now, you might consider a few actions to combat both scenarios, easy and free.

On the CPAP, I'd say kill off the ramp. I don't recall if EPR was on but if so reduce it. See if these have an affect on lowering CA. However this may make hypopnea increase. In that case, you'll have to choose the best balance between comfort and low events.

Got it. I'll kill off the ramp and see how it goes. Thanks! I've completely disabled EPR but no lowering of CA yet. I assume it takes some time for changes to take effect.

[Unkikonki]

CA could be due to the fact that you  are new to PAP.

Post your Sleep Study Report, redact your name, address, etc.

Hi. I uploaded the full Sleep Study Report here: https://drive.google.com/file/d/1Upnj_sX...sp=sharing

"I went to see one of the specialists from the company providing the machine, who said the minimum pressure was too high for someone like me, so he set it down to MIN 5 - MAX 10"  

What did the specialist know about "someone like you"? Do you have any known medical conditions that would result in something bad happening?

No, he meant I'm not overweight or big, and I'm overall healthy and fit (I exercise regularly). I have the feeling he was talking out of his a** though, he didn't look like an expert to me.

Put the settings where you were most comfortable and had a better AHI report. include EPR 2 or 3, if you were comfortable with EPR. We can address CA's later.

I've had EPR disabled for the last couple of nights and I haven't really noticed any difference in terms of comfort. It might be worth mentioning that my mouth sometimes drops open, probably due to the pressure. I got a chin strap but not sure if going for a full face mask might be better.

Turn off Ramp. You get no therapy from ramp.

Leave your settings at that pressure while you work on getting a good mask seal. Read the Mask Primer:

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


   Be sure to read all the way down to include  "How to achieve the perfect mask fit - GUARANTEED! by Jeffy1958" 

Will do. Thank you so much for taking the time to help me.

[SarcasticDave94]

OK, for myself anyway, the important info on the study was events and count, which were heavily in favor of Obstructive not Central. This indicates your centrals are due to the CPAP causing CO2 flushing, meaning the bit of pressure that makes up your therapy is having you exhale more efficient than the body is accustomed to. This in turn causes breath pauses, which are much like other centrals. With the edit like lower EPR for a short time, this helps with the breath "reprogram". Maybe a few days to a week and you can trial EPR again, and if it's fine on CA you'll be good. It may take a few attempts to introduce EPR and be able to keep it.

You can check in anytime with a new OSCAR if you want feedback on progress. You'll begin to note things yourself though, feeling better with lower events, and vice versa. You'll know if you're doing OK by feel before even seeing the chart.

You'll want a balance between low events versus comfort and rest. You'll find a place where both are good, then just run with it without dial turning.

best wishes to success