OSA/CA on Resmed9

[christinepi]

I was diagnosed with moderate OSA end of November 2010. I'm technologically challenged, so it's taken me a while, with the help of my husband, to figure out how to install and operate Rescan (we are Mac users). So I've discovered only recently that according to the machine I have more CAs than OSAs (over the course of data of almost two months), with a smattering of hypopneas. I've also noticed that the pressure line stays flat during the CA events, whereas it responds mildy, but clearly, to the OSA events. I'm a beginner at this, so any help interpreting this kind of thing would help, in a kind of low tech way, if possible... Might this data mean I'm more central apnic (not according to the sleep study, but...), and why is the machine not ramping up the pressure during central events? I've not seen any improvement on APAP and am thinking Bipap might be more appropriate, since I also have huge issues with aerophagia. I'm seeing my doctor Thursday; I'm trying to get her to let me at least RENT a bilevel machine for a month to see.

I don't have a clue how to post graphs on my posts, which may not come as a surprise...

[kempo]

Does your CA events happen all through the night or are they mostly at the beginning of your sleep time and at wake time in the morning?

[christinepi]

I go to bed at 10 and the CAs can start anywhere from ca 11:45 onward and can go all through the night till close to get up time. There's great variation as to frequency and times. But there's not clear pattern at all like you describe.

[Pugsy]

If you wish to post an image of one of your reports that is easy.

Not sure how to take a screen shot with Mac but I assume you know how.

Open the report to full size for easy reading.
Obtain the screen shot. If you can crop out the excess desktop stuff great, if not that is okay.
Save the image as a jpeg file or similar file type that results in small size file. Bmp is huge file when compared to jpeg of same image.
Upload that saved file to a photo hosting website. Photobucket is one free on, there are many others.
Once uploaded, copy the entire IMG address of the image and paste that address here in a post. Be sure to include the open and closing IMG brackets in the address.
Use the preview button to see if you can see the image, if you cannot, then try again.

If you use the IMG button on this forum message board editor, the url address needs to be between the IMG brackets.

Copying the entire IMG address from the hosting website saves a step.

[billbolton]

and why is the machine not ramping up the pressure during central events?

Central Apneas are not obstructive in nature, so increasing the treatment pressure does nothing at all in terms of addressing them. In some cases, increasing the pressure can cause further central apneas to occur, so xPAPs in general are designed to not do anything but record that a central apnea event (if they can detect it) ocurred in their time-series data.

Cheers,

Bill

[B_4]

Hang in there. My CA averaged about 6 per hour for the first three months of therapy (with only 1 per hour during titration). However, after about three months it is like someone flipped a switch and I am probably averaging 2-3 per hour now with AHIs consistently below 4.

Hang in there, give it 4 months of therapy and see what happens.

[bkdraft]

Hmm, guess I just need to hang in there also. I had NO centrals at my sleep study and now my average AHI is 6 and only having 1 or 2 OSA's per night, rest is all centrals. I am on my second week of cpap.

[robysue]

To both bkdraft and christinepi,

Both of you have said that your machine data indicates the OAs are down, most of the events are scored as CAs by your machine, but on your diagnostic study Centrals were not a problem.

How do you feel when you first wake up? And how well are you functioning during the daytime? These centrals could very well be nothing more than part of your adjustment to CPAP. But if you are not feeling any better than you were pre-CPAP or if you are feeling WORSE than you did pre-CPAP, I'd call the sleep doctor's office and report them. Some people are sensitive to pressure and develop centrals when they are put on CPAP at pressures of 10cm or higher. And it is possible that during the titration study you were at your prescribed pressure for less than 30 minutes. So it's possible that you simply were not at your current pressure long enough for any pressure related centrals to show up.

And finally, since you're worried about the CAs being scored by the machine, then I think you should report it to the sleep doctor's office SOONER rather than later.

[bkdraft]

I cannot tell any difference, still get sleepy during the afternoon as before cpap. My machine is set at 7, pressure determined by sleep study. I have tried apap at 4-10 and 7-12, same results. Lowest AHI I have seen was 3.9 with a high of 9.4. Last night was my 13th night.

[christinepi]

I've seen zero improvement in almost 4 months. During titration they drove me up the wall with pressures so high (for me: 9-10) that I was a burp and fart machine (excuse the bluntness) all night and had a tummy so bloated for the next 15 hours it was awful. So the only pressure that won't cause aerophagia right now is 5.2. I seem to have centrals at 6.6 or higher. My AHI's have been at around 0.3 since I started CPAP, but there must be something else going on, because I still feel awful. I still have to go to the bathroom between 2 to 4 times a night, that doesn't help, and I'm menopausal, oh joy (maybe that's the reason). And I have bouts of insomnia every now and then.

[avi123]

delete

[robysue]

Avi,

The OP is posting her AHI numbers UNDER TREATMENT. She has NOT told us what her diagnostic numbers are. Presumably her diagnostic AHI was high enough to warrant a trial at CPAP and her early numbers indicate the CPAP is taking care of the obstructive part of the OP's apnea just fine.

We have no idea whether central apneas were or were not present during her diagnostic PSG. Nor do we know whether she had any centrals show up on her titration study. All we know is that when she sets her machine at pressures greater than 6.6, the machine starts scoring apneas as centrals.

You go on to write:

I would not trust PSG results on Central Apnea and instead go see a Neurologist or a Cardiologist.

The only way to diagnose central sleep apnea is through an in-lab PSG. This is even talked about on the link you provided---albeit it is several pages in. Moreover, the "treatments" page of the link you provide talks (at length) about the use of CPAP---BiPAP---ASV machines in the treatment of central sleep apnea. And, unfortunately, it is common for US insurance companies to demand evidence that the cheaper machines (CPAP and BiPAP) be tried and demonstrated to be ineffective before they will pay for an ASV to properly treat central sleep apnea. In my opinion, it sucks for the people with central apnea to be forced to jump through hoops before having their insurance company pay for the needed equipment. But that's how our convoluted, complex, for-profit health system works here in the US.

[christinepi]

Exactly, Robysue: my original sleep study showed 18.8 AHI/moderate OSA. The Centrals didn't start appearing until I started using CPAP. My titration study showed 4.4 (the mentioned night from hell). I was never diagnosed with Central.

[avi123]

delete

[robysue]

Avi,

I have deleted my post until this forum becomes CLEAN. No Erics in NC anymore!

Not sure why you started out, but didn't finish some quote from me.

I do agree that EricinNC needs to clean up his obvious attitude problem, his language, and learn some netiquette. But I don't have any real desire to try to run him off or ban him. "Foe" him if his posts are bothering you.