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Requesting help w/ CPAP adjustments - flatlander - 11-20-2019
[attachment=17278][attachment=17278][attachment=17280][attachment=17279]Hello,
I came here from reddit hoping to get some assistance. I have been using the Resmed AirSense 10 now for about a month with not great success.
Since starting I have only had a few days where my AHI is around 5 (baseline 16). It seems to usually range between 7-15. More importantly I don't feel any better, still fatigued throughout the day. My machine is set up for range 4-20. I have tried to tweak this (as tight as 7-12) with no success. I started with a nasal mask going over my nose. But since I tend to be a mouth breather (chronic allergies) I was switched to a full face mask that sits directly under my nose. It is comfortable enough. Im doing my best to use CPAP for at least 4 hours a night. Most nights there appears to be zero leaks on the MyAir app. So I don't really know where to go from here. If I have zero leaks and using an auto machine, shouldn't I be getting AHI less than 5?
The respiratory therapist told me to call my Dr as she felt my machine should be working better and my AHI should be less than 5. My Dr requested an overnight study. I have an overnight sleep study set up but its about 40 days out so hoping to get some relief in the meantime.
I have included a few screen shots to hopefully provide more information.
RE: Requesting help w/ CPAP adjustments - JoeyWallaby - 11-20-2019
Setup OSCAR as instructed on the wiki http://www.apneaboard.com/wiki/index.php/OSCAR_Chart_Organization
Please share a couple close-ups of the flow-rate when you're suffering an event and when you're not.
RE: Requesting help w/ CPAP adjustments - Sleeprider - 11-20-2019
Flatlander, Welcome to Apnea Board. There is a solution for you, but it's not with your current Resmed Airsense 10 Autoset. That machine works best-in-class to treat obstructive sleep apnea, but you have central sleep apnea, or perhaps complex apnea which is a combination of obstructive and central. Your therapist is on the right track, but is staying in her lane and not committing to diagnose you, which is the doctor's job.
We should review your diagnostic sleep test to see how much central and obstructive apnea was present before you started therapy. If your test shows mostly obstructive apnea and hypopnea, then you have treatment emergent central apnea. If it was mostly central, your doctor is probably waiting on your call that CPAP has failed. The ultimate solution for central and complex apnea is Adaptive Servo Ventilation (ASV). The ASV provides a steady exhale pressure that keep your airway open and prevents obstruction, but is provides breath by breath pressure support that can inflate you lungs when you don't take a breath. It's a smart machine and when you breathe spontaneously, it stays out of the way. It works great, and we have many members using ASV
So what you need is to schedule a titration test with bilevle and with orders to move to ASV if bilevel fails. Here are some wiki articles for you to read. There is much more. You will need patience to get the machine and therapy you need, and you will need to understand the problem, the process for machine approval and be a strong advocate for yourself. It starts by calling your doctor unless you want to self-treat and buy out of pocket. ASV is not cheap.
ASV: http://www.apneaboard.com/wiki/index.php/Adaptive_servo-ventilation_(ASV)
Justifying Advanced PAP Machines http://www.apneaboard.com/wiki/index.php/Justifying_Advanced_PAP_Machines
To try to minimize events, I recommend the following settings:
Mode: CPAP
Pressure 5.0
EPR OFF
This will provide a low constant pressure, and should minimize your apnea events. It may help you to avoid ASV. Variable pressure, high pressure and exhale pressure relief (EPR) all can contribute to an increase in cenntral apnea events.
RE: Requesting help w/ CPAP adjustments - Gideon - 11-20-2019
Welcome, I agree with what SleepRider has said.
Let's see if we can improve your treatment a bit. First your pressure is very low are you having any difficulty breathing?
Your EPR is set to 1. Most people with Central Apnea do better (lower AHI) with EPR=0. Can you try that please.
This I'm sure is not going to be the solution, at least not the total solution.
To better understand your apnea we would like to see full copy (redacted) of your sleep studies, not just the summary, the tables and chart as well.
RE: Requesting help w/ CPAP adjustments - flatlander - 11-21-2019
I really appreciate the response. I have my home sleep study results. Would it help if I posted those?
Since I have an overnight sleep study scheduled, will that also detect central sleep apnea?
The recommendation of 5 pressure, is that a min of 5 and max of 5?
Again, thanks very much. The daily struggle is getting real.
Thanks very much for the response! I only have the summary of the diagnostic sleep study, but I will request the actual charts. I will also try the adjustment to the EPR set to 0 and see how that goes for a few nights. I will let you know when I get the full summary. Thanks!
RE: Requesting help w/ CPAP adjustments - Sleeprider - 11-21-2019
An overnight PSG study will detect central apnea, but you already qualified for CPAP using a home study, and many of those also detect centrals, so I suspect an overnight study at a clinic mainly serves to refine those results. As I mentioned before, a titration study, or at least what is called a "split study" where a diagnostic PSG is conducted in the first half, and an evaluation on CPAP/BiPAP is done in the second half would be far more efficient. We can tell you more if you post the Home Sleep Study report with private information (names, addresses) redacted. We can help you better with decisionmaking if we understand whether you pay a significant amount of money in copays or deductibles, or if most costs are covered. Clearly, we want to be sure you feel the minimum financial pain, and avoid unnecessary studies and source services and equipment efficiently.
RE: Requesting help w/ CPAP adjustments - flatlander - 11-21-2019
[attachment=17284][attachment=17283][attachment=17283][attachment=17284][attachment=17284]Hello thanks for the response! Does this help? Im on a mac so I could not follow the instructions exactly.
RE: Requesting help w/ CPAP adjustments - Gideon - 11-21-2019
Post your home sleep study results,
Yes min and max set to 5, EPR=0
The waveforms in your detailed view show waxing and waning suggesting a possible issue with your pCO2 levels. This is good because this implies Treatment-Emergent Central Apnea which is easier to impact. The first steps are EPR=0 and a constant pressure (5 cmw). The results of these settings will have an impact on direction for you to take going forward.
RE: Requesting help w/ CPAP adjustments - flatlander - 11-21-2019
[attachment=17318]Here are my home sleep study results. Its terribly quality, I know. Im going to try and get a better copy from them. I wrote down what I could make out.
Im going to try those setting out tonight. Thanks!
Currently I pay 30% out of pocket for the CPAP machine and supplies. But I can currently switch my insurance until December 9th to a different plan. I won't have my split sleep study until December 23th unfortunately.
Here are my home sleep study results. Its terribly quality, I know. Im going to try and get a better copy from them. I wrote down what I could make out.
Thanks for the help!
RE: Requesting help w/ CPAP adjustments - SarcasticDave94 - 11-21-2019
Ah only 100 CA to 14 OA taken from page 6 in the summary. That's over 50% centrals, and that's ASV land. Sounds like welcome to the club bub.
Bet the guy that wrote that sundry didn't compute what they just summarized. OA is all that counts is pulmonary doc 101. And they must write that 1,000,000,000 times or they have to take legible writing classes.