Symptoms returning after 21 months of APAP use - OSCAR data included

[victoriabk]

I've been using a ResMed AirSense 10 for Her since June 2019 and have had a lot of success with treatment. However, about a month or two ago, I started feeling some of the same fatigue/excessive daytime sleepiness that I had for years prior to my diagnosis and treatment. I am still sleeping at least 8-9 hours every night and haven't changed anything else. My AHI is showing as low (avg 1.37 over the last seven nights). Counterintuitively, this has coincided with my MyAir data suddenly showing zero leak whatsoever, whereas I used to have a small amount of leak most nights before this period (though I suppose that could be unrelated).

I've made an appointment with my doctor but he has no availability for 2+ months, so in the meantime I figured I'd turn to OSCAR and this community to see if it looks like there might be anything obvious going on based on the data. This is my first time using OSCAR and while I'm happy to try to learn how to interpret what I'm seeing, I know there are many people here who are already experts, so I would love to be able to take advantage of the expertise of anyone who is amenable to taking a look!

OSCAR data from last night attached. Please let me know if there is additional information that would be helpful to have or a different way to display the data that is more helpful - I followed the OSCAR Chart Organization page on the wiki, but like I said, I'm totally new to OSCAR!

   

[staceyburke]

Sorry I had problems with my computer and it shut down.... Let me try again.

All of your events were centrals.  No settings on your machine can stop them AND YOU DO NOT have enough to worry about.  But let's talk a little bit about centrals.  They are very inconsistent - one night you may have a few next night none.  You just don't know when you will have them.  IF there are a lot constantly then you need a different pap machine to have therapy.  Again, you are fine you do not have many.

What are centrals - centrals are when there in NO obstruction but for some reason you do not take a breath for at leat 10 seconds.  It may happen when you roll over in bed or pull up the blanket.  Many times it happens when you are just waking up or going to sleep.  Besides holding your breathe your body sometimes stops taking in Oxygen when you have a decreased amount of CO2 in your blood stream.  That is one thing that regulates your normal breathing.  Pap therapy does a great job of stopping  apnea and getting rid of CO2.

There are a couple of things I would suggest. --- your settings are Min=5 max=15 EPR=3

To begin with 4 is as low as a pap machine can go and these machines are used for children also.  An adult needs more air on inhale than 4.  I would suggest 7

You may already understand this but EPR is exhale pressure relief.  And what it does is lower the min pressure on exhale so that you do not have as much resistance (pressure) when you exhale.  So your exhale pressure is min-EPR.  On your settings that would be 5(min)-3(EPR)=2.  obviously Your machine can NOT go to 2, the lowest it can deliver is 4.  So your setting of the EPR is not doing you much good.

New settings
Max 15 (stays the same)
Min 7 (change from 5)
EPR 3 (stays the same)

Last suggestion is the ramp.  You have it set for 20 minutes.  While you are on the ramp you are getting NO therapy - it stays for 20 min at 4 and never tries to strop your apnea when it happens.  Now that might not be to bad but each time you turn it off (you did it 2 times and 1 when it first started) the ramp starts again - so you went 1 full hour without therapy.  If you can turn it off if you can't do that cut it down as much as possible.  Most everyone that has been on pap therapy for a while turns it off.

[SarcasticDave94]

Hi victoriabk and welcome to Apnea Board.

Some actions for you to assist the PAP therapy: you'll want your Apnea test results in detail as you need these for your personal health folder and I'd like you to post redacted versions attached to this thread. US HIPAA law says you are entitled your copy from the doc's office.

Next you should edit your PAP pressures a bit to take advantage of the machine features. You're using EPR of 3 and you'd need to give it more pressure to work properly. Let's edit your minimum to 7 instead of 5, to allow EPR that room and to give you a bit more air. The AutoSet has a physical minimum pressure of 4, but EPR 3 attempts to reduce Min pressure by that EPR number yet it cannot mathematically.

Secondly, there's flow limits on the chart that may disrupt sleep a bit and can also benefit from the slight pressure boost. FL are untimed events that aren't quite big enough to be Apnea.

Another area that can help is to turn Ramp off. It can possibly disrupt sleep more than it helps and it also may hinder therapy by forcing pressures to be too low.

Recap:
Get your charts
Edit min pressure to 7
No Ramp
EPR 3
Max 15 should be OK as is
Post OSCAR after a night to show results and tell us how you feel

[victoriabk]

Great suggestions on the adjustments to make - will definitely be doing that and will follow up with OSCAR data afterward. 

I did several sleep studies over a period of three years. Most recently I did two consecutive nights of an at-home study in 2018. I'll post the overall results and detailed first night info here and second night info in a separate reply. Sorry the quality could be better on the detailed info pages - I can let you know what the column headers are if they're not legible. Thank you!!

   
   
   

---

Second night sleep study (higher AHI) posted here.

   
   

[SarcasticDave94]

Both of the nights data show nearly equal Central and Obstructive Apnea, with lots of Hypopnoea which maybe were mixed. So despite that, the results on OSCAR are quite good. Now the real test, how you feel, isn't quite as good. You're feeling fatigue, possibly sleep disturbances.

So here's where I see you on this, a crossroads of sorts. Keep this therapy or take on a fight to get ASV for CA treatment. You have to decide if you're well enough rested or not.

To help your learning, an ASV is the only one specifically designed to treat Central Apnea. It will treat the others too. But the opposing side, AutoSet and others can't treat CA. You can only use settings to avoid CA on anything other than ASV. The ASV is BPAP with backup rate.

If you want to take on that fight, start documenting not being well rested and similar, but the test results help too as they show predominently half your events as CA.

The best choice for CA combat is the ResMed AirCurve 10 ASV. And if that's your choice in getting ASV to treat CA, get your doctor to agree on a titration with ASV included.

[victoriabk]

Here's the data from my first night with the settings changed. Just one night but definitely not a resounding success. Sounds like ASV is something I should consider. I just feel confused because I did so well with this treatment for almost two years.

   

[SarcasticDave94]

OK something to think on, any changes medical? New medications? Living at high altitude? Any thing at all different with the timing of your 1-2 months ago where treatment started being "off"?

Also, let's start over on the therapy suggestions in light of basically all events are at least now being Central.

Would you try EPR 0 as in off?

Note what happens to your events, particularly CA. And note down how it changes therapy feel and your overall feel as well, comfort, rest or not, and similar. Try it a bit unless it gets too bad then revert back and just tell us the results with an OSCAR chart.

[victoriabk]

Will reply here in a moment with data from last night with EPR off (ran out of attachment space and can't post a link until I have four posts).

I see it's very similar to the previous night in terms of the number of clear airway events. And no real difference in how I feel today, but curious if you notice anything in the data. Thank you so much for all of your help!

---

OSCAR data with EPR off: https://drive.google.com/file/d/1OdW5yhm...sp=sharing

[OpalRose]

Your EPR is still set to 3 in the 4/8 graph. Turn it off for tonight.

[victoriabk]

Thanks, I noticed that too - and the other changes I made are also not reflected (upping the min pressure and turning off ramp). I double-checked and those are the current settings on my machine. So either there is an issue with the settings that are reflecting on the machine not actually taking, or they are not showing accurately on OSCAR. Not sure how to know which it is!