[Treatment] New User Seeks Guidance

[Sleeper396]

Guess I fell through the cracks on getting anybody to respond to this last post. Maybe there is nothing to say.

[Gideon]

I'm waiting for you to add the EPR in. That will help your flow limits.

And if your consistent CAI is below 2, by the numbers you don't need ASV.

That said, therapy with CA but without ASV is a balancing act between obstructive and Central Apneas.

[Sleeper396]

Thanks, Gideon.

[Sleeper396]

Good morning.  Just wish to follow-up on my posts and solicit next step advice from the expert team.  I am 4 months into treatment using a ResMed AirSense 10 Auto Set. As a reminder, I used a dental device prior to this for my sleep Apnea, but the device failed to help and my mild apnea was exacerbated to become borderline severe.  I currently have landed on an AHI average of 2.3 (for the last 30 days), which now consists 90% CA's. Currently I have perhaps one OSA event per night of almost 7 hours, and the rest are usually CA events. On a good night, there are no CA's until early morning hours, and then, they hit. On a bad night, the CA's hit throughout the evening and generally run 10-15 CA events on between 6.5-7 hours of time on the APAP. The inconsistency of the CA's are just as predicted by the expert team. My biggest problem by far is broken sleep, waking up 3 times per night with the need to pee. I have an enlarged prostate which contributes to the wakeups, and I take meds for that; but all other tests and blood workups are negative, and it appears that this is just my nightly frequency. By the way, my bathroom wakeups are down to 3 from a pre-APAP treatment number of 6 per night, which was torture. I wonder if the CA's are contributing to the over-production of urine at night. My current settings on my AirSense 10 Auto Set are 9.6/14.8 with EPR of 1. I previously was at 8.2/14 with no EPR, and I achieved the same basic results from that setting. Once again, do you feel that I should push for an ASV as a possible path to fewer bathroom wakeups and more restful sleep, or will my enlarged prostate continue to wake me up regardless of the CA treatment?  The CA's do not usually show as directly waking me (they do not appear just before my wakeups on the Oscar graphs). It is just the need to pee that seems to be causing the 3 wakeups per night. Please give me your thoughts.  I understand that you are not urologists, and I am treated by one. However, I feel that your expertise is certainly superior to my sleep doctor and would love to hear your thoughts. I am enclosing my graph of CA Index for the last few months, and my Oscar report from last night. Thanking you in advance for your excellent input, as always.

[Sleeper396]

What does it mean when my respiratory rate occasionally pops to a 50 peak rate, with a 95% respiratory rate at 40? Most nights are considerably lower, with a peak respiratory rate of 30, and 95% respiratory rate of 20. Median always falls below 14. These higher respiratory rates seem to fall in clusters of a few nights at a time, up to 4 nights of higher rates, then returning to what is my norm. Thoughts on why that might happen?  Please see Oscar graph attached. Thank you.

[Sleeper396]

Hi Apnea Team,

This board and the team of responders have been nothing short of great. I was doing very well over the last 6+ months; that is, until last week. Here's what just happened.

A week ago, I got a cold with bad nasal congestion and saw my Oscar data "tank. " Sleep sessions went from typically 3-4 per night (each averaging a 2+ hour durations, which was very good for me compared to my pre-treatment disaster nights), to currently more than 10 awakenings per night -- for each of the last 5 nights -- with each session having a duration averaging 30 minutes. Oscar actually clocked 17 times that I hit the main button last night (though some of those times were me looking at the AHI and time duration data). My bathroom trips shot back up to 5-6 (from a previous 2-3 per night (note that I also have a nightime/nocturia condition that is being treated by both APAP + meds). My cold has mostly receded, but the results remain shockingly poor and are very concerning to me.  

One more piece of information: The day after my major setback was clocked on my ResMed AS Auto Set 10, I changed my APAP to the new ResMed AirSense Auto Set 11, so I am now on a new machine as well. I may go back to the Resmed AS 10 tonight just for comparative data.  I had bad results on the AS 10 for one night at the start of my cold, followed by 4 nights of terrible results on the AS 11. 

I am very concerned that this is a new negative pattern for my apnea condition, with now 5 days of the same issues, despite my cold symptoms being almost completely gone. I am enclosing screen shots and hope that some of you might have suggestions for me.  Finally, does the Oscar latest release handle the new ResMed Air Sense 11 data in the same way as the Air Sense 10? (i.e., can I make accurate comparisons between the 2 machines in Oscar, with statistical reliability?). 

Thanks in advance to all who may have comments/suggestions for me in handling my New Year's dilemma which has me very concerned.  And Happy New Year to all on this board.

[Ratchick]

I'm pretty sure that the differences between the 10 and 11 are minimal.

What's waking you up? Are you congested? Are you stressing over the AHI and that's keeping you awake?

I generally avoid stopping the machine, unless I really need to. If I want to mark something, I just nudge my mask to trigger a leak so I can find it, if necessary. But I know for myself that if I am constantly checking and wondering what my AHI is doing, then I am NOT going to sleep well.

It's pretty normal for something like a cold to knock you on your ass a little. It's affecting your respiratory system after all. So I wouldn't worry too much about that, it's still well below an "untreated" level. And yes, if you keep waking up for whatever reason, that is going to prevent your body from switching your kidneys into "low overnight urine output" mode. Add that on top of your pre-existing prostate issues and you're going to be up and down a lot more to pee. And then, because you're waking up more, you're more likely to "go because you're awake" rather than "waking because you have to go" and of course, getting out of bed etc, makes it even harder to drop off again. So it's kind of a vicious cycle.

[SarcasticDave94]

The new, negative factor is the cold and related congestion. Among possible actions is taking an over the counter Flonase spray, and other cold fighting actions you normally take.

[Sleeper396]

Thanks so much, Ratchick.  

I was doing well with therapy, and do not want to lose the progress that I have made. This is actually my very first cold since being on CPAP treatment. You have helped to reassure me that the current setback is probably just a temporary cold/respiratory-related series of issues, which makes total sense.  

Appreciate your support.

[Sleeper396]

The new, negative factor is the cold and related congestion. Among possible actions is taking an over the counter Flonase spray, and other cold fighting actions you normally take.

Thanks, Dave.