[Treatment] After years of successful treatment: a Big jump in AHI and drop in restfulness

[AtRest]

Hello all,

I have been using a Bi-pap machine for 'severe sleep apnea' since 2012 and it saved my sanity. Since Covid started I have embarked on weight loss that has seen me drop from 265lbs pounds and well in Obese BMI to 205, just under the Obese range. Middle of March I had an anxiety attack after a night of sleeping and every day my AHI crept higher and higher reaching 45 at it's worse.  I called my PCP and they ordered an at home sleep test which took for ever to arrive. The last month has been hell with my AHI settling into the 15-30 range depending on the day. I noticed I seemed to be swallowing more air and my mouth and throat would be extremely dry with drool crusted around my mouth. I read through this forum and tried a chin strap and the neck brace, but they didn't seem to make much difference.

The sleep test arrived last week and I had my appointment for the results today: I don't have sleep apnea. My PCP agreed with me that this is extremely unlikely and we starting the process of an in center study, which honestly, is pretty expensive with my insurance this year and I know can take a long time to schedule. I made a lot of mistakes with my sleep apnea journey. I'm downloading OSCR right now and ordering an SD card reader. I will pick up the results of my 2 in-home studies and my original in-center study in 2012 tomorrow.  I'm fearful this is CSA, I'm hopeful my OSA really is better and the settings are just too high. With that historical information and the OSCR data alone, is there any chance I can find relief?

[Gideon]

With OSCAR alone we will be able to see what is going on. After we see a night we may ask you for a night of very low pressure and no PS to run a sort of test to see if events show up. But that is after we see your OSCAR results. Unless your machine has had an SD card in it we will not be able to see detailed past results.

Any brand SD card 2-32GB not bigger.

[AtRest]

Thanks Gideon. I have an old SDHC card in the machine right now from my previous machine. It seems to be recording. I just don't have reader, but a card reader (and backup SDHC card) should be coming tomorrow.

[Gideon]

Good to know

[AtRest]

Okay I have attached the last three nights of information my Aircurve 10 VAUTO. Looking back through the roughly year of data it has, the Obstructive events have almost always been near zero, and the AHI I see in the MyAir app is almost exclusively due to 'clear airway events'.  I did my best to follow these two links, but please correct me if I missed something important. In full screen mode I had trouble avoiding a yellow pop-up box in charts when having the app full screen and with mouse focus.


OSCAR_Chart_Organization
Attaching_Images_and_Files_on_Apnea_Board
[I'm not actually allowed to post links yet]

   
   
   

[SarcasticDave94]

It looks like you've won a bit of a trainwreck outlined with purple event marks.

We'll work with what tools are present and see if the avoid game can net you a prize. Um OK, number 1 turn off Ramp. Number 2, cut back your PS either to 2 or 3 maybe even off. We'd need to minimize any extra pressure swings to cut down the maybe CA.

Oh let me back up. Edit this OSCAR chart to zoom in about a 2 to 3 minute window on the flow rate and etc. Then we can go back to suggesting PS and such. No matter what, the ramp's needing to go off.

[Crimson Nape]

First, about the tool-tip.  If you go to File > Preferences > Appearance > Graph Settings(upper left) - Slide the Tooltip Timeout slider to the left.  The lowest that this will go is one (1) second.

Now, your graphs;  Your high PS is probably causing your CAs.   I would try dropping your IPAP to 13 or even 12.  Make sure that Easy-Breathe is turned on and the Trigger setting is set to High or Very High.    What is are the length of your CAs?   Specifying a range will do.

[AtRest]

I will turn off the ramp. I have attached a zoomed in flowrate for last night and the night before. Last night you can see my sleep habits were a mess, I was woken up with a chest pain that triggered some anxiety and it took a while to get back to bed. I also picked up the results of my 2 night at home sleep study, sounds like they don't actually have my 2018 test or the one from ~2012, waiting to hear back from my previous doctor's office on that.

Night 1: 8 (1 Central, 7 Obstructive) apneas recorded, AHI 1.9, RI(?) 4.7 
Night 2: 9 (5 Central, 4 Obstructive) apneas recorded, AHI 2.1, RI(?) 5.1
There is other data for both, but I don't want to scan in the document as it has personal info scattered around.

   
   

[AtRest]

I would try dropping your IPAP to 13 or even 12.  Make sure that Easy-Breathe is turned on and the Trigger setting is set to High or Very High.    What is are the length of your CAs?   Specifying a range will do.

You replied while I was replying so I missed this. Is there a link to what the EPAP IPAP and PS are and do? Also, I'm not sure how to answer your question about CA's. Thank you.

[Crimson Nape]

PS stands for Pressure Support.  It is the difference between IPAP and EPAP.  The PS term and setting parameter is used when you have the AC10 set to the VAuto mode.  It will set the pressure difference throughout the entire pressure range.  When you are operating in the S-Mode, all you have is the IPAP and EPAP pressure settings.   You can mimic your current S-Mode settings in VAuto using a setting of EPAP min=8, IPAP max=15, and a PS=7.   If you wanted to maintain your current pressure range, but limit the pressure difference between EPAP/IPAP to 5, then the pressure settings would remain the same, but the PS would be set to 5.  This would make your settings start at 8/13 and allow your pressures to go as high as 10/15.    For your information: VAuto mode does not display the Easy-Breathe mode option.

Is that as clear as a bucket of grits?  

The CA's; In the Daily screen look for the tab on the left named, Events. Under this tab will list the different type of events that occurred on that day. Expand the one named, Clear Airway. This will list each event with the time in seconds that it occurred within the parentheses. Since the number of events for this parameter rivals a small city's population, a span in time would be easier to list here.


- Red