are these real CSA events?

[sue60]

Hello,

Can anyone give an opinion as to whether these look like real CSA events? This is pretty much what is normal for me. AHI is all over the place. Been on therapy for about 2 years now- first on cpap but after 6 months went to bipap as I could not tolerate air swallowing with cpap. Sleep doc said my bipap looked like it was acting like a cpap on my last visit? Thanks in advance.


https://imgur.com/a/gNkUO


Susan

[Pugsy]

What are your machine settings? That information is missing from the left side and is normally seen easier when the calendar is hidden and the pie chart turned off (Preferences/Appearance tab remove check mark for "show pie chart").

Your graphs are so tiny that the size makes it difficult to evaluate much of anything. Don't need all those graphs.
See this thread for examples of what to show.
viewtopic/t103468/Need-help-with-screen-shots.html

To best show each event go to the Events tab and click on the ClearAirway category where you will see a long list of the flagged events with the time they happened and pick one with a couple of events in real close proximity and click on the one in the middle so that the graph on the right side changes and zooms in so we can see that event and maybe a couple of the others at a level of zooming in that makes evaluation easier.
So that you can see things more along the lines of this level of zooming and the graphs being larger.
This happens to be one that I was only interested in just the flow rate but you can include the pressure graph and leak graph and flow limitation graph....and still not be too tiny for evaluation.

[sue60]

https://imgur.com/a/h5SLP


I think I have it this time, apologies.... had to figure out imgur-thanks anyone

bipap 4-15, ramp 45 min at 4

Susan

[Pugsy]

What is the Pressure support settings?
Your settings aren't showing up for some reason or other or you cropped them out.
The various machine settings should show up under the AHI numbers.
See mine on the image below.

Which event did you highlight and zoom in on? This level of zooming in doesn't look any different than the other graph. I can't see enough of the other breaths to get a feel for what is going on here. I suspect that they are the real deal and that's why I am wondering what the settings are and I don't see 2 pressure lines...so yeah, it does look like a single pressure apap report but bilevel can do that depending on the settings for pressure support.

Can you get me an image of the detailed report that looks like this one...no zooming in for this one. Turn the pie chart off.

[sue60]

https://imgur.com/a/Xf4jk

I have no spo2, never able to keep a pulse ox on long enough
again, thanks

[sue60]

https://imgur.com/a/neDgK

745-8am

I do not know why the machine settings do not show- its
mode vauto
max ipap 15
min epap 4
ps 0.0
timax 2.0s
timin 0.3s
trigger med
cycle med
ramp time 30 min
start epap 4.0
climate ctrl auto
tube temp auto

[Pugsy]

Your Pressure support is 0 and that's why the pressure line is showing only 1 single pressure and not the usual 2 separate pressure lines for bilevel.
Your machine is looking like an apap report because it is setup like an apap machine.
Was it supposed to be setup that way?....it's no different than a ResMed AutoSet when set up this way.

Not sure why your settings and other stuff aren't showing up properly in the SleepyHead report unless you have inadvertently turned something off.
Or maybe it's related to a bug in SleepyHead but this should be there.


At any rate...now can you get me a zoomed in picture of one of the central apneas?

Go to the clear airway events list and highlight and click on the event #26...click on that event timed at 7:36:36
so that the graph will zoom in on that event...then get me a screen shot of the flow rate after you have clicked on that one event....and a couple of the others will get included.

Do you take any medications of any kind?
Any other health issues going on?
It's very odd that you have prolonged periods of time with no centrals and then prolonged periods of time with a truckload of centrals and centrals seems to be all that gets flagged with the exception of a few hyponeas and occasional OA.

[TASmart]

To get your info to show up on the left-hand side you need to select the details tab over on the left about 1/4 of the way down. You currently have the events tab selected.

