[Treatment] The Client's Treatment Request Thread

[theclient1437]

            Hi all, 

I've been recently diagnosed with mild OSA (AHI ~6, RDI 10, ODI 3).  I've been prescribed (and purchased) a Resmed Autoset 10, and have settled on a Resmed F30 as my mask.  I have nasal stuffiness at night, and tend to mouth breathe, hence the F30.  I've been undergoing treatment for a little over a week, which I know is early, but my AHI hasn't really decreased.    

My home study (WatchPAT) revealed significant positional apnea when on my back.  

Currently, my minimum pressure is set to 8.2, and EPR set to 1.  I'm still getting an AHI of 5-7, and am getting both central and hypopneas.  So, I'm wondering what, if any changes I should make (apart from adding a cervical collar, which I'll do tonight).  I already use a pillow propped under me at night to force me to side sleep. 

Here are my OSCAR graphs from the past few nights.  Let me know if you have thoughts, and thanks in advance! 

[G. Szabo]

I suggest increasing your minimum pressure to 10 cm.

[Deborah K.]

If you changed your chart a bit, we could read it more easily. We only need to see the first five lines on your chart. That way, they will spread out to fill the space and be more legible.

It would also help if you could narrow the left panel some.  That would allow us to see the chart itself better.  

[theclient1437]

Will repost shortly.

[theclient1437]

Here are updated OSCAR screenshots, with higher graph heights and less left menu.

[theclient1437]

    Hi All, 

I've changed pressures, masks, EPR, you name it, and my apneas remain.  The Resmed APAP classifies them as central apneas, but I want to get an expert opinion of whether they're in fact centrals or something else in disguise.  Attached are a few nights worth of OSCAR screenshots along with close-ups of typical central apneas. 

Note that the central apneas don't seem to get better or worse with pressure or EPR  changes, nor do they change if I wear a cervical collar. 

Thanks for all your help!

[G. Szabo]

On the Dec 26 chart, you initially had a period of inspiratory flow limitations, which triggered a recovery beating session with high inhalation volumes. This latter, in turn, altered the oxygen/carbon dioxide balance in your blood, and your body was trying to find the new equilibrium between the low and high carbon dioxide levels, resulting in sequential CAs.
If this interpretation is correct, these "CAs" should be reduced by a reduced flow limit. The best way to do so is to increase your EPR. Because you are already on EPR 3, the only option left is to increase your minimum pressure. 
You can also try an AirCurve 10 or 11 device with higher EPR capabilities and options to reduce CAs.

[theclient1437]

Great.  Do you have suggestions on min and max pressures to overcome flow limitations? 

Also, you mention other machines.  Would this be a Resmed VAuto? 

Thanks!

[G. Szabo]

I suggested earlier that you increase your minimum pressure to 10 cm. You can set your maximum to 13 cm. EPR=3 full time. 
One of the best instruments on the market for this purpose is the ResMed AirCurve 10 Vauto. 

[theclient1437]

Thanks for your quick response.

Yes, I saw your previous post, and have set my min. pressure as high as 11.8 without much reduction in "CAs" (which I agree appear to be related to flow limits - see screenshots).

I'll work on getting a VAuto machine.