Post Covid 19/Ventilator new user

[Cariano]

Hi!
I figured out how to use Oscar and it shows I am still having 6AHIs. I had Covid 19 in March and was on a ventilator for only 4 days and now I have a severe sleep apnea. I assume I had it before but I never knew nor snored. I think I figured out how to post but I am not as good on the computer as I was before, better but not quite normal.
I am very jealous that you all seem to get your AHIs down to 1. Please help me to do the same. My respiratory therapist says as long as it is below 5 it is good. I have my next appt with the Pulmonary doc on 10/30/2020. I would like to be more educated before then. I am a retired Physical Therapist and understand most of this but not how to fix my score. My at home sleep study in July showed REI respiratory event index of 35, 0 central, 295 obstructive, and 29 hypopneas, so 35 per hour. I attached the OSCAR report from last night. But I may have posted it incorrectly, let me know please.

My question is, if I did not have any central apneas with the sleep study, why do I have them now? Or is clear airway apnea different than central apneas? They started me on pressure of 6, then 7, now 8. I was ranging 12-20 AHIs when on 6. The biggest improvement is that I only wake up once or twice, when I started the APAP I was waking up 5 times per night.

I was truly and completely EXHAUSTED for months and now can walk 3 miles. I did not receive steroids until 3 months post hospitalization (which made a huge difference) because they did not yet know how to handle Covid 19 when I had it. I did not have a problem sleeping, I had a problem feeling rested, and needed naps throughout the day. I only rarely take naps now and do feel better but I want to feel great, )
Thanks,
Cariano

[Cariano]

The attachments do not go in, it says that OSCAR 10:20:20.png is an invalid filename. What would be a valid filename? LOLOLOL
Cariano

[Cariano]

OSCAR.10.20.2020.png (439.37 KiB) Viewed 1275 times

[Cariano]

OSCAR.10.20.2020.2.png (515.37 KiB) Viewed 1275 times

[Pugsy]

Try turning EPR off if you can.
If not...maybe use it in ramp only and make use of the ramp feature. EPR can be set to ramp only instead of full time.
Sometimes exhale relief can be a trigger for central apneas.

[Cariano]

Thank you for responding, Pugsy.
I looked back to a post you were part of in 2017 that discussed the EPR and central apneas. It also mentioned the gas exchange issues. When I had my PFTs they found my DLCO is 63% for my age. So this may explain my issue maybe. Anyway I also liked the comments about changing just one thing at a time. I still have some issues with low SpO2%. I was on a nebulizer for a few months, Idk if I am supposed to still be using it, they said prn and I haven't used it recently.
They set me up with the ramp at 4 initially and I could not use the machine AT ALL. I thought I was suffocating and could not tolerate it.
So I will try to adjust the EPR and see how it goes.
Cariano

[Julie]

Hardly anyone else can breathe at 4, so don't feel bad about that.

[Cariano]

Thank you, Pugsy.

The past few days my AHIs have been between 2 and 3 by lowering the EPR to 1. I was afraid to take it away altogether.
I now have a drier mouth and a little more leaking.

I’m going to see if I can get used to it. The leaking is noisy. I think I tried to tighten it too much and it wakes me up now.

[Cariano]

So, now I have had a few days with the EPR at 1, should I take it to zero? Idk what to look at in the graphs related to the clear airway apneas. There are episodes of loud blowing air that wakes my husband but idk what precipitates this, maybe me moving and dislodging the pillow slightly. I haven't been waking up and don't notice them but it wakes him up.

Resmed 10.26.20.png (468.26 KiB) Viewed 1117 times

[khauser]

You are certainly doing better on paper ... how are you feeling? (Don't expect a night and day difference, if you'll pardon the pun ... but maybe you feel a little more rested in the morning?)

I think you could indeed reduce EPR, unless it makes you uncomfortable or you get aerophagia. Only way to tell is to try. Generally EPR is a comfort feature.

You only show a relatively small area of leaking large enough for the machine to make note, from about 5:30 to 5:50. You were probably re-positioning and disturbed it.

How's the dry mouth problem? Same? Better? Worse?

[Cariano]

My numbers definitely are better with lowering the EPR so I am loving that. I still am exhausted though. I think the leaking is from me moving around during the night. Last night I only used the Machine for 4 hours, I VAGUELY remember tearing off the whole apparatus because I woke up with a super parched mouth, throat, everything, lolol. I saw another thread where people are using cervical collars. Maybe that will help keep me in place. I am going to try one of those neck collars you use on an airplane, in reverse, until I get a real collar. Just to see if it helps.
My current new problem is that I fell really hard on my left knee while doing my daily walk last Sunday, now with crutches and getting an MRI on Saturday. I also tweaked my right shoulder and it hurts to lay on that side. 2020 is not my year.

[khauser]

Owww!

I fell on my knee a few weeks ago but no long term damage. My other knee is hurting, must be sympathy pains.

I wish you a speedy recovery! You've had enough health problems no?

[Cariano]

Just found out that I have an avulsion fracture of my patella and torn retinaculum, I am sooo athletic that I can't even walk without hurting myself.

I have some questions about my last night OSCAR. Can anyone explain the flow rate graph, what is the difference between the OA and the CA, they look the same to me.

I sleep straight through everything.

Thanks!

Resmed .png (509.9 KiB) Viewed 1041 times

[Cariano]

Here's another one. I am doing great with the OA's. Just checking with the CA's

RESMED 10.28.20.png (517.01 KiB) Viewed 1037 times

[Pugsy]

Are you on any pain meds?

OA....80 to 100% reduction in air flow because of soft tissues collapsing and blocking the airway for at least `10 seconds.

Central/Clear airway apnea...no air flow but the airway is open...simply no effort to breathe that lasts for at least 10 seconds.
Hold your breath for 10 seconds. That's essentially a 10 second central apnea. Nothing is blocking the airway but there is no air flowing because you are holding your breath.

You have not zoomed in quite enough to establish if the flow rate looks like asleep breathing or awake/arousal breathing but the overall pattern looks like you weren't asleep when the bulk of those flagged events happened.

Watch the videos here especially the last one.
http://freecpapadvice.com/sleepyhead-free-software

If you weren't asleep all it means is poor sleep quality and with the recent injury ...not unexpected.
Awake breathing is very irregular when compared to asleep breathing and these machines can and will flag false positive events in any category especially central apneas.

If you are on pain meds that might suppress respiration they can also be a factor in triggering real asleep central apneas.