[Treatment] High CAs, Need Some Direction

[BobbyApnea]

       
Hey Apnea Board,

I have recently been diagnosed with OSA after a sleep study. My AHI at the time was 25, and at the follow-up sleep study with therapy my AHI increased to 35. I figured it was due to the horrible sleep I got in the environment and the clinician mentioned small periods where it looked like CPAP therapy could help. I have had my Airsense 10 for 3 weeks now and I am relatively comfortable with sleeping in the mask. I use an F40i full face mask and tape my mouth shut due to aerophagia.

All that being said, I have consistently monitored my results with OSCAR and have noticed a relatively high amount of CAs and low OAs. Is there something I can do to lower these events? I have pressure settings from 11-17 and an EPR of 3. I wake up feeling generally better most nights and I can tell when I have a 'bad' night, so thats good! Just looking to get to that magic number and feel fully rested.

I have attached screenshots of a whole night and a zoomed in portion of the same night during a spree of CAs. My AHI has ranged from as low as 6 to as high as 20 through these 3 weeks.Thanks for all your help.

   

   

[staceyburke]

I typed this but it did not seem to post, so you might find 2 very similar ones.  The machine you have can not treat centrals.  We have found that EPR in some people cause more centrals so I would turn off the EPR and see if that helps.  The machine you need to fight centrals is a ResMed AirCurve 10 or 11 ASV.  Most of the time you have to show the machine you do have will not work for centrals and insurance will cover the ASV.

[SarcasticDave94]

Ramp will also affect CA, turn it off as well.

Also, did you get your copy of the sleep study detailed report? If not, request it ASAP. The doctor must give it to you once requested, in a reasonable time. HIPAA law gives you the right to request and receive it. You'll want to get images from that to post here, redacted of your personal info. The bit of info that is most useful regarding CA is the event table with type and count, and possibly the diagnosis to see if there's comments on CA.

[AshSF]

I would suggest this experiment:
1. Make EPR = 0
2. Make min pressure to 10. You can have a ramp. No issues
3. Make top pressure to 10 as well. The too high a pressure of 12+ may be stretching your diaphragm muscle as its early days for your therapy. Resmed has an aggressive algorithm so the person responds with the typical waxing and waning amplitude signwave of breathing.

Try for a week and then re-evaluate and adjust.

[BobbyApnea]

Thanks everyone for the replies. Last night I tried EPR 0 no pressure changes and my AHI was on the lower side of my average at 9.90 but I had horrible aerophagia (might be coincidence as I may be coming down with a cold / allergies). I also felt like my sleep quality was much lower than average. I wear an O2 ring as well and there was nothing outstanding in the data vs my average. Will try reducing pressure to 10/10 tonight as suggested.

It does look like my CAs this past night were more arousal based vs central apnea.

On my results from initial sleep study it was listed that I had 100 obstructive hypopneas and 10 apneas, 9 central , 1 obstructive. There were no other notes on central apnea.

[Deborah K.]

You really need to turn ramp off.  You get no therapy during ramp, and if you get up for a bathroom break, when you return to bed ramp starts all over again, robbing you of needed therapy.  Turn it off.

[SarcasticDave94]

OK with those numbers on the test, now these CA will be more likely treatment emergent. You'll have to try avoiding some, and they should diminish with time.

[quiescence at last]

Another take on the ramp. The value of a ramp is if you cannot get to sleep because of the initial pressure. But, the ramp only needs to be low enough for you to "feel at ease" and since it looks like you think there is a need to have the minimum at 11cm, the ramp pressure should not be starting any lower than about 8.0. Later in your treatment, you may really rather just start at 11, and at that time you can eliminate the ramp altogether.

Another take on the EPR. The CA chatter you have posted obviously has the quality of waxing and waning breathe volume, and it results in those just plain stops. The driving force for over breathing is the result of your body reacting to the amount of EPR. There are other respiratory drives at work, but this is why we usually suggest to reduce the amount of EPR. A drop from EPR 3 to EPR 1 or 2 will likely steady this waxing and waning. some. so try.

I think the other respondents are steering you well.

Keep it up.

QAL

[BobbyApnea]

I did what you all suggested and had a great nights sleep with the lowest AHI I've had in the 3 weeks its been measured. Thank you. I will maintain the current settings that you all recommended, 10/10 pressure, EPR 0, Ramp off, for the next week and see how it goes. My next battle is aerophagia and how to combat that, you may see me make another post in a few days asking for more recommendations.

[SarcasticDave94]

It's an improvement, so that's good. Let's see how this plays in the next day or so. If the CA begin to settle, then you can consider adding EPR 1. Get used to that then step up again to EPR 2, then 3 gradual. You also might be able to soon add a small pressure range. Aerophagia will diminish over time for most.