[Treatment] New to CPAP - Central or Obstructive?

[madsleepy]

Hello all. I'm new to CPAP (been using the AirSense 11 for about 3 weeks now) after getting diagnosed with sleep apnea just last month. I tested after going to the hospital a few times in April of this year for symptoms I was experiencing both during sleep and while awake. Those included trouble sleeping, frequently waking up, and having trouble going to sleep. I would start falling asleep and then wake up having trouble breathing, repeatedly. These were in addition to other daytime symptoms including lightheadedness and chest pain (getting this looked at by other doctors currently - so far, no answers). Anyhow, I took an at-home sleep test which showed that I had an AHI of 16 (3% desat) and 11 (4% desat), but the test couldn't distinguish between OA or CA in those events. I then had a titration study done, during which a CPAP was used. I was told that I do NOT have CA because the CPAP worked to control my events, ultimately leading to stable O2 levels and an AHI below 3. However, that titration study also showed mainly central events and very few obstructive ones. I sought clarification and was told by the reviewing doctor that I likely had treatment-emergent central sleep apnea and that these should ultimately go away. I now have the CPAP and have been using it with a range of 9-15. I use EPR of 1 right now (decreased from 2 which was how it was set up initially) and I have it on full time. I also have the soft setting on, versus standard, in the Autoset setting. My AHI is below 5 every night and below 2 most nights. However, the vast majority of these events are clear airway events. I will be following up with my sleep doctor in a couple of months, but am curious as to whether I really do just have OSA or I have CSA. I noticed that my CA events tend to occur in clusters and usually around when I wake up. Anyhow, I'm new to this and am still researching OSCAR and how to interpret the data it provides. 

I've uploaded my most recent data from OSCAR as well as some data from the sleep study and titration test. I'm curious to see if any of these graphs/numbers pop out to anyone. I'd be happy to provide more info if that's needed as well. 

Thanks for reading!

   
   
[attachment=64671]

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Attached are the second page of the sleep study and some data from the titration test as well.

[SarcasticDave94]

Welcome to Apnea Board,

The black and white page below the colored chart did sort your events as follows:

1 Obstructive Apnea
3 Hypopnea 1B
9 Hypopnea 1A
40 Central Apnea
0 Mixed
0 RERA

Over a 327.5 minute sleep time session

On the AutoSet, you'll want to do away with the Ramp to gain more therapy time. Ramp time gives zero therapy.

The OSCAR chart with the AutoSet surprisingly isn't swarming with CA. Maybe it's on the next one.

Let's see what happens, but with very, very pre-dominant Central Apnea, you're probably going to require a ResMed AirCurve 10 ASV to treat these. Again let's see though, surprising things can happen. Just be prepared either way.

[madsleepy]

Thanks for the response, SarcasticDave94. That black and white document is the titration study results. I had the same concern re: the majority CSA events, but the reviewing doc said it was likely (but not surely) treatment-emerging and still recommended a CPAP. Before doing the titration study, I too was thinking I’d need a bipap, but was told it wasn’t necessary.

[SarcasticDave94]

Oh OK, I didn't see a Titration identifier there. Sorry about that.

Then to focus on the OSCAR chart, there's a small amount of CA which should be of little concern, being under 1 AHI-C. I would still consider removing Ramp as in my own experience can enhance CA, along with being a no treatment time period.

[madsleepy]

Thanks for the reply. I started last night without using ramp. It was a bit difficult and I ended up switching back to ramp in the middle of the night. I will continue trying without ramp but I may still be getting used to the therapy overall. My AHI was 2.9 last night with .3 of that being OA events.

[SarcasticDave94]

If CA is under 5, medically it's considered treated. This counts for any specific Apnea as well. So with you're numbers being 5 AHI or less, it's now based on how you feel. Saying all this to not get too hung up on numbers but how you're feeling for the therapy.

[madsleepy]

Thanks for that. Been obsessing over this trying to figure out how to best use my machine.