[Pressure] Sleep Study results, 1 month trial APAP - OSCAR breakdown

[pilothaz]

Hello to all, 

I had my sleep study in the summer and received my results, spoke with the sleep clinic and setup an appointment to have a 1 month trial on APAP (with a AS10).  Initial setup was to have me on 5-15cm to which I have attached the results from the sleep study (AHI of 16.8 they rounded to 17).   When working with the DME - they also initally had me on EPR of 3 and Ramp on auto.  From reviewing these forums I noted that with ramp on there is no tracking during that period.  With my results from the sleep study and from my data on my watch about my sleep patterns I knew that my time to fall asleep was short - so I lowered my ramp down to 10 minutes which should not be any issue for tracking purposes. 

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I also lowered my EPR down from 3 to 1 which from what I was reading would also help lower my CAs that were occuring from my early days (first night with a P10 mask and I was at 18.78).  Each night I have worn the mask the whole night and actually not woken up with it off my face.  The one big concern I have is mouth leak for which I have been trying to correct now with some tongue posture and spoke with DME to give me a chinstrap for trial in the month.   It didn't seem to help in much of the night with any correction on my leaks. 

I have had the opportunity within the DME to try different masks (had P10, N30i, Brevida and F30i).  Right now I am a toss up between the N30i and Brevida.

I try and attach notes to every night of my sleep when I pull the data into OSCAR - the following are for the attached screens. 

For Mar 6 notes were:
F&P Brevida XS-S, sore base of nostril.  Might have been caused by inflation with overtighten straps pushing up my base of the nose.
No Chinstrap
Lowered my EPR to see if that would lessen the CAs I was getting.



For Mar 9 notes were:
n30i mask S
tried using tongue posture on roof of mouth to be trained for leak rate to go down.


For Mar 12 night my notes were:
n30i mask SW
Lowered humudity to 1.
Woke up a few times with feeling dry mouth and my tongue stuck to the roof of my mouth.


If any of the information can be gathered from this and suggestions from you all it would be greatly appreciated.  I am going next week to break it all down with my Sleep Clinic Doctor and will bring my laptop with OSCAR at the ready to speak with her about it all.  On the summary I already know that I would likely have my range shortened since I don't ever hit even 11cm so could have my min at 6 or a bit higher.  

Many Thanks.
Haz

[Gideon]

Nothing of significant concern.
Your centrals show the waxing waning pattern of CO2 and byproducts induced breathing. And you don't have enough centrals to be concerned about them. Keep an eye on them yes, but don't worry.

Simply stated our drive to breathe comes from our need to flush CO2 from our system. It does not come from our need for oxygen.

The simple use of any PAP machine improves our breathing. With this improvement we flush more CO2 from our system and the volume of our breaths lessens. When our CO2 level go below our apneic threshold a central apnea occurs. Now that you are not breathing your CO2 levels build up and when the go above your apneic threshold you slowly start breathing. Due to a lag in the signal this increases to where you are breathing more than normal. Guess what , now you are flushing more CO2. Than you need to be and your breathing becomes more and more shallow until you are once again below your apneic threshold. This repeated pattern results in the waxing and waning and the clusters of CA events you have.

Realize that
Using a CPAP is good for you as it does reduce your apnea.
Using CPAP alone can, not will, result in this Treatment Emergent Central Apneas (TECA)
Increased pressure, variable pressure, and EPR also can, not will, result in TECA. Also note that this things that can cause CA events are the same things that are used to treat obstructive events.

[pilothaz]

Thanks for the insight Gideon.  I did recall that when utilizing the machine it can bring on more issues.  The worst part was when I finally drop this thread for information, last night was one of my oddest nights.  

Tried using the Brevida mask again with terrible results.  Felt that I was awake in such a light sleep till 1:15am when I stopped treatment and swapped quickly to the N30i.  Sitting at work now I feel a little off for my full night of sleep.

Last night's pic

[pilothaz]

My stats breakdown are as follows till Mar 14

[Crimson Nape]

You seem to be experiencing some hypopneas.  This usually can be a sign of either a poor sleeping position or too low a pressure.  As stated in another post, most adults find a pressure of 7 to 8 cm is better for breathing without feeling air starved.  I would try a starting pressure of 8 cm to see if you feel better, and it helps to clear up the hypopneas.  Since you are nowhere near your maximum set pressure, there isn't a need to modify it.

Good luck with your future doctor's appointment, as mentioned in your PM.

- Red

[pilothaz]

After meeting with my Sleep Dr today she adjusted my range for now and we also booked for an additional sleep study overnight in their room.
She only reduced my range from 5-15 to 6-10.

I had already booked with my DME that was in the same building and got my AS11 today. I set it up and popped in my new SD card (have already sent a PM to Gideon about the new model for OSCAR). See how tonight goes with all my own personal equipment now. See how tonight goes with at least it up a slight amt vs the 5, if not I might adjust myself to being my min.

[pilothaz]

Last night with the new machine and setup for 6-10 seemed a little off.  It could have been trying to use the medium pillow instead of the previous setup but this did feel like it was more comfortable.  

I did wake up adjusting a little more and also when I was done felt very bloated and gassy in the morning. No taping and was tossing a little more than usual. 

[Dr.Bob]

This may be a controversial comment, so I’ll be eager to see what others have to say.

Two thoughts:
1) Don’t focus too much on individual nights. It takes a while to get used to CPAP, to find the mask (and maybe chinstrap) that works best for you, and for your new sleep pattern to stabilize. See what happens over a couple of weeks before sweating it - unless, of course, something feels WAY off, in which case consult your DME or sleep doc right away.

2) I would recommend turning to your DME and sleep medicine doc for advice rather than making “clinician level” adjustments on your own. It’s fine to change the settings that patients are supposed to have access to, but - especially as a new CPAP user - it would be easy to choose the wrong pressure settings.

And that said, there are some really crummy sleep medicine docs out there, as well as DME providers who lack expertise or motivation to optimize your setup. So for me the bottom line is, if you think you’re getting better advice here than from your clinicians, fire your clinicians and find better ones. (I’m on my fourth sleep medicine doc and finally found someone I trust.)

And no disrespect intended to some of the people who post here: There are clearly some true experts. But even those experts don’t know the specifics of your medical history … and there are others here who offer advice that may not be so valid.

That’s my $0.02. Looking forward to what others think.

[pilothaz]

The last 2 nights ahve been increasing 4.58 then last night 10.43 with the first actual registered CSR in my charts. 


I also did a zoom in of the CSR 

[pilothaz]

To tap off of Gideon's message about our breathing and importance of CO2 in wanting to get oxygen there is a recent breakdown in Andrew Huberman podcast

https://pca.st/episode/f34a2956-1865-44a...2b359e630d