Recently diagnosed, looking to make sense of my data.

Hello everyone.

I'm a 35M, diagnosed with OSA as of Aug 12, 2020 after I pressed my GP to refer me to a sleep study. For the past 10+ years I've been waking up with headaches, nausea, and just general malaise that would take me up to 10 mins to actually get out of bed.

The good news is that after completing the sleep study, I finally had a semblance of an answer as to why I've been feeling like crap all this time. My untreated AHI was 77.1, REM AHI was 63.0, and my SpO2 dropped to 82%.

As of Aug 17, I've been on a Resmed Airsense 10 Autoset for Her (still not sure why I got the for Her version), so today would mark my 3rd day on the treatment.

My sleep clinician recommended an initial 1 week of APAP at 7.0-12.0 to determine my minimal threshold, and then an additional 3 weeks on CPAP at the 90% pressure percentile.

Being a techy person, I naturally researched what I can do with my Resmed device, and found the SD card/OSCAR option. I did not use the SD card on my very first night, but have been the past two.

I've attached the screenshots of the last two nights. Would really appreciate if anyone could help me understand these a bit better.

Cheers.

Where are you located?

Turn off EPR....if you don't know how the manual explains how to get to the clinical menu setup area.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

How are you sleeping? Soundly or lots of wake ups? Specifically wanting to know if you might have been awake when all those CAs were flagged. CAs....clear airway apneas...central apneas....you are having way too many of them if you were asleep. Now if you were awake when they were flagged we don't worry about them except we want you to be asleep and we want to know why you weren't asleep.
More pressure won't fix those.

One more question to add: do you know what the mix of events was in your sleep study (obstructive apneas, central apneas, hypopneas)? If you don't have a copy of your sleep study, I'd recommend you ask for one. In the U.S. you are entitled to have a copy.

Pugsy asks about your location; your elevation above sea level is especially important to know.

Pugsy wrote: ↑

Thu Aug 20, 2020 10:36 am

Where are you located?

I'm in Ontario, Canada.

Pugsy wrote: ↑

Thu Aug 20, 2020 10:36 am

Turn off EPR....if you don't know how the manual explains how to get to the clinical menu setup area.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Okay. I'll turn off EPR for tonight and see what that does..

Pugsy wrote: ↑

Thu Aug 20, 2020 10:36 am

How are you sleeping? Soundly or lots of wake ups? Specifically wanting to know if you might have been awake when all those CAs were flagged. CAs....clear airway apneas...central apneas....you are having way too many of them if you were asleep. Now if you were awake when they were flagged we don't worry about them except we want you to be asleep and we want to know why you weren't asleep.
More pressure won't fix those.

As for the correlation about the CA events and being awake.. I do not specifically remember being awake, but looking at my sleep tracking on my Apple Watch it does relate to times that I was deemed to be in light sleep, and at least 1 point where I fully woke up (according to the data, but I have no recollection of being awake)

I seem to be sleeping alright. Still getting used to the apparatus and the fact that I can't comfortably sleep on my side. I used to be up 4-5 times a night that I remember, pre-treatment. Now I don't seem to be leaving my bed at all.

At first I thought that perhaps that leaking was causing the events since they seem to line up, but the inverse could be true as well, and that the disturbances caused the leaks.

A little comforting to know that the amount of CA events during non-sleep time could be ignored since it actually gave me anxiety thinking I may be developing some kind of treatment-emergent central apnea.

Edit: Added screenshot of my Apple Watch tracking.

We are going to proceed and assume that some of those central apneas are real asleep flagged events....for the moment anyway.
Especially since you can't report "I spent massive times awake" with the mask on.
Treatment emergent central apneas was indeed the first thought that went through my mind.
If you do wake up during the night...reach over and turn the machine off and then right back on again. That way we have a clear marker for known awake times and can then maybe discount false positive flagging more easily.

