[Treatment] Two Year Treatment, Recent Lurker (OSCAR screenshots within)

[HeyHolland]

Hi all!

I've spent the past few weeks lurking around this message board trying to figure out a solution. I hadn't really gotten into reviewing my data until recently, despite owning the machine using a suggested pressure setting by a doctor 2 1/2 years ago. My AHIs have been inconsistent on some nights and anything below a "3" was considered a win (despite scoring 98-100 points on most nights via MyAir). Prior to having the curiosity to actually look into my data via SleepyHead/OSCAR, I had no idea I've had clusters of CAs that usually happen anywhere in the last 2-3 hours of each session. I've attached a session from last night using a newly purchased Swift Nano cushion. I've neglected to get new Swift FX cushions for the entire duration of my treatment. D'oh! I decided to try out the Nano cushion to see if it'll help. I do have an extra Swift FX cushion in the mail.

In the screenshots, I've also included a couple of zoomed-in charts of CA clusters. Any feedback would be appreciated. Let me know if you'd like more info to help with your assessment.

Additional Note: I purchased my machine back when I didn't have insurance for CPAP equipment off a private seller. I was running on 7-15cm with EPR off for the majority of the treatment (about 2 years). I must've misread the original suggested "8-15" APAP setting until I dug up the paperwork from back then. In that prescribed pressure setting was also a recommended "11" for CPAP mode in addition. The only paperwork I have were the settings and stats from a 1 week trial period in late 2017 with a borrowed ResMed AutoSet 10 where the settings were all on the factory default, although the ramp was set at 45 minutes and EPR was 2. I recently was laid off my job, so my "good" insurance is gone, so anything from here on out would be out of pocket.

Thanks in advance!

[Sleeprider]

With settings of 8 to 18 and EPR off, your pressure is all over the place, and most of these events are CA. You have a relatively high flow limitation which is what is driving pressure fluctuations. I think your solution is to get an effective pressure, and use EPR and limits on the maximum pressure to tame the pressure fluctuations, flow limits, RERA, and hypopnea. The risk in using EPR is that it may increase the CA events. I think we should take that chance and see what shakes out. If the CA does significantly increase we can retrace our steps and look for another solution.

I'd like to see you increase minimum pressure to 9.0 and maximum at 13.0 and use EPR on, full time at 2. We can compare after you try this and decide on a direction. My hope is that the use of EPR will stabilize pressure, and of course the changes in pressure limits will also keep fluctuations to 4 cm or less. You have good tidal volume as-is, and a somewhat slow respiration rate of 12.0

[HeyHolland]

Thank you for your input! I'll give it a go! I had experimented a bit in the past few weeks here and there to see how I'd respond to a smaller gap. I just couldn't quite figure out the pressure range in correlation to the EPR settings.

[Sleeprider]

This should be more comfortable and effective, but with such a wide range of pressure currently, and no real correlation of events to pressure, we just need to tame the chaos. This will do it, and it's easy to refine.

[HeyHolland]

Hey guys!

Here's some data from the past couple of nights at 9-13 pressure, EPR 2. The first night with the new settings went okay and cut the previous night's (at the 8-15 setting) CA's in half. But last night was pretty bad with a whopping 53 CA's and a 15-minute CSR to boot. Yeesh. Might consider switching from the Nano back to the normal Swift FX pillows because I just realized I couldn't scratch my nose without having to remove or nudge the cushion.

Monday night:
   

Last night: (also included the zoomed in chart of the CSR)
   

   

[Sleeprider]

We prefer to call that periodic breathing. Just because Resmed labels it CSR doesn’t make it so (thank goodness). Here’s the deal. Your settings are appropriate to treating your obstructive sleep apnea, but only an adaptive servo ventilator treats CA clusters. Your CA is probably therapy related and is a result of occasional reduction of CO2 (hypocapnea) which reduces respiratory drive. This usually diminishes and cleans up in a short time. We can address it with Enhanced Expiratory Rebreathing Space (EERS) but I think it’s premature. ( see our EERS wiki).

Meanwhile, CA is going to be consistently inconsistent and is something to keep track of. It’s not dangerous and rarely results in the kind of oxygen desaturation or sleep disruption of obstructive apnea, but we want to address it if it continues. If you have a copy of your diagnostic sleep study we can review a copy, with personal info redacted, and see if this was a condition prior to therapy.

[HeyHolland]

Unfortunately, I don’t have a copy of that sleep study from a few years back. I just knew that my AHI was about 27, somewhere along the lines of almost “severe apnea”. I snore really loud and breathe through my mouth when I slept without treatment. My parents snore super loud, so it’s probably hereditary. As for my sleeping habits, I tend to switch between side and on my back throughout the night. I’ve also had a history of gasping for air in my sleep. I’ve been told over the years that I’d stop breathing all of a sudden and then gasp for air. I’ve had friends wake me up out of worry. Not sure if this info helps without the actual sleep study data.

I’ll give the settings (and the new Nano mask) another week to see if the therapy adjusts itself. The 2.85 AHI without anything major except about a dozen CAs seem to be a sample size that’s bit more towards normal.

Since I’ve had therapy for two years, there’s some sample data I can provide for settings like 7-15 with EPR off, 8-15 with EPR off, and even tried a few days a while back at 7-20 to see where my actual range is at these days. Those were with the Swift FX pillows.

Thanks for your input, I’ll look into the other events you mentioned.

[Sleeprider]

Movement and sleep disruption can cause CA, but not usually in clusters. As I said with most people these events settle to a low number and don’t disrupt sleep to a significant extent. If it becomes something to worry about we will help you discuss it with your doctor. It seems you are pretty comfortable and you have not been kicked out of the bedroom. Except for the erratic central events, it looks great.

I’m not sure how you are getting your screenshots, but please read the Organizing Your Oscar Charts in my signature links. When using the F12 screenshot function the monthly calendar should close. Also it would help if you used the menu View/reset charts and choose the standard view. You are using version 1.1.1?

[HeyHolland]

Alright, an update. Here's some screen shots from the past couple nights. Last night, I switched back to my original Swift FX pillows out of curiosity, but the settings were still the suggested 9-13, EPR 2.

Thursday night (used Swift FX Nano cushion):
   

Last night (Friday, used the Swift FX pillows):
   

Zoomed in on last night's CSR:
   

[Sleeprider]

Your machine events are mostly central and after using CPAP for two years it’s still pretty high. If we were to try and treat this, so you think insurance is the best path or self-financing a new or lightly used unit. We are kind of closing in on ASV.