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AHI Increasing, Struggling to read OSCAR Data - cam412 - 12-28-2022
Hi folks, this is my first time both posting on these forums and using OSCAR. I was diagnosed with obstructive apnea a year ago back in November and received my cpap (an Airsense 11) in March of this year, and overall the adjustment wasn't too difficult. What I'm struggling to understand, however, is why my AHI is on the rise, and I'm also concerned that, despite my diagnosis being obstructive, my cpap data is reading most of my events as central instead.
I understand that there's a period of central apneas that can occur from cpap treatment and that those normally go away over time but in my case the central apneas have seemingly only increased and I don't know why. I'm currently uninsured and afraid admittedly of what to do, especially when it comes to contacting my doctor if needed.
I'm going to attach my OSCAR data below, if anyone would be as kind as to summarize it for me and explain how I could read it myself going forward I would really appreciate it. Any other advice would also be greatly appreciated- I'm kind of a nervous wreck and the thought of having complex apnea is really stressing me out.
RE: AHI Increasing, Struggling to read OSCAR Data - OpalRose - 12-28-2022
Hi cam412,
Did your sleep study show central sleep apnea? If you have a copy of that study, pease post it here. Otherwise, I think the clear airways we see may lessen in time.
However, your pressure settings need to be adjusted. Try a minimum setting of 7cm and a maximum setting of 10cm. Also, set EPR or 2. This will help with comfort and the Obstructives. Also, turn the ramp feature to off.
One more thing, your leak rate is borderline. If your using nasal pillows, you might want to try a size up or down with the pillow.
Watch this for a couple days and repost. The CA's may increase with EPR use, but maybe not.
RE: AHI Increasing, Struggling to read OSCAR Data - Gideon - 12-28-2022
Welcome to the forum.
First I've learned not to trust diagnosis unless I see the data that it was based on. Opal hit on it, post your sleep Studies. I've actually seen sleep Studies with zero obstructive events, 100% Central and a diagnosis of OSA.
Could you provide a couple 3-minute views of your centrals. My gut says they are likely idiopathic/ without known cause. One thing here is they are evenly distributed,band not clped together.
Can you tell us about your medical history, cardio pulmonary issues, head injury, strokes or seizures, Neuromuscular issues, meds any thing for pain, muscle relaxers, depression etc. Why? Because these may be the cause of your apnea.
On the worry scale, don't. The goal is to get you comfortable with a reasonable AHI. Complex apnea is far more common than you think.
RE: AHI Increasing, Struggling to read OSCAR Data - cam412 - 12-28-2022
(12-28-2022, 09:49 AM)OpalRose Wrote: Hi cam412,
Did your sleep study show central sleep apnea? If you have a copy of that study, pease post it here. Otherwise, I think the clear airways we see may lessen in time.
However, your pressure settings need to be adjusted. Try a minimum setting of 7cm and a maximum setting of 10cm. Also, set EPR or 2. This will help with comfort and the Obstructives. Also, turn the ramp feature to off.
One more thing, your leak rate is borderline. If your using nasal pillows, you might want to try a size up or down with the pillow.
Watch this for a couple days and repost. The CA's may increase with EPR use, but maybe not.
Thank you for the reply, I appreciate it. I don't have a copy of my sleep study unfortunately, all I have is the script which has this info at the bottom:
EDIT: sorry, I didn't know I can't post images yet directly in posts. I'll edit this to be an attachment.
I had the pressure set higher previously but decreased it at the suggestion of a friend who also uses a cpap since I was having issues with stomach pain caused by swallowing too much air.
I'm going to change it to your recommended settings.
RE: AHI Increasing, Struggling to read OSCAR Data - cam412 - 12-28-2022
(12-28-2022, 12:29 PM)Gideon Wrote: Welcome to the forum.
First I've learned not to trust diagnosis unless I see the data that it was based on. Opal hit on it, post your sleep Studies. I've actually seen sleep Studies with zero obstructive events, 100% Central and a diagnosis of OSA.
Could you provide a couple 3-minute views of your centrals. My gut says they are likely idiopathic/ without known cause. One thing here is they are evenly distributed,band not clped together.
Can you tell us about your medical history, cardio pulmonary issues, head injury, strokes or seizures, Neuromuscular issues, meds any thing for pain, muscle relaxers, depression etc. Why? Because these may be the cause of your apnea.
On the worry scale, don't. The goal is to get you comfortable with a reasonable AHI. Complex apnea is far more common than you think.
I don't totally know how to work OSCAR yet so I apologize if I'm attaching the wrong images. I selected two of the central events in these screenshots.
My medical history: I have depression and anxiety and my obstructive apnea, according to the doctor, is related to some sort of deformity in my jaw. Something to do with it sliding back or my tongue going in the wrong place- I don't totally remember. I don't take any medication and I don't have any concrete history of seizures altho in the past I've had some strange epilepsy-adjacent experiences. They did a CT scan on me and said nothing was wrong, tho.
RE: AHI Increasing, Struggling to read OSCAR Data - OpalRose - 12-28-2022
cam412,
Since you mentioned you were swallowing air and having stomach cramps (Aerophagia),
instead of pressure changes I gave you earlier, I think you should use Cpap mode at a pressure of 6cm.
Make this one change and set EPR to off. Let's see how you feel before doing anything else.
Right now, we're not going to focus on apneas so much as comfort.
If you find you're not swallowing air at this setting, we can start to raise it a bit.
RE: AHI Increasing, Struggling to read OSCAR Data - Gideon - 12-28-2022
Thanks for the zoomed shots, they were 1 minute not 3 minute but what is important is not what I see but what I don't see. I don't see the tell tales of therapy induced central apneas. This supports my thoughts of idiopathic central apnea, especially with the lack of medical history that could indicate otherwise.
This means that the use of EPR may not increase your central apneas.
RE: AHI Increasing, Struggling to read OSCAR Data - cam412 - 12-28-2022
(12-28-2022, 05:01 PM)Gideon Wrote: Thanks for the zoomed shots, they were 1 minute not 3 minute but what is important is not what I see but what I don't see. I don't see the tell tales of therapy induced central apneas. This supports my thoughts of idiopathic central apnea, especially with the lack of medical history that could indicate otherwise.
This means that the use of EPR may not increase your central apneas.
Is there any way to decrease the centrals? The idea of me not breathing for a full 32 seconds is making me nervous. Is there anything I can do on my cpap to help with this or do I need something like an ASV instead? Thank you for your help.
RE: AHI Increasing, Struggling to read OSCAR Data - Gideon - 12-28-2022
With a CAI of under 5.0 (3.86) you don't qualify for an ASV but I suspect the ASV is what you likely need. I'd give us a week or so to see what we might be able to do.
RE: AHI Increasing, Struggling to read OSCAR Data - Gideon - 12-28-2022
Opal suggested a range of 7-10 and an EPR=2, Fulltime. Let's see what that does.