evanms17 Therapy Thread

[evanms17]

Background :

I started therapy back in March 2022 with great success. I am a 23 year old male, fit, and was diagnosed with obstructive sleep apnea. My fatigue went away within a fairly short period and was feeling great unit about August. My Resmed Airsense 11 Autoset fell off my desk and broke. I went 2 days without until a rental Airsense 11 Autoset arrived. Those were the only two days I went without my Cpap. Unlike most I had zero issues using my machine ever. This is where I started running into issues. While using this rental machine my fatigue seemed to worsen and worsen. I finally got a warranty replacement for my Airsense 11 three weeks ago. My fatigue still seems to be worsening and I am back to taking daily naps to compensate with heavy brainfog. Another note, I use phillips dreamware nasal pillows and mouth tape.

Previous to buying an SD card for my machine yesterday my only source of data was the MyAir app. My scores are always high 90s so I am not sure why this is happening. I just learned of this resource yesterday which is what prompted mt to buy an SD card and install Oscar.

Note: This is my first data point from Oscar. Last night was a bit unorthodox where I had gotten up to go to the bathroom about three times and was awoken by my cat once. Usually I sleep all night and will update with more data. I just found out about this forum and am positing with the hope that it may be an obvious fix that I can start implementing tonight.

Is there anything I should adjust from my auto settings? Everything is on auto including pressure and ramp. The pressure range is 4.0-15.0

[Gideon]

Welcome to the forum.

First your numbers are awesome.
I'd like you to flatten pressure curve via setting modifications

Set min pressure =7 to allow full therapeutic use of EPR

Set EPR=3, Fulltime

Turn Ramp off. At these pressures you shouldn't need it. If you need ramp set it to 6 and cut back time.

Finally repost the first charts and let's see how you feel.

[evanms17]

Thanks so much! Will do. I will record data tonight and report back. Honestly I didn't like ramp because its a little uncomfortable breathing with the pressure only at 4. Excited to try these settings!

[quiescence at last]

frankly, I don't see the need to adjust the settings. you are getting the needed therapy, and your machine is giving you about an EPR of 1. The pressure is not boosted automatically even to 7. Based on that and your comments, I would limit any adjustment to eliminating the ramp, and have starting pressure of anywhere between 5.0 and 6.0 and keep the EPR set at 1.

QAL
Dedicated to QALity sleep.



p.s. Your chart looks like you were in REM sleep at about 1:20 and 2:55. this is where tidal volume and respiration rate show deviations.

[Gideon]

Thank you QAL, I am trying to improve his comfort. The results will say which is best based on the OP's subjective feelings.

[evanms17]

Welcome to the forum.

First your numbers are awesome.
I'd like you to flatten pressure curve via setting modifications

Set min pressure =7 to allow full therapeutic use of EPR

Set EPR=3, Fulltime

Turn Ramp off.  At these pressures you shouldn't need it.  If you need ramp set it to 6 and cut back time.  

Finally repost the first charts and let's see how you feel.

Here is the data from Last night with your settings! So far I am feeling less fatigued after one night with these settings. My Apple watch also indicated better sleep statistics such as more deep sleep. I have attached the Oscar data below. If all looks well I think I am going to stick with these settings! Breathing was much more comfortable with the higher starting pressure and no ramp

[Gideon]

Looks good. If you were using a BiLevel, and you certainly don't need one and I doubt your insurance would cover one, I would increase your PS(EPR) to 4. This would be to a bit better control your flow limits and your pressure increases.

Keep these settings for at least 3 days so things stabilize then try increasing your min to 8 and then repost and let us know your impressions. Again I'm looking for comfort not efficacy.

[evanms17]

Hello Everyone

Two years ago I was sent to a sleep doctor for fatigue. I did an at home sleep study and overnight. I barely slept both times but they said given my symptoms i probably had OSA. So I bought an airsense 11 autoset and have been using it ever sense. I am young, not overweight and not a typical candidate so it seemed strange that I had OSA but anyway, i began cpap and it helped but I am still very much fatigued.

Fast forward to present day/year I started having headaches and found out I had a brain malformation known as a Chiari malformation. I just had brain surgery a few weeks ago to fix it. The days where there was no data I was on the hospital.

The thing about Chiara is it is in fact associated with sleep apnea, specifically CENTRAL sleep apnea, not OSA. I have had a CSD card in this machine for about a year and a half (had to warrenty my first model) and I just put it into oscar and noticed something interesting.

Almost all of my events are Clear Airway events and not Obstructive events.

Was I misdiagnosed with OSA and actually need a bipap? Data attached. Or is it a pressure issue? I have my min pressure set fairly high because that's where its comfortable for me to breath

TLDR; Diagnosed with OSA two years ago. I have a brain malformation that can cause CSA. Most of my events are CA events and not OA.

Thank you!!!

Please see attachments

[SarcasticDave94]

There's some CA but not excessive. You'd likely need a new sleep study unless you have the older report in detail. It would have to have been able to capture CA info.

If not, then the in lab sleep study would be needed. If you do get this done, request the detailed report. To get a machine to treat CA, best in that case then is the ResMed AirCurve 10 ASV. To qualify, about 50% of your events need to be CA.

If that happens, you'll likely also need a Titration including ASV.

[evanms17]

Is there any evidence in this data that I should be using something like an aircurve asv for central apnea rather than a cpap for OBS?

I have been extremely tired for months now and almost all of my events are CA events. Would the resmed airsense 11 (what I have now) be able to reliably pickup CA events and detect CSA? I have caught myself about to fall asleep and stop breathing and then wake myself up. I also have a brain structure issue associates with CSA rather than OSA.

Thank you for any info you can provide.