Using EPR creates a bilevel situation because there's one pressure or inhale and another distinct pressure for exhale and for a very small percentage of people who use bilevel they get central apneas popping up in numbers that we worry about.
So the first thing we do is just turn EPR off and see what happens. If you can't get comfortable enough with EPR off...reduce it as much as you can. So we start with easy and cheap potential solution first and go from there.

Do get a copy of your sleep study results. We need to know if you had many centrals apneas during the sleep study. I assume it was done in a lab???? Or was it a home sleep study and if it was a home study did you wear any sort of belt around your chest or abdomen?

Miss Emerita wrote: ↑

Thu Aug 20, 2020 10:57 am

One more question to add: do you know what the mix of events was in your sleep study (obstructive apneas, central apneas, hypopneas)? If you don't have a copy of your sleep study, I'd recommend you ask for one. In the U.S. you are entitled to have a copy.

Pugsy asks about your location; your elevation above sea level is especially important to know.

Unfortunately, I have not received a copy of the actual sleep study. I'm not sure if I'm entitled to a copy by Canadian law. But I do remember them telling me it was mostly obstructive.

As for elevation, my city is 618 feet above sea level.

Pugsy wrote: ↑

Thu Aug 20, 2020 11:15 am

If you do wake up during the night...reach over and turn the machine off and then right back on again. That way we have a clear marker for known awake times and can then maybe discount false positive flagging more easily.

Good idea. I'll start doing that.

Pugsy wrote: ↑

Thu Aug 20, 2020 11:15 am

Using EPR creates a bilevel situation because there's one pressure or inhale and another distinct pressure for exhale and for a very small percentage of people who use bilevel they get central apneas popping up in numbers that we worry about.
So the first thing we do is just turn EPR off and see what happens. If you can't get comfortable enough with EPR off...reduce it as much as you can. So we start with easy and cheap potential solution first and go from there.

I will turn it off completely for tonight and post the results in the morning.

Pugsy wrote: ↑

Thu Aug 20, 2020 11:15 am

Do get a copy of your sleep study results. We need to know if you had many centrals apneas during the sleep study. I assume it was done in a lab???? Or was it a home sleep study and if it was a home study did you wear any sort of belt around your chest or abdomen?

Unfortunately that data was not shared with me. And yes, it was done under a lab setting. I wore two belts, one across my chest, one across my abdomen, and had what seemed like 15 leads coming off me.

I don't know Canadian laws about medical records but you can at least ask for a paper copy of the results of the sleep study.
In the US they have to give us a paper copy when requested.
Since your sleep study was done in a lab...they should have easily been able to figure out obstructive apnea vs central apnea and that's what the chest belt thing helps out with. A few central apneas here or there isn't a big deal but a lot of them is obviously a problem.
So for now we take them at their word that you didn't have a large number of centrals in the lab without cpap.
Obviously if you did then this machine is the wrong machine for you and you would need a totally different kind of machine.

I assume no medications that might suppress your respiration???? Specifically pain meds are usually what we are looking at.

There's a long explanation as to why central apneas happen that I don't have time to go into at the moment and it's related to carbon dioxide and not oxygen levels.

Let's see if easy and cheap fixes the situation with EPR being turned off.
And if it does....don't let them swap the machine for a fix cpap machine. In Ontario the for Her model is considered a cpap in terms of your OHIP insurance coverage but it's an apap machine and a better machine than the fixed cpap machine.
You've got the best possible machine for your trial....it may have more features than you need but it's always better to have something and not need it than need it and not have it.
Just get past the "for Her" thing. What it can do isn't limited to just the gals....it can benefit the guys as well. ResMed just elected to target market the women with this model machine. Stupid idea IMHO but they do a lot of stupid things and didn't bother to ask me my opinion.

Let's see what tomorrow's report shows with EPR off. Be sure to put the SD card back into your machine because without it being in the cpap machine when in use we don't get the detailed graphs.

camo wrote: ↑

Thu Aug 20, 2020 11:16 am

Unfortunately, I have not received a copy of the actual sleep study. I'm not sure if I'm entitled to a copy by Canadian law. But I do remember them telling me it was mostly obstructive.

excuse me a minute, camo, i'm going to alert dog slobber to this-

Dog Slobber wrote:

Tue Aug 18, 2020 9:16 am

hey, dog? can camo get a copy of his/her sleep study?

