Help for the clueless

[Underdog]

I started CPAP with a new machine after a ten-year hiatus and could use a few pointers on reading CPAP data. What should I look for?
My Dr. wondered if my old sleep apnea might have returned because I have not been feeling great and gained a lot of weight. I had been diagnosed 14 years ago. The old Remstar Pro (2 of them) died 8 years ago. With the old Remstars I had gone from a sleep study pressure of 8 down to 5 and the lower pressures seemed to provide better therapy ( I got a lower AHI). But I never really felt better and could never really get a handle on central apnea so I was reluctant to go down that road again. This time around I thought I would try an ASV. I'm still adjusting to the machine (a lot of leaks) but would appreciate any pointers. I also have been recording with a fingertip pulse oximeter at night (attached) and noticed that short duration drops in blood oxygen saturation (80s) that used to occur right after I fell asleep and right before I woke up seem to be better. Not sure if there is a correlation.
https://sleephq.com/public/1611204e-6c4 ... aa1b815ddd

https://photos.app.goo.gl/dC3H2Npx31NT42Hb8
https://photos.app.goo.gl/cK1eDv8cWY6FfX3d8

[Pugsy]

Your link doesn't seem to want to work correctly.

viewtopic/t183806/Attachment-storage-is ... MENTS.html

[Underdog]

Your link doesn't seem to want to work correctly.

viewtopic/t183806/Attachment-storage-is ... MENTS.html

Thankyou for the heads up. I'll try to fix this. Appreciate the feedback.

[vandownbytheriver]

I started CPAP with a new machine after a ten-year hiatus and could use a few pointers on reading CPAP data. What should I look for?
My Dr. wondered if my old sleep apnea might have returned because I have not been feeling great and gained a lot of weight. I had been diagnosed 14 years ago. The old Remstar Pro (2 of them) died 8 years ago. With the old Remstars I had gone from a sleep study pressure of 8 down to 5 and the lower pressures seemed to provide better therapy ( I felt better). But and could never really get a handle on central apnea so I was reluctant to go down that road again. This time around I thought I would try an ASV. I'm still adjusting to the machine but would appreciate any pointers. I also have been recording with a fingertip pulse oximeter at night (attached) and noticed that drops in blood oxygen saturation (80s) that used to occur right after I fell asleep and right before I woke up seem to be better. Not sure if there is a correlation.
https://sleephq.com/public/1611204e-6c4 ... aa1b815ddd
(google pics links broke, did you give All Access?)

Your doctor put you on ASV, or you thought you'd try ASV? Just curious... you skipped bi-level entirely and went to adaptive servo-ventilation, which is supposed to help with CA's. CPAP doesn't cure OSA, btw... you probably still had it. Your SleepHQ shows mostly obstructive events, so if you were having CA's then that appears fixed. Are you on your back? That would explain a lot.

Of course your machine is improving your blood sats... you're still having flow limitations which make it want to give you more pressure... and the leaks aren't helping. See how it flat-tops at 16cm? It's capable of 25cm... that's just how it's set right now. Were you wearing the finger thing when you quit CPAP? O2 saturation is the main thing... sleep quality a close second. We don't know your AHI diagnosis numbers unless that 8 to 5 was two sleep studies.

We're not doctors (most of us) here... but we can help with leaks. See if you can fit the mask using the Mask Fit menu... if you're going to spend a lot of time around 15cm see if you can get a good mask fit there. My CPAP pressure is 14... APAP drives it up over 15 all night. I had a lot of weight gain and years... moved me from 10cm up to here. You may be mouth leaking, the profiles roughly fit, although with a bi-level machine it's not as clear... they kind of ramp up as your muscle tone goes away. SHQ shows a nasal mask... do you wake with dry mouth? You may need mouth taping or a full-face mask (or both, like me).

Here, watch an informative and silly video from Jason:\
https://www.youtube.com/watch?v=dGAHEENnatw

[Pugsy]

Your google images require a log in to view.

How did you come up with these setting choices?

How are you sleeping and feeling?

Do those leaks wake you up?

[Pugsy]

While Hyponeas can be central in nature the vast majority of them are obstructive in nature.

[Underdog]

. Your SleepHQ shows mostly obstructive events, so if you were having CA's then that appears fixed. Are you on your back? That would explain a lot.

I'm just getting reacquainted with these metrics. When I look at the SleepHQ I see 3.37 hypopnea (out of 4.16 AHI). Is Hypopnea obstructed? Ocar lists obstructive apnea separate from hypopneas so I thought they were different.