[sue60]

https://imgur.com/a/kOfPz

How do I turn on pressure support? -The doc never mentioned it. the only settings I have changed are the min and max and ramp-
on my sleep study it suggested 15 for OSA, my sleep do is not recommending anything and I do not have alot of faith in her

Yes, I have severe arthritis and back, neck issues - I do take a tramadol ,if I cannot sleep by midnight I take an zolpidiem 6.25 cr
I know, I wish I did not take anything and have tried that only to suffer miserably and my ahi even more off the charts.
I'm 61 and still work full-time. I recently had an mri of my thoracic spine that showed a syrinx (cyst inside the spinal fluid) and will see a neurosurgeon end
of the month mainly to ask if this can be a factor in CSA, From what I've read it can be but am not really sure. I sleep on a backmax wedge system that simulates
sleeping in a recliner- if not the disc in my back causes sciatica. I have had a hard time trying to understand apnea since the beginning, I only went 2 yrs ago after'my husband
described what sounded like cheyne stokes respirations and he said I'd been doing it for years- my normal- now he thinks I do not breathe that way anymore ,
even when I fall asleep on the couch every night for 1-2 hours, he says I "pass out"" because it is sudden and I cannot be woken easily. I need
to lose about 50lbs. Otherwise, I am fine

[palerider]

https://imgur.com/a/neDgK

745-8am

I do not know why the machine settings do not show- its

because you're either scrolling down past them, or you're selecting the wrong panel.

[TASmart]

[Pugsy]

Pressure support is a setting available in the clinical setup menu area. The same area where you could change the mode of operation. There are 3 modes...cpap, fixed or S mode and Auto mode.

Can you get me a zoomed in snap shot using the directions I posted earlier. I really need to see the event at the level of zooming in the way I asked it to be done to have any idea as to real or SWJ. I suspect it is real though. Especially now that we know pain and meds are involved.
Now what to do about them...assuming that they are real and need something done about them.
Your most recent image isn't what I asked for. I can tell by the amount of white showing in the graph and the length of time showing up. At most maybe 3 to 5 minutes total ....you are showing 24 minutes.

If these are real...then you have complex sleep apnea...which is when a person has both obstructive and central apnea issues going on probably brought on by meds.
I don't see it as being pressure related....you have as many at the lower pressures as with the higher pressures.

We can add some PS and see if it helps or not with the central numbers. Do you wish to try doing that?
Has your doctor made any comments about the centrals? I don't know how much faith I would have in a doctor who didn't understand why the machine was behaving like a cpap/apap machine and not a bilevel.

[sue60]

https://imgur.com/a/vhGs7
Pugsy,
is this any better? I zoomed in on #26

Yes I would like to try pressure support- how would I do that? where and what range?
My doc and her intern acted surprised , overheard them say "did you see that its acting like a cpap"
but no comment to me. I believe she is well intentioned but her knowledge is more of basic cpap.
She is sleep specialist but not a pulmonologist, in your or anyones opinion are the pulmonologist/sleep
combo MDs better to go to for apnea?


Thanks

Susan

[Pugsy]

https://imgur.com/a/vhGs7
Pugsy,
is this any better? I zoomed in on #26

No...the flow rate is still compressed for the entire night.
The flow rate needs to look like this when you click on the #26. See the difference between yours and mine??


Do you know how to get to the clinical setup menu area?
That's where the pressure changes can be made and PS setting is available.
With your machine there is only the one PS setting...no minimum and maximum and I would suggest trying 3 or 4 PS and seeing how it feels.

So...the only thing I would do is set PS to 3 or 4...and with your EPAP minimum of 4 that would give you 7 or 8 IPAP (EPAP plus PS equals IPAP) and a true bilevel pressure function.
Will it help the centrals...to be honest I doubt it but bilevel like yours is usually the first thing that is offered when centrals are numerous as in your situation....and sometimes it is sufficient...sometimes it isn't and people have to move on to the high dollar bilevel ASV machine that will actually breathe for you when you aren't breathing on your own. It's worth trying.

It would be nice if you could get an overnight pulse ox report done...with as many centrals as you are seeing flagged I would be worried about desats until proven not a problem.

This manual is for the AirSense machine so not totally like yours but how to get to the clinical setup menu area is the same on all the ResMeds.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

or go here and request the clinical/provider manual for your machine...it is a combo manual but combo for the other bilevels.
Instructions about 2/3 down the page on how to request the manual via email.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

[ChicagoGranny]

It would be nice if you could get an overnight pulse ox report done

Many DMEs will provide the equipment and send the report to you doctor - all free of charge. They will need an order from your doctor.