OSCAR Interpretation Help Please

[Geer1]

You are right that the original results were a little bit better. As Sleeprider mentioned the higher EPR helps treat the flow limitations that are part of the problem though..

In simple CO2 driven central apnea cases you can just turn down EPR and they improve/go away. As we noted with your father lower EPR actually makes things worse because it worsens the obstruction/restriction present causing more arousals and somewhat surprisingly more centrals.

With time some of these things can get better and potentially using EPR of 3 would start to get better results than previous settings. The one down side is that your father hasn't shown any significant improvement since starting treatment and he has been on it for quite a while. Although there does appear to be a minor amount of CO2 effect I do believe your father also has idiopathic central apnea (should have shown up on sleep study) as well.

Imo ASV would be the best treatment for your father. You could try to convince sleep doctor to trial him on it considering his results have always been questionable (~5 AHI and mostly central).

[SarcasticDave94]

Just my opinion, if you're eventually headed to get ASV, keep track of actions done already, settings edited, results, how your father felt, with not only symptoms but the complaint list too. And then harp on these to the Max when discussing this with doc

Note this too, a VAuto might be somewhat helpful with the trigger settings, but ST will be a disaster, please refuse ST definitively and vehemently.

[CPAPUser73]

Thanks to all for the continued help and feedback. It is most appreciated! I will have him try to talk to his doctor about getting ASV. 

Two nights ago, we tried the original pressures of min 12, max 20, and EPR of 3. His AHI was 6.5.
Last night, he returned to the original settings of 12, 20, and EPR of 2. I'll see what his AHI was later on.

Here is a copy of his sleep study if it is of any help. Note, that it is 6 years old and he slept horribly that night due to all the wires. He also did not have A-Fib at the time.

   

[CPAPUser73]

So his AHI was 4.45 last night which is the best in a while. He used his original settings of 12, 20 and EPR of 2.

           

So besides looking into ASV, if he were to just stick with his current CPAP device, then would you agree that his settings are best as is? Is an AHI around 4-5 decent enough?

[SarcasticDave94]

My thoughts run this way, IF the results can build a trend like this it might be good enough. IF number 2 is whether or not your father is comfortable and resting well with this as is.

Secondly with results like this, ASV will probably be an impossible sale. So keep that in mind.

Side comment, that report you posted mentions Ventolin. Is this for Asthma or COPD as in rescue inhaler duty? I myself have Ventolin and sometimes Asthma, sometimes COPD symptoms. Dopey docs have diagnosed mine as COPD only to later change it to Asthma. The reason for the questioning is that this added Respiratory Disease may complicate Apnea therapy and make the machine choice more murky as it did for me. The ResMed ASV lacks timing controls that may be useful in your case too.

[Geer1]

These settings do appear to be the best middle ground right now anyways. As mentioned previously there is potential he would adapt to EPR of 3 and it be beneficial for him in the long run but it might also not obviously improve so it is a bit of a long shot.

Just as a bit more information what the ASV would do is allow EPR of 3 and then when apnea occur it would work to kick him out of it and stabilize breathing.

As Dave notes depending on the doctor it may be tough to convince them to try ASV. Many doctors seem to be wary of it or not know enough about it and since your fathers AHI is under 5 (albeit only just) some might consider that good enough results.

Your argument to the doctor is that results are no longer good enough on APAP. Tiredness and fatigue have been getting worse and now atrial fibrillation is also a factor potentially caused or worsened by apnea not being fully treated. You have tried different pressures and EPR and the apnea which all made the central apnea and symptoms worse. You believe treatment specific to these central apnea is required and that you understand ASV is the recommended treatment for central apnea like this.

If the doctor is good and knowledgeable he will agree. If he seems hesitant or not knowledgable you can share this Resmed document with him, CSA starts on page 29 and it discusses ASV as the treatment.

https://document.resmed.com/en-us/docume...er_eng.pdf

If doctors aren't willing to try you get stuck where many patients do trying to decide if you stick with what you have or buy a machine used to try it out (unfortunately supplies are low and prices high right now). They do recommend heart ejection fraction rate testing prior to using ASV which is something to consider, I imagine if he told doctor he was going to buy an ASV and try it anyways the doctor might at least do the testing.

[CPAPUser73]

These settings do appear to be the best middle ground right now anyways. As mentioned previously there is potential he would adapt to EPR of 3 and it be beneficial for him in the long run but it might also not obviously improve so it is a bit of a long shot.

Just as a bit more information what the ASV would do is allow EPR of 3 and then when apnea occur it would work to kick him out of it and stabilize breathing.

As Dave notes depending on the doctor it may be tough to convince them to try ASV. Many doctors seem to be wary of it or not know enough about it and since your fathers AHI is under 5 (albeit only just) some might consider that good enough results.

Your argument to the doctor is that results are no longer good enough on APAP. Tiredness and fatigue have been getting worse and now atrial fibrillation is also a factor potentially caused or worsened by apnea not being fully treated. You have tried different pressures and EPR and the apnea which all made the central apnea and symptoms worse. You believe treatment specific to these central apnea is required and that you understand ASV is the recommended treatment for central apnea like this.

If the doctor is good and knowledgeable he will agree. If he seems hesitant or not knowledgable you can share this Resmed document with him, CSA starts on page 29 and it discusses ASV as the treatment.

https://document.resmed.com/en-us/docume...er_eng.pdf

If doctors aren't willing to try you get stuck where many patients do trying to decide if you stick with what you have or buy a machine used to try it out (unfortunately supplies are low and prices high right now). They do recommend heart ejection fraction rate testing prior to using ASV which is something to consider, I imagine if he told doctor he was going to buy an ASV and try it anyways the doctor might at least do the testing.

Thank you! I appreciate all of your feedback throughout this process. It has been very helpful!