Understanding graphs and reducing CA's

[SBHill]

   

I was prescribed this cap machine to use all the time at both locations.  

After my initial settings of 4-12 i developed Centrals almost immediately.  So my doc put my settings at 7 all night and took off my EPR's.   For the past several months I've made changes trying to improve my Centrals (actually would love them to go away!!) 

Can someone explain to me what these graphs basically say, and which ones are important? They are carry looking!!  

Secondly If you check the respiration before a CA its usually spikes right before a central.  Why is that?

Lastly, are my pressures good? Can this be proved?  I love my Mask a nasal cushion no issues or much leaks!!

Also ive currently been bleeding in oxygen in Breckensidge due to my constant desaturation all high but haven't noticed any improvement on Centrals.  I would love to just use oxygen and not CPAP one day just in the mountains and do away with the CPAP as i was tested with the wabtchpat having less than 10 apneas (texted at 10,300 ft and not 5280)


Thank you in advance.  

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[SarcasticDave94]

You'll likely need more base, minimum pressure than 4, regardless of Central Apnea flags or not. I'd try 6 to see if there's any difference.

Central Apnea, or what the machine calls them, clear airway. Either way, it's basically a breath pause. Clear airway are due to flushing out extra CO2, as in using CPAP.

You mention elevation, either 5.xK or 10K. This can make you more sensitive to CA. If you have your sleep study, please post it here, redacted of your personal info. You need this detailed report for your personal info anyway, so request it from the prescribing physician's office. HIPAA law gives you the right to request and receive it.

Two big pieces of data most important are the event table with type and count, then the diagnosis itself.

If you're using oxygen, that should be monitored via a recording pulse oximeter. If you get one that uploads to OSCAR, you can get this info added into the CPAP report. Wellue is one quite a few use successfully with OSCAR.

[SBHill]

Here’s my Wellvue o2 ring with O2 added just last month. June 14 with O2 set at 1.5ltm and the next day JUne 15 without O2 (I was testing) just the cpap.

Sleep study is attached as a screenshot.  

I did read a lot about the flushing out of CO2, Is is possible to fix this? 

Are you able to zooms into CA’s and see that there a spike oof breath before the actual CA? 

Also I know that H stands for Hypopnea what causes that and could you explain what the AHI graph actually means in general terms? 

If it wasnt clearly attached i will attach these two in the next thread.

Thank you so much for your help!!

[SBHill]

       

Here are the graphs from Oscar that show exactly what usually happens right before the Central.  There's a spike in the breath and don't know what causes that.  Hope the remaining graphs help to decipher

Thanks for your continued thoughts!

[SBHill]

Oh elevation did not affect the Centrals better or worse, they were the same. I just started going to 10K altitude this June and July on weekends.

Lastly, the sleep study was done at 10K ft. not lower altitude(5K)  because that's where i was showing symptoms of desaturation only.  Only after that was that they saw i had mild apnea (see screenshots in previous thread).

[SarcasticDave94]

I'm not even close to being a doctor, so none of this is anything like medical orders, but I'd rather make certain to stay on the supplemental oxygen. I'd tell myself the same if I had it. 93% average is much more acceptable than 89%. Myself, if I get to 92%, which I can actually feel that level, I'd be doing poor, feeling the need for oxygen. I have COPD.

I think your Wellue ring can upload those charts into OSCAR, even so they're helpful. I don't recall how it's done, others do use it so maybe they'll add in the directions.

Hypopnea are roughly a half Apnea, still at 10 plus second duration, but half to 3/4 blocked airway. ResMed AutoSet has EPR that gives a differential, and ResMed VAuto bilevel has PS. They're doing the same thing, giving a differential between exhale and inhale, this leverages against Hypopnea. Otherwise, just more base min pressure will help.

The problem with EPR and PS is that on machines that don't have a backup rate, people that like yourself have some CA on the test, EPR or PS can increase CA if the machine doesn't have a timed backup rate such as the ASV for CA treatment, ST (I'd not recommend this one), ST-A for COPD Asthma etc, these have a backup rate that can affect CA, with ASV by actively treating them. Second whammy is elevation, even your 5k lower elevation can affect some.

Events and count from sleep study: likely Obstructive based events are within the pAHI 4%, Central Apnea within pAHIc of 10. Having a small amount of CA isn't extraordinary, many have a few. I think your CA count signifies a higher sensitivity to CA.

Maybe a surprise, but I'm not great at reading the charts such as that zoomed segment. What I'm getting out of it though, there's an unstable aspect to the breath, you're about to breath pause or CA due to CO2 being flushed more than the brain expects, and it gets confused by that imbalance. The CO2 if following a normal pattern would be increasing and triggering a breath signal. It actually went lower, opposing what's expected, so no signal for breath and a CA gets flagged.

The CO2 flushing: this might correct itself over time, medicals say 3 months. But that's for those that have few CA on the diagnostic test, and are at lower elevation. For yourself with some CA and higher elevation, it's not as clear. Can your body adapt? Likely, but how long and by how much CO2 flushing diminishes isn't sure.

[SBHill]

Dave, Thank you for your thoughts! Ive had Ca’s for over 6 months was hoping it would improve. I will up the base to 6 tonight with the upper level at 9. Will report.

Correct EPR (1) when i added it a few weeks ago to test it was the worst no of events i ever had. So no EPR for me.

What do you think of the FOR HER setting?

[SarcasticDave94]

You could try it and if things go badly, I'm sure it'll manifest pretty quick. Unfortunately unless you try it, it's a guess. The for her mode dampens some response, I think, but for some it's actually not a good thing. Your case is catching up on my unique state, minus things like my COPD, so bets are off on if the for her mode is good for you or not.