[Pugsy]

Ocar lists obstructive apnea separate from hypopneas so I thought they were different.

OA....reduction in air flow from 80 to 100% because of obstruction that lasts at least 10 seconds.

Hyponea....reduction in air flow from 30 to 79% because of obstruction that lasts at least 10 seconds.

There had to be some lines in the sand....think about it...a hyponea that is 75% reduction in air flow really isn't all that different from an OA with an 81% reduction in air flow....especially if they both only last 12 seconds.

[Underdog]

While Hyponeas can be central in nature the vast majority of them are obstructive in nature.

So it sounds like hypopneas when your breathing is reduced and you're not taking in enough oxygen and these events are called obstructive apneas if your breathing completely stops.

[Underdog]

Ocar lists obstructive apnea separate from hypopneas so I thought they were different.

OA....reduction in air flow from 80 to 100% because of obstruction that lasts at least 10 seconds.

Hyponea....reduction in air flow from 30 to 79% because of obstruction that lasts at least 10 seconds.

There had to be some lines in the sand....think about it...a hyponea that is 75% reduction in air flow really isn't all that different from an OA with an 81% reduction in air flow....especially if they both only last 12 seconds.

This is offers a better perspective.

[Underdog]

I looked back at 2011-12 and noticed that my average hypopnea index was 5.7, RERA was 1.9, and OA of .9 (total AHI of 8.7) and clear airway apnea index was 2.1
The prescribed pressure was 5.0
https://photos.app.goo.gl/RWeRfRF8mFEoMXy56

[ozij]

So it sounds like hypopneas when your breathing is reduced and you're not taking in enough oxygen and these events are called obstructive apneas if your breathing completely stops.

Not so. Your breathing can stop completely because your airway is obstructed, and you're struggling to breathe, and your breathing can stop completely because your brain has decided you don't need to take in a breath, without there being any obstruction of the airway.
Both are a-pnea, non-breathing. The first is obstructive the second is central, because it's presumably caused by your central nervous . Also called clear airway apnea.

[ozij]

There are indications of obstructions in your present chart: definitely the snoring -- Edit: rest of the sentence deleted after I read Respirator 99's post.

A question you didn't answer: who suggested and ASV an who set it up?

What you tell us about you data from 2011-12 does not in any way scream out you could benefit from an ASV machine. ASV machines can be a solution to treatment emergent central sleep apnea, but that happens when the pressure is high enough to take keep obstructive events from happening.

Who decided to drop you from the titrated study of 8 to 5? How long were on 8 and what did those results look like?
Who decided to stop CPAP therapy altogether?

Since your present data show snoring and flow limitations, my understanding is that your EPAP pressure is too low to take care of them.
Edit: I accept Respirator99's s more informed comment about the flow limitations.

[Respirator99]

Obviously the leaks are the main concern right now, and other factors really only come into play once the leaks are under control.

You can ignore the flow limitations - Resmed ASV machines report limitations differently from other types. From the Apnea Board wiki:

Flow limitation is a common characteristic of pressure support induced inspiration. When you don't make the spontaneous effort to breathe, the ASV pressure support does ensure a volume of air is inspired; however as the lung fills, resistance increases, and this gives the appearance of flow limitation. This is not upper airway resistance, but a function of resistance in the lung itself. We see this on nearly every individual that has posted close-ups of the respiratory flow wave during ASV and ST non-invasive ventilation intervention. We don't try to treat this form of flow limitation, but rather accept that it is a common result of non-invasive ventilation.


Assuming your central apnea was in fact bad enough to warrant an ASV, then your settings are a long way off what is normally regarded as optimal. For a start, you're not making use of the ASVAuto mode. Secondly, Resmed recommend that PSmax be not less than 15 (you have 10). Once your leaks are sorted, I'd suggest the following settings to establish a new baseline, and adjust from there:

Min epap 7.0
Max epap 15.0

Ps min 3.0
Ps max 15.0

Min ipap 10.0
Max ipap 30.0

[Underdog]

Watched videos on leaks and modified the settings on the cpap (thank you Respirator99). Still struggling with the seal on the nasal mask (an odd toucan-beaked-shaped face). Taped the mouth. Not successful in uploading oximeter data to Sleephq.
https://sleephq.com/public/e261a9de-5c7 ... 6a57cfef38
https://photos.app.goo.gl/ECQMXoSBCn4cfwWZ6