Pugsy wrote: ↑

Thu Aug 20, 2020 11:33 am

I assume no medications that might suppress your respiration???? Specifically pain meds are usually what we are looking at.

No prescription meds. The only depressant that I use is alcohol. And I've been tapering that off since the treatment began.

Pugsy wrote: ↑

Thu Aug 20, 2020 11:33 am

Let's see if easy and cheap fixes the situation with EPR being turned off.

I can only hope

Pugsy wrote: ↑

Thu Aug 20, 2020 11:33 am

And if it does....don't let them swap the machine for a fix cpap machine. In Ontario the for Her model is considered a cpap in terms of your OHIP insurance coverage but it's an apap machine and a better machine than the fixed cpap machine.
You've got the best possible machine for your trial....it may have more features than you need but it's always better to have something and not need it than need it and not have it.
Just get past the "for Her" thing. What it can do isn't limited to just the gals....it can benefit the guys as well. ResMed just elected to target market the women with this model machine. Stupid idea IMHO but they do a lot of stupid things and didn't bother to ask me my opinion.

Let's see what tomorrow's report shows with EPR off. Be sure to put the SD card back into your machine because without it being in the cpap machine when in use we don't get the detailed graphs.

Aside from the branding, I actually like the machine and the feature-set! Even picked up a climateline hose for it yesterday!

Would hate for them to switch this out, but I highly doubt that they will since this one will do APAP/CPCP all in one machine. And I don't think OHIP nor my insurance would cover another machine (they won't take it back because of COVID and obvious liability reasons. The DME specifically told me that the sale was final)

camo wrote: ↑

Thu Aug 20, 2020 8:23 am

As of Aug 17, I've been on a Resmed Airsense 10 Autoset for Her (still not sure why I got the for Her version), so today would mark my 3rd day on the treatment.

I don't think anyone addressed that part. That's the machine almost everyone here would recommend for you. The "for her" part of the name refers to an additional algorithm the machine has that was initially designed to treat female users, but has proven quite useful among some male users as well. Aside from that one difference, and the look of the exterior, it is exactly the same as the model that lacks the "for her" label.

So, IMO, you got lucky!

Ahhh....final sale. That's a good thing unless we can't get those centrals reduced significantly.

The part about setting it to cpap at your 90/95 % pressure number is BS though.
That's old school and not necessarily what needs to be done in your case even if we weren't facing all these central apneas.
Example...my OSA is worse in REM and I sometimes need 6 to 8 cm more pressure during REM. REM normally amounts to about 20% of the night's sleep. My 90/95% pressure numbers might be up around 15 but all that means is I was at OR BELOW that pressure for 90/95% of the night. It is NOT where I was actually at for 90/95 % (depends on the software reporting) of the night.
Going by the old school reasoning my minimum pressure or using cpap mode I would have to use 15 cm all night long. Just to deal with REM stuff....the rest of the night I might get by quite nicely with 8 cm...Let me tell you using 8 cm for most of the night is a whole lot better than using 15 cm all night long.

Now since we are looking at an unwanted number of centrals....we might need to restrict the pressures a bit depending on what happens with EPR off and the starting pressure but lets cross that bridge if/when we come to it. It might be that cpap mode or a more restrictive apap mode is better for you but there are ways to get around that problem. It all depends on if those centrals are asleep centrals or not and if they reduce with just turning EPR off or not. I have seen people have treatment emergent centrals at 5 cm pressure and EPR not being on. We get to have a whole different discussion should that happen in your situation.

