Help please-newby cpap pressure/Oscar data

[SleepAdjunct]

Hello,
I've been struggling for a few weeks with my cpap. I'm still having several events & I feel TERRIBLE. Doc sent me home on 8-20 settings
I'll attach some Oscar data- any help appreciated [

[Respirator99]

Welcome to the forum.

It's not surprising you feel terrible, with highly fractured sleep and a high AHI. And pretty much all your events were central apnea.

It would help if you could reformat your chart to show the following graphs: Event flags; Flow rate; Pressure (not mask pressure); Leak rate; Flow limitations. You will need to reduce the height of the graphs to get them all to fit - use your mouse drag the horizontal dividers up or down to suit.

Looking at your experience to date we need to understand why you have so many central apneas. My guess is that you had pre-existing central sleep apnea, which needs a different treatment approach. I assume you had a diagnostic sleep study? If so, please post the report here. We need to see all the charts and tables. Please make sure all personal ID including name, address, phone number, Medicare number etc are erased before posting.

In the meantime, turn off the EPR (exhale pressure relief) as this can sometimes cause central apnea in susceptible people. It may or may not help in your case but it's worth giving it a try.

[SleepAdjunct]

Thank you.
Yes, I had a study done. I'll attach:

[Pugsy]

There are a lot of starts and stops of the machine happening.
Do you think that maybe you weren't sound asleep when those flagged events happened or maybe you were sound asleep????
This would be important to figure out.

You probably should take a crash course in evaluating the flow rate to get an idea if those flagged centrals are arousal/awake related or if you were sound asleep.

OSCAR calls the centrals flagged by your machine Clear Airway Apneas....so all that ugly...central apneas per the machine
but you didn't have any on either of your sleep studies so makes me wonder if you were for sure asleep with these flags.

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

[clownbell]

I notice that the sleep study recommends a pressure setting of 9. Why is machine at 8-20?

[ozij]

Please do what Pugsy says, you and we have focus on your graphs differently. You have to focus on the info that helps you distinguish wakefulness from sleep.

The PSG says they titrated you at a pressure of 9, and had an AHI of 0 (!). With a small full face Fisher Paykel Simplus mask.

That being the case, I would set the machine at a fixed pressure of 9, no ramp, keep it there for a week at least (2 or more is better), and see what happens. You're using a nasal mask -

You need to control your obstructive sleep apnea in order to assure a stable, sufficient oxygen supply and to avoid heart rhythm disturbances.

However, obsturctive sleep apnea is not the only thing disrupting your sleep.

They also noted that your sleep is badly disrupted due to "excessive periodic leg movement" and recommend a "clinical assessment for Restless Leg Syndrome".

Have you / your doctor done anything about the RLS? RLS sometimes appears dramatically once the breathing disturbances are is controlled.

kteague is a longstanding forum member who suffered terribly from RLS, and eventually got a handle on it -- you may want to search her posts.

[Pugsy]

I notice that the sleep study recommends a pressure setting of 9. Why is machine at 8-20?

The machine settings (at least on the image you shared) show the minimum at 9 and the max at 20.
And if we look at the statistics the machine seems to barely come close to 10 max so that 20 max is really irrelevant to anything.

I don't know if EPR is a factor in the centrals flagged or not but it possibly could be and I doubt exhale relief was used during the titration sleep study where they decided that 9 cm was your optimal pressure. I don't see a setting for 8 cm on your report. All I see is 8 cm EPAP result because you are using EPR set to 1....that means at the minimum of 9 for inhale that the pressure drops to 8 during exhale.

First thing I would try is just turn off EPR if at all possible and if you can't go to sleep without EPR then maybe change EPR to ramp only and not full time.

Your machine isn't varying the pressure very much at all since we see not much movement above 9 cm.
What we don't know is they tested you with any sort of exhale relief.

I would aslo suggest setting minimum to max at 9 cm or changing to CPAP mode and set it to 9 without EPR and see what happens.

All this assuming that you were asleep when the central flagging occurred. If you are sleeping then we have to try to figure out why you aren't sleeping.

[SleepAdjunct]

I was asleep during the flagged data.

At the sleep study, I had a great deal of difficulty going to sleep. I did sleep, but not as deeply as usual.

I have a great deal of movement during sleep- I have since I was a child. I often sleepwalk. My father once found me standing in the middle of a busy highway and I was completely asleep. I've cooked an entire meal in my sleep before. If I get upset- it's not unusual for me to perform complex tasks while asleep (logging on to a secure network, completing phone-calls that I have no memory of, etc). Apparently the people I speak/interact with have no idea I'm asleep. Only close family can tell.
I wish I were making this up.

It's not classified as RLS thus far. I don't feel the need to move or anything- it just happens when I'm sleeping. If it's only leg/arm movement, I count myself lucky.

I'm scheduled to see a sleep specialist- one more nuanced in these areas that happens to be a neurologist but it's months away.

Do I need a different machine for the OSA?
Turned off the ESR, and adjusted to constant pressure of 9 as suggested.

Thank you. Any help very much appreciated. I honestly feel EXHAUSTED when I wake. I'm having memory issues & I feel like I'm 90yrs old. I'm nowhere near that.

[SleepAdjunct]

"I notice that the sleep study recommends a pressure setting of 9. Why is machine at 8-20"
The pulmonary dr wrote a prescription with 8pmin/20pmax as the setting-Med Warehouse filled the RX with an Ibreeze. It was H-E-Double-hockey-sticks! The med Warehouse wouldn't adjust the ibreeze, so I went rogue & did it myself-last settings were 7pmin-9pmax. I just took a shot tbh outta desperation. But, the machine kept shooting water up my nose even on a setting of 1 with a barely filled tank or leaving sores in my airways. So, i took it back.
I purchased a refurbished Airsense 10 for Her on the recommendation of a friend. Ive had it for 2wks.
Now, you're all caught up.

[SleepAdjunct]

One last thing (I promise) until I post data tomorrow (hopefully):
1) I wear a finger oxometer & it consistently drops into the 70s. I DO have Rynaulds Phenomenon (big word for poor hand circulation), so I purchased a smartwatch with oxometer 24hr monitor (shows same kind of dip)
2) I HAVE been upset (family illness) and sleepwalking has been an issue - and I've found my machine in odd places (obv. with mask off by morning) Anyone else deal with this successfully? I have hard to open locks on my doors, but really not sure plus sleep deprived as to how to keep me from dragging my machine all over the house.

[Pugsy]

Wow..complicated history for sure a a good bit of I am not very experienced with but my own sister was a sleepwalker as a child. Once we were at my dad's house (divorce and so 2 families) and my step brother woke us all screaming because my sister had got my dad's fishing rod and was beating my step brother with it....all while she was asleep. Standing up asleep at the foot of his bed whaling on him with the fishing rod.

If you are significantly having oxygen level drops like you are reporting then you were asleep.
If you were awake the drops wouldn't happen like that. I would be much easier to blame awake false positive flagging on those centrals but I guess again that you aren't going to get off with easy.

I don't know if you are going to need a different machine at this point...so lets say "maybe" for now.

One question ...what was the altitude of the sleep lab you had your diagnostic sleep studies and compared to where you live and sleep now?? You didn't appear to have problems with centrals during the sleep studies but now you do.
Altitude can affect centrals so maybe that will explain the centrals popping up.
So altitude of sleep lab and where you live??????

And lets see if reducing EPR changes the results or not.

You are also using the for Her mode...haven't heard of it being a cause for centrals happening but we might consider changing modes if you didn't change to cpap mode last night.

[SleepAdjunct]

I didn't change to cpap mode, but will today.

The sleep lab is 2 miles from my home in Nashville, so no significant Altitude difference.

I,too,have been accused of sleep-assault. Apparently, I turn into Mohammed Ali at night

[SleepAdjunct]

Btw- I did have several freak-outs at the sleep-lab. Ended up using several different masks. I woke up several times too & was awakened (my 02 dropped into 80s-and they wake you when that happens) so I really didn't feel that I got a good deep sleep there.

[Pugsy]

Try CPAP mode set to 9 cm with EPR off tonight and let's see what happens.

If you really need the EPR exhale relief you can set it to ramp only and use it until ramp period is over and you are hopefully asleep.

I have often wondered how much of my sister's sleep walking held over to adulthood. Never heard much about it though so I guess it didn't create a problem. I am 70 now and my sister will be 69 in Sept....so that fishing rod beating and all the sleep walking was some 60 plus years ago. Man, time flies. Don't tell anyone (and she will deny it to this day) but she would also get up and sleepwalk and go pee in the closet. But I remember it vividly.

Anyhow we can help (hopefully) with cpap and apnea issues and it's good you have other help lined up for your other sleep issues that are separate from the apnea issues because it does sound like you have a really remarkable problem in the sleepwalking department which is beyond our expertise here.

If you didn't sleep so great during the titration part of your sleep studies then it wouldn't be impossible for the centrals to simply not manifest themselves during the sleep study. We don't know what is triggering them (and we have eliminated altitude as a trigger) at this point and about all we can do is try to eliminate the known triggers that could possibly be causing them and see what happens.
If we can't reduce them by doing the things that can be done with your current machine then there is always the option of a different machine and actually the neurologist might be a good starting point. We should have that question at least answered by the time you see the neurologist. It is fixable though...either by some tweaking of current machine settings maybe...and if no luck with current machine tweaks there is a different kind of machine that can treat both your obstructive sleep apnea AND the central sleep apnea available to use. Cross that bridge if/when we come to it.

[SleepAdjunct]

Data from 7/22 & 7/23

7/23 has recommended settings.
9max/9min constant pressure.

I feel horrible. I'm getting no sleep (less than 5min REM according to sleep monitor) and I'm not thinking clearly.