MiAmigo's CPAP thread

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
MiAmigo
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MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 5:09 pm

Happy new year! I'm 25M 170cm 71KG from Australia, and I was diagnosed with severe OSA about a month ago, with AHI of 38.3. I didn't sleep well during the sleep study (it was a warm night and the tape was starting to itch), but this was broken down into
  • NREM 445 mins (88% of total sleep)
    • Central: 18.7; Obstructive: 9.4; Mixed: 1.3; Hypopneoa: 8.9; RERA: 0.
  • REM 62 mins (12% of total sleep)
    • Central: 7.8; Obstructive: 26.3; Mixed: 0; Hypopnoea: 3.9; RERA: 0.
I'm about 10 days into a CPAP trial, using an Airsense 10 and I am using a ResMed N30 nasal cushion mask. I've attached the last 4 days of OSCAR data I've recorded. Some notes on each day:

29/12/2021
Pressure was CPAP 8cm. The sales rep at the shop has been telling me that I should try and sleep on my side, so I was trying this for the first few days, but I'm still not too used to it. The mask having small leaks and I decided to take it off and put it back on later in the morning.
Image

30/12/2021
Pressure was CPAP 8cm. Tried to sleep at 10:30, only really slept at 1:30AM (Note: up to this day, the machine was actually 1 hour slow, so that's why it says I started at 9:30). I slept on my side to start, but woke up sometime early in the morning and noticed I had rolled over on my nack. I used the SnoreLab app to measure sleep on the 30th and it only recorded one small period of very light snoring noises.
Image

31/12/2021
The sales rep was trying to get centrals down so decided to switch to CPAP 7cm. I decided to sleep on my back. I drifted to sleep sometime between 11-12, but woke up because of the fireworks around