For now lets play the odds and see what kind of results we get with EPR off.
We need you to be for sure asleep though....and don't use alcohol to help out if at all possible. It's actually bad for the sleep stages we need. It messes with the central nervous system and messes with normal sleep stage architecture.
I would rather see you take some sort of OTC sleep aid if you can safely do it than use alcohol at bedtime.

khauser wrote: ↑

Thu Aug 20, 2020 11:53 am

I don't think anyone addressed that part. That's the machine almost everyone here would recommend for you. The "for her" part of the name refers to an additional algorithm the machine has that was initially designed to treat female users, but has proven quite useful among some male users as well. Aside from that one difference, and the look of the exterior, it is exactly the same as the model that lacks the "for her" label.

So, IMO, you got lucky!

I initially thought that they maybe ran out of the other model, which is why I got this one.

But I'll take it as a blessing and slap some manly stickers on it to cover up the flowery pattern

zonker wrote: ↑

Thu Aug 20, 2020 11:34 am

camo wrote: ↑

Thu Aug 20, 2020 11:16 am

Unfortunately, I have not received a copy of the actual sleep study. I'm not sure if I'm entitled to a copy by Canadian law. But I do remember them telling me it was mostly obstructive.

excuse me a minute, camo, i'm going to alert dog slobber to this-

Dog Slobber wrote:

Tue Aug 18, 2020 9:16 am

hey, dog? can camo get a copy of his/her sleep study?

Medical practices fall under provincial jurisdiction. But, they are pretty consistent between provinces.

In Ontario (and likely most provinces) patients are entitled to copies of all medical records for a reasonable fee.

College of Physicians and Surgeons of Ontario wrote: Access and Transfer of Medical Records
Providing Access to Medical Records
...

• Physicians must provide patients and authorized parties6 with access to, or copies of, all the medical records in their custody or control upon request, unless an exception applies.
• Where an exception applies and access is refused, physicians must inform the individual in writing of the following:
  • the fact of the refusal;
  • the reason for the refusal; and
  • the right of the patient to make a complaint to the Information and Privacy Commissioner of Ontario (IPC)

https://www.cpso.on.ca/Physicians/Polic ... Management

I requested a copy of my Sleep Study and was provided with it for $5.00

As of Aug 17, I've been on a Resmed Airsense 10 Autoset for Her (still not sure why I got the for Her version), so today would mark my 3rd day on the treatment.

The machine you're on *might* be a loaner, and then they will order yours. That's what happened with me.

When they do order yours, unless you medically qualify you for an APAP or BiLevel they will order you a CPAP machine. If they do, insist on the Resmed Airsense 10 AutoSet for Her. For some strange reason the for Her model qualifies as a CPAP machine, even though it is an APAP (under the Ontario Assisted Device Program)

Many DME's will try to get you a straight CPAP device such as the Resmed Airsense 10 Elite.

I can't stress this enough, you may have to insist for the for Her model. Do not let them talk you into a lesser model, where they have a greater profit margin.

Here is the supported devices for the OHIP ADP program. Note the AirSense 10 AutoSet is listed under APAP devices, but the AirSense 10 AutoSet for Her is listed as a CPAP.

http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

If the machine you have is you permanent machine, you got the for Her model because it is the best device that qualifies under ADP as a CPAP machine.

Those are leaves and not flowers but there are face plates available if you just hate the leaves.

I don't know about availability in Canada but here in the US about 20 bucks.
https://www.cpap.com/productpage/resmed ... -faceplate

The for Her model is actually like having 3 machines in one.
It has 3 modes of operation
Cpap fixed pressure mode
Apap or auto adjusting pressure mode
and a special different algorithm auto adjusting pressure mode which someone decided women might need but actually males or females might benefit from it...and they call it the "for Her" apap mode.

In Canada it takes an act of God to get an apap capable machine instead of cpap fixed only machine ...at least under OHIP.
BUT for some reason the "for Her" model apap machine got on the list of cpap machines and thus OHIP pays their portion which the for Her model gets dispensed. I tend to think someone screwed up but since it is a good screw up we don't go pointing that little boo boo out to the powers that be. You can't get the regular AutoSet under OHIP but you can get the for Her AutoSet.