03-19-2022, 12:45 PM
RE: Need guidance for complex sleep apnea and leaks follow-up
You didn't appear to have bad leaks with the FFM until you tried high pressure, I believe it was the combination of FFM and high pressure that caused the leaks. That is why I recommended trying low pressure to see what happens but I didn't realize you switched back to nasal mask. I think it is worthwhile to try min 8, max 8, PS 4-15 with FFM to see if we can replicate Mar 6th data again as those were roughly the settings used and by far your best data. That could have just been a fluke good night or perhaps that combination works well for you.
A home sleep study would not be much use. An in clinic titration study would however be helpful if you can get one and have coverage for it. That is a type of study where you wear a CPAP machine and they try different machines and pressures to see what works best for you. They collect far more data than a home test and are much more capable in determining what the issue is and figuring out machine/settings capable of treating it.
The main thing that I see being an issue is the inconsistent breathing and although I do think there is complex apnea involved so far I don't see any obvious correlations with pressure causing any improvement or worsening etc. Part of me thinks this is a rare case where a square waveform, ability to adjust backup rate and ability to control min and max inspiration times could be advantageous. These abilities would give the machine more power to help you breath and keep breathing in time. Unfortunately this machine does not have any of those capabilities and getting one that has all of them would be tough with a titration study probably being the main way you might be able to learn if they would help.
As far as home tests go there is one we could do that would potentially help. That test would be change the machine mode into CPAP mode at 10 cm pressure. The reason this would be interesting and potentially helpful is that it would get rid of the pressure fluctuations ASV mode uses which would make it easier for us to interpret the OSCAR data and know that all of the changes being seen in data are being caused by your spontaneous breathing effort and not because of machine inputs changing. With that data we might be able to better identify if the issue is obstructive or central and then could try to refine settings with that knowledge. If doing this test the machine would not be working to treat central apnea and it would have slightly less capability for treating your obstructive apnea so it is possible apnea and sleep could be bad the night of test. If you are interested in trying this you could try a shorter test first (nap as an example) or if you are able to sleep without CPAP machine some nights I would imagine this test should not be much worse then those nights.
A home sleep study would not be much use. An in clinic titration study would however be helpful if you can get one and have coverage for it. That is a type of study where you wear a CPAP machine and they try different machines and pressures to see what works best for you. They collect far more data than a home test and are much more capable in determining what the issue is and figuring out machine/settings capable of treating it.
The main thing that I see being an issue is the inconsistent breathing and although I do think there is complex apnea involved so far I don't see any obvious correlations with pressure causing any improvement or worsening etc. Part of me thinks this is a rare case where a square waveform, ability to adjust backup rate and ability to control min and max inspiration times could be advantageous. These abilities would give the machine more power to help you breath and keep breathing in time. Unfortunately this machine does not have any of those capabilities and getting one that has all of them would be tough with a titration study probably being the main way you might be able to learn if they would help.
As far as home tests go there is one we could do that would potentially help. That test would be change the machine mode into CPAP mode at 10 cm pressure. The reason this would be interesting and potentially helpful is that it would get rid of the pressure fluctuations ASV mode uses which would make it easier for us to interpret the OSCAR data and know that all of the changes being seen in data are being caused by your spontaneous breathing effort and not because of machine inputs changing. With that data we might be able to better identify if the issue is obstructive or central and then could try to refine settings with that knowledge. If doing this test the machine would not be working to treat central apnea and it would have slightly less capability for treating your obstructive apnea so it is possible apnea and sleep could be bad the night of test. If you are interested in trying this you could try a shorter test first (nap as an example) or if you are able to sleep without CPAP machine some nights I would imagine this test should not be much worse then those nights.
