So Happy!!

[Bjjpapi]

Great news is that I passed my recertification test, couldn't have done it without CPAP. Bad news is it seems I'm an issue with my SD card. I can see files written to it when I open the folder but they aren't being imported to Oscar, or at the very least I can't see them as "sleep charts". Anyone have any clue what's going on? I've tried searching for an answer but can't come up with anything.

[Bjjpapi]

I clicked on "rebuild CPAP data" under the data tab and was able to see all the charts. I've had some issues but managed to get some sleep in between them. I initially set the machine to max of 15 and minimum 10 (afraid of too much and too little). last night I think I may have set it to max 20, minimum 7, EPR 3. I may have changed that half way through the night, I can't remember.

most of the AHI in my charts are from when I'm awake or have woken up due to issues but the one flag I think is real if the clear airway flag, probably central apneas.

[Bjjpapi]

Charts from Tuesday night


the first is the entire sleep session, second chart is a close up where I don't believe I was awake,

[Bjjpapi]

two more from last night

[Bjjpapi]

This first 4 charts look Cheyne stokes to me, definitely not awake. that's from the night before last.

[Bjjpapi]

last night I made my max 13, min 10 and EPR of 1. the rest of the charts are from last night, I believe I was awake for the section flagged Cheyne Stokes, but for the Cheyne Stokes looking parts that weren't flagged I'm pretty sure I was asleep. Didn't have a whole lot of sleep, still need to work on that, but I feel way better than I did before.

I did get an automated call from DME saying they have my prescription and that they'll call me in the next few days for mask fitting and machine.

[Gideon]

You are showing a good amount of Flow Limitations and with EPR of 1 some RERAs.  This says you need to increase your EPR.  EPR of 2 looks better from an Obstructive point of view but your Centrals increased indicating that your Centrals are likely Treatment-Emergent Central Apneas. 

Control of centrals on your current equipment is a matter of avoidance.  Decrease of EPR being the biggest control, and the overall lowering of pressure/pressure changes being the other. Note that this advice is the opposite of that issued in the initial paragraph.

Treatment-Emergent Central Apnea often goes away as your body adjusts to treatment.  This takes 2-3 months of adaption.  

The other option is EERS.  Treatment-Emergent Central Apnea occurs because your treatment with CPAP is washing out too much CO2 from your blood.  Decreasing EPR improves the CA results because that action lessens the effectiveness of the breathing assists delivered by your CPAP/APAP/BiLevel.  This effectively raises the pCO2 in your blood to a point where a signal to breathe is initiated. (high CO2 level is a primary driver in our breathing mechanism)  EERS does the via a mask modification which slightly increases the amount of CO2 that is rebreathed.  This effectively eliminated the central apnea.  Note that this is a process that your medical team has not likely heard of and because it requires a mask modification is frowned on by many in the medical profession.  I'll add that this process is used extensively by a few doctors in cooperation with a few DMEs and Sleep Centers.

[WillSleep]

Hi guys,

The other option is EERS.  Treatment-Emergent Central Apnea occurs because your treatment with CPAP is washing out too much CO2 from your blood.  Decreasing EPR improves the CA results because that action lessens the effectiveness of the breathing assists delivered by your CPAP/APAP/BiLevel.  This effectively raises the pCO2 in your blood to a point where a signal to breathe is initiated. (high CO2 level is a primary driver in our breathing mechanism)  EERS does the via a mask modification which slightly increases the amount of CO2 that is rebreathed.  This effectively eliminated the central apnea.  Note that this is a process that your medical team has not likely heard of and because it requires a mask modification is frowned on by many in the medical profession.  I'll add that this process is used extensively by a few doctors in cooperation with a few DMEs and Sleep Centers.

I would only just add to this that random guessing on sizing EERS could be dangerous to the levels of pH and CO2 in your blood.  I have not yet seen any MD, PhD or Sleep Lab use of EERS that does not involve a Lab or Sleep center titration of etCO2 and sometimes BGA (blood gas analysis testing (pH, PaCO2, HCO3-)) testing so please make sure you are set up to be safe if/as you pursue EERS.  

You are showing a good amount of Flow Limitations and with EPR of 1 some RERAs.  This says you need to increase your EPR.  EPR of 2 looks better from an Obstructive point of view but your Centrals increased indicating that your Centrals are likely Treatment-Emergent Central Apneas. 

Control of centrals on your current equipment is a matter of avoidance.  Decrease of EPR being the biggest control, and the overall lowering of pressure/pressure changes being the other. Note that this advice is the opposite of that issued in the initial paragraph.

Treatment-Emergent Central Apnea often goes away as your body adjusts to treatment.  This takes 2-3 months of adaption.  

"Control of centrals on your current equipment is a matter of avoidance."
 
Bonjour I can sure see why you wrote this and all of the quote above.  

What next steps do you recommend for him?

My "help us all learn" questions are:
- At what point should he consider a VAuto or ASV instead?
- What will determine if the recommendation is VAuto rather than ASV?    

WillSleep

[Gideon]

He is getting a new machine, observe and see what that yields, and to think about what direction to take.

VAuto does provide higher PS and higher pressure. PS is at least early on contraindicated because of the generated Central Apneas.

A typical course of action would be to observe for a month with a setting that actually reduces the CO2 somewhat and thus gives some centrals at a manageable level. Alter the settings as adaption occurs to continue the adaption. On failure of this to consider ASV and/or EERS.

I'll add that it is not random guessing but starting with 6 inches and expanding with additional 6 inch segments.

[Bjjpapi]

Thank you both so much. I'll be sharing the screenshots with my pulmonologist when I go see him on Tuesday. I've yet to see what the prescription is for, I'll probably get sleep study results on Tuesday. In the meantime I guess I'll keep a close eye on this. Thank you both for the advice!!