Help interpreting data -- all CAs??

[dboss]

Hi all, I am new here but not to sleep apnea. Hoping someone can help me interpret the data from my new machine.

My story: I did a sleep test and was prescribed CPAP 6 years ago (my wife had been complaining about stopping breathing and gasping, and my BP had risen significantly). I used the Resmed S8 (pressure level 7) faithfully, BP dropped, and doctor said things were good after sleep test a year later, so I carried on for 5 years. No real problems (that I knew of) but realized recently that I was long overdue for a retest and a new machine. New doctor downloaded data from my S8 and found average AHI of 21, made appointment for a sleep test (not until December!!) and arranged for an APAP loaner for a month (an S9 with pressure range 7-14). Based on the results from the loaner he prescribed an Airsense 10 Autoset (also set 7-14). I looked at the summary data from the S9 in ResScan (it didn't save detailed info) and the AHI results were all over the place (from 0.4 to 16) but he said it was because leaks were high due to my worn out mask (up to 72 L/min) and not to worry. So I got the Airsense 10 but decided I would monitor things myself -- did some research, installed Sleepyhead, etc.

I have been using the new machine and mask for 3 weeks. Leak is much lower but the results are still all over the place (AHI from 1.4 to 19.6, average 7.29) and almost all of my events are CAs. Here is one of the bad nights



I note in the "By Pressure" chart that events increase rapidly with increased pressure. Does this mean that the pressure increases to stop OAs are causing CAs?

One more issue: My best nights in the last 3 weeks were 7 in a row while on a cruise in the Caribbean (AHI from 2 to 6). I did a lot of things that are supposed to be bad for apnea (eating and drinking late in the evening, irregular sleep hours, etc.) but for some reason the sleep environment (I assume) more than made up for it. I have been working on replicating the conditions -- significant pink noise (from ship's loud air conditioner), darker and cooler room than I am used to, softer pillow, etc. but no real success so far (AHI= 9.4 last night). The only other thing I can think of is that, unlike at home, I spent no time at all using a computer or tablet so will try that on the weekend (no exposure to blue light in the evening, etc.). Any thoughts?

[Wulfman...]

Hi all, I am new here but not to sleep apnea. Hoping someone can help me interpret the data from my new machine.

My story: I did a sleep test and was prescribed CPAP 6 years ago (my wife had been complaining about stopping breathing and gasping, and my BP had risen significantly). I used the Resmed S8 (pressure level 7) faithfully, BP dropped, and doctor said things were good after sleep test a year later, so I carried on for 5 years. No real problems (that I knew of) but realized recently that I was long overdue for a retest and a new machine. New doctor downloaded data from my S8 and found average AHI of 21, made appointment for a sleep test (not until December!!) and arranged for an APAP loaner for a month (an S9 with pressure range 7-14). Based on the results from the loaner he prescribed an Airsense 10 Autoset (also set 7-14). I looked at the summary data from the S9 in ResScan (it didn't save detailed info) and the AHI results were all over the place (from 0.4 to 16) but he said it was because leaks were high due to my worn out mask (up to 72 L/min) and not to worry. So I got the Airsense 10 but decided I would monitor things myself -- did some research, installed Sleepyhead, etc.

I have been using the new machine and mask for 3 weeks. Leak is much lower but the results are still all over the place (AHI from 1.4 to 19.6, average 7.29) and almost all of my events are CAs. Here is one of the bad nights

I note in the "By Pressure" chart that events increase rapidly with increased pressure. Does this mean that the pressure increases to stop OAs are causing CAs?

One more issue: My best nights in the last 3 weeks were 7 in a row while on a cruise in the Caribbean (AHI from 2 to 6). I did a lot of things that are supposed to be bad for apnea (eating and drinking late in the evening, irregular sleep hours, etc.) but for some reason the sleep environment (I assume) more than made up for it. I have been working on replicating the conditions -- significant pink noise (from ship's loud air conditioner), darker and cooler room than I am used to, softer pillow, etc. but no real success so far (AHI= 9.4 last night). The only other thing I can think of is that, unlike at home, I spent no time at all using a computer or tablet so will try that on the weekend (no exposure to blue light in the evening, etc.). Any thoughts?

Obviously, a range of pressures isn't your cup of tea.
I would suggest resetting it back to a fixed pressure of something between 7 and 9 (that's the pressures I see the fewest number of events) and see how that works for a number of nights.
It's not OAs that the machine is chasing, it's the snoring and flow limitations that drive up the pressures on an APAP.


Den

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[dboss]

The results are still better than my old machine at fixed pressure 7 though...

Also I have seen discussions of EPR causing CAs and my level is currently set to 3, would reducing that help maybe?

Details I didn't mention: male age 60, 5'8" and 185 pounds, no other medical problems.

[Wulfman...]

The results are still better than my old machine at fixed pressure 7 though...

Also I have seen discussions of EPR causing CAs and my level is currently set to 3, would reducing that help maybe?

Details I didn't mention: male age 60, 5'8" and 185 pounds, no other medical problems.

Don't know.
Virtually everything with XPAP therapy is hugely variable with each and every one of us. The only thing you can do is try different things and settings and see if anything helps.
If you've had all of these Centrals throughout your history of therapy, maybe you need a specialized machine like an ASV.


Den

.

[JohnBFisher]

Agreed. If that chart is common, then the CA events should be addressed. Print and bring that to your sleep doctor. Discuss it with your doctor to see what your doctor recommends. If your doctor won't address it, find another doctor.

[gasp]

Everytime I cruise I sleep like a baby. For me, it's the slight movement of the ship. On open water when the ship rolls I sleep even better.

If that's also true for you, then we have a big dilemma how to mimic a rolling ship

[Guest]

Update: I turned off EPR and my results for four nights were much better. AHI was 3.9, 3.24, 2.66, 4.07 with CA = 3.73, 2.36, 2.19, 3.17. But I had large leaks several times a night caused by opening my mouth (confirmed by my wife). Leak rate was about 30-35 at those times. I tried EPR+1 the last couple of nights and got AHI = 7.44 and 4.92 (CA = 6.23, 4.10) and only one bout of large leak per night at leak rate about 30.

Going to turn EPR off for a few more nights and see if maybe I will get used to the pressure and stop mouth breathing. If that doesn't work I guess the other option is to look at other mask options. Is there a pillow mask that is better at preventing CO2 washout than the Swift FX? Will I need to consider changing to FFM?

[Pugsy]

See how you continue to do with EPR turned off. There is a very small percent of people who seem to find that the bilevel pressures (that's what EPR is doing) is a trigger for centrals. It's a very small minority that sees this happen....if it was common these machines wouldn't have EPR available to everyone.

I don't know if the ResMed P10 AirFit nasal pillow mask would maybe help or not. I would think it would be worth a try. The venting system on the P10 involves tiny holes and is more diffused. Meaning the air doesn't exit the vent holes nearly as forcefully as with your Swift FX.
Another option to try might be the Swift FX Nano cushion. It will fit your Swift FX headgear and frame so all you would need to buy is the cushion..check EBay for a good deal on price if you want to try it.

Since you really prefer nasal pillows....look at the P10...link in my profile...with its venting system and turning EPR off...you might have success. If your DME doesn't have one or can't get you one without your paying out of pocket...check cpap.com. The mask comes with free return insurance so if it doesn't work out you can get a full refund (must be returned 30 days from time for cpap.com shipping) and they will send you a prepaid return label.