Very High CA Events in Oscar

[dupre299]

Hi - 
Tried to upload a CSV output from Oscar but file type not accepted.

I have had high CA events in my AirSense for about a year now. Occasionally I will get a good run - like from September 1 - September 5 of this year they were all under 7. My OA is always very low, below 1. On my sleep test, my AHI for OA was 5.2. My CA wasn't described in my sleep study that I can see, but I did a WellUe PulseOx text and my O2 saturation is not dropping below 89-91% on these CA events.

I have included a screenshot as well as Export from Oscar 1.5. The export is past 6 months of data. I am hoping someone can help. I have tried adjusting pressure - my script says APAP with 4-20, but I changed to 4-10, then 4-8.4 to see if that helped. It doesn't seem to make a difference. I have EPR off except for Ramp. I have APAP to not be a "Soft" change. I used to be congested sometimes but stop using humidifier and that seemed to help alleviate almost completely any congestion. 

I have about 3 in 10 nights I feel slightly OK next day, about 5 in 10 nights I feel tired next day but not crazy tired, and about 2 in 10 nights I feel wiped like a train hit me and headache.

Any help would be appreciated! I have started to look at my HRV index on my heart and it does seem to correlate to days I have bad sleep. Also I have GERD not sure if that impacts. I sleep on my side as well but my wife says I move a lot at night. I used to snore loudly at night but she says she doesn't hear it anymore.

It looks like all days are not recorded on the SD card, not sure why. I bought this machine through a company called Respshop they seemed reputable and required a prescription.

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My CA averages 19 according to the Extended Display on the AirSense over past 365 days.

[dupre299]

More screenshots

[PeaceLoveAndPizza]

Why are you using that pressure range with no EPR? Doctor recommended or other reason?

There may be reasons why, but based on the chart I suggest using a pressure range of 7-12, EPR 3 full-time. No ramp at all. That should give us a good starting point to work from going forward.

Also, when you post please only show the main session. You can select which to include in the bar at the bottom of the left hand column. Also, please read the “Organising your OSCAR charts” link in my signature.

[dupre299]

Hi - that was how the machine was programmed from the supplier I believe. The doctor didn't specify - honestly it might have been the other way from factory and I changed it. I will change it tonight and see results. I had read somewhere that EPR on can create more CA events that's why I have it on RAMP only. Just curious, is the default from factory for it to be on all the time?

Thank you for replying!

[SarcasticDave94]

The questions I would have is:

What was your Apnea diagnosis? It's going to indicate what you're treating and what machine you should be on.

Did you get your copy of the detailed sleep study report? You should get it if you didn't. You can keep it in your personal health file, and post a redacted version here.

Ramp and EPR can influence CA, due to pressure swings. You might need to try straight pressure of about 6.

[Gideon]

Please post a 3-minute screenshot from before the start of those central and one from the middle. Thanks.

a 4-20 range says defaults, the fact your doc left them there IMHO says "I don't really care"
4 is often too low for an adult. 7-8 is a safe starting pressure until your charts say it should be something else,
Max pressure matters little as ideally, you should never reach it.
EPR during Ramp Only, there is a school of thought that EPR MAY, not will, cause CA events and so do not use it after the ramp. If it is bad after the ramp, it is bad during the ramp only during the ramp events are not reported (they do occur).

Your Flow Limitations are high (95% stat is 0.13 which is above the 0.10 we consider as high. We like to see them 0.02-0.03 or lower. There is no official value for these. EPR is the best tool to manage these.

You may have noted the conflict between treating your flow limitations and central apnea. Actions that help one usually hurt the other. Trying things is how we see how your body reacts.

It is true that EPR. or higher EPR pressures do cause increased flushing of CO2 and other respiration byproducts out of our body and this may result in central apnea. You are having high CA events in a periodic breathing sequence and at this time we do not know the cause. While not common, the simple use of a CPAP or an increase in pressure can also do this.

The reason for the 3-minute views is to review the breath form in the flow rate to see if we can determine the reason. i'm actually ithinki t may be obstructive and falsely reported.

[dupre299]

Thank you. I tried the EPR last night to full time and level 3, and it made no difference on CAs - still had a ton of them in hundreds. However, it did feel easier to breath - I tested it with it on and off while awake. As one person above recommended too - I changed pressure to 7-12. No difference. 

I don't know why but occasionally I will have a string of good days every 2-3 weeks. Like September 1-5 for some reason all were amazing. Take a look at the screenshot with almost no CAs.

The other thing that sings to me, if you will, is the near perfect pattern of the CAs. I thought if I had non-CPAP induced CAs that they should be random to an extent. This looks like a pattern - like each breath I am taking is restricted or something causing my breathing to be longer or labored? 

I can post the sleep reports - I will do that.

Could it be a bad mask exhale vent? That little corner valve thing with a butterfly looking thing inside of it - I used super hot water - not boiling - but probably 125 degrees when washing - could that have damaged them? 

First screenshot is actually FROM SEPTEMBER 2023 - not past 2 days - just giving contrast. If I think about when first started using the CPAP, my AHI was below 10 and I cannot remember when it started jumping really high. I always had CAs but usually 10-15 of them not hundreds.

Thanks so much for posting!

[dupre299]

Here are screenshots from last night too - the screenshots in the above reply are - 1 - good run from early September, and 2 and 3 above are from night before last and screenshots in this reply are from last night after after adjusting pressure from 4-20 to 7-12 and changing EPR from Ramp only to full time level 3.

[SarcasticDave94]

One common characteristic of central apnea is they're consistently inconsistent. Just like you said, lots one day and low the next.

The butterfly is an anti-asphyxiation valve to prevent you from suffocating if the machine stops.

Lots of CA there, it'll be interesting to see what the sleep report says.

[dupre299]

One last piece - I took a look at my numbers trying to find when I had an AHI below 5-10 for long periods of time last. This was January - all month of 2023. I don't for some reason have data before that.

In mid-February the numbers starting becoming erratic - some days would be below 5 and some days 15-30. It seems gradually over past year the numbers have become worse more frequently, but occasionally I still do have a good day or two. 

I haven't changed medications and no health changes, especially nerologically. 

Is it possible my machine is bad? Should I get a different mask type just for giggles to see if it changes the patterns? 

Thanks