+- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums)
+-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area)
+--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum)
+--- Thread: liebano - Therapy Analysis (/Thread-liebano-Therapy-Analysis)
Pages:
1
2
liebano - Therapy Analysis - liebano - 03-28-2024
Hi everyone! I did a sleep study, and it showed I have mild obstructive sleep apnea (13.6 events /hour). I have been using CPAP for 2.5 months and I am still feeling drained. I think I am more tired than I was before starting the therapy. Most of my episodes after starting using CPAP were related to CAs. I turned the EPR off, and it helped. Since then, the AHI has always been below 5. Even though I still have a relatively high number of CA on some nights, I don't know if I should try a cervical collar or if my pressure is not correct. Could you please see my OSCAR data and give me some advice? I don't know how long I should keep insisting on the CPAP. Thank you!
RE: Still tired and CA events - PeaceLoveAndPizza - 03-28-2024
On 3/26 your AHI was 0.73 and pressures were med 8.94, 95% 10.4, and 99.5% 10.9. On both 3/25 and 3/27 your AHI was 3.25 and 3.69 respectively. Your pressures med 9.58 and 10.04, 95% 12.4 and 12.5, 99.5% 13.74 and 14.34.
I cannot see the flow limitations, but the CAI on 3/26 is very good, and on the other nights a bit above it but not dramatically.
Have you tried a fixed pressure? It may be worth trying either CPAP mode with a set pressure of 10 or a fixed APAP with min = max = 10. Something to consider.
I do not know if a cervical collar would help as you are not having obvious positional apnoea. It would not hurt to try as it may help a bit with the flow limitations.
You had more leaks on 3/26, but things look consistent there.
Another thing to try would be setting your response to soft from standard. It makes the pressure transition a bit slower.
Central apnoea’s are a difficult beastie to tame at times. You found part of the code by getting rid of EPR. Unlike a Vauto we have no trigger settings to change, so we only have pressure and pressure support to try and manage things. Give the suggestions a thought and let us know how it goes.
RE: Still tired and CA events - liebano - 03-29-2024
Thank you for your suggestions! I tried the CPAP mode with pressure at 10 cmH20, but it didn't help. Should I keep these settings for a few more days?
RE: Still tired and CA events - PeaceLoveAndPizza - 03-29-2024
No reason to keep it. What I was hoping to see is you were responding to the pressure swings, but that is not the case.
With the current machine your options are limited. You could try it again, but with a lower fixed pressure, maybe something like 8. Or even try constraining the range to 8-10 instead of 8-15. Trying a soft cervical collar may be worthwhile, but I don't think it will make too much difference as your challenges are not flow limitations or clusters from chin-tucking.
You have already been down the pressure support path with EPR and trying different levels, which did not help. Nothing much to do there.
It may be the only real choice is to use a bilevel like a Vauto. Setting the trigger to high would likely eliminate most or all of the CA's. We can try to manage them as best we can, but it is likely just faffing around.
RE: Still tired and CA events - liebano - 03-30-2024
These are the results from the pressure 8-10 setting. My doctor recommended a titration study to address my treatment-emergent central sleep apnea. Would this be helpful or just a waste of money?
Considering that the AHI is consistently lower than the value I got in my sleep study, should I not feel more rested? Why do I feel more tired?
Thank you!
RE: Still tired and CA events - Deborah K. - 03-30-2024
If your CAs are treatment-emergent they will lessen or go away on their own as time passes. A titration study will tell you nothing about them unless the doctor is considering prescribing you a different type of machine.
Did your sleep study contain a high number of CAs? If so you may need a different machine.
RE: Still tired and CA events - liebano - 03-30-2024
Thank you Deborah. My sleep study did not show CA. It only showed obstructive, hypopneas and airflow limitations associated with arousals. Considering that my AHI is below 5, should be these CA fine?
RE: Still tired and CA events - SarcasticDave94 - 03-30-2024
I'm probably missing the connection how a Titration test will help the treatment emergent Central Apnea. Titration supposedly indicates what pressures to run, although doubtful, maybe this is what your doctor expects to help. Treatment emergent CA will likely diminish over time. At worst, you may do better with a ResMed AirCurve 10 VAuto. With the sleep study of zero centrals you'll not qualify for ASV, the specific machine for Central Apnea. The ASV is typically not prescribed for the treatment emergent variety of CA.
RE: Still tired and CA events - liebano - 03-30-2024
Hi! That is my main question. I would like to know if a titration study is useful to fix the CA. According to your answer it is not. Maybe the best option is to try a different machine and save money avoiding the titration study…?Thank you.
RE: Still tired and CA events - PeaceLoveAndPizza - 03-30-2024
The question to ask both the doctor and insurance, is what is necessary for you to show that the APAP is not meeting your needs. A titration study may be necessary to get insurance to cover an upgrade to a bilevel.
One thing puzzling me is why was your 3/26 night so different than the other nights? Did you do anything differently?
Back to the soft cervical collar, it would be a worthwhile experiment to see if it helps. If you go that route be sure to measure from chin to sternum and the circumference of your neck before ordering. You may be able to find one at the local pharmacy as well, but be sure to get the correct size.
Note you always could consider buying a gently used Resmed AirCurve 10 Vauto on the free market like Facebook marketplace. Sometimes you can find them cheaper than most insurance co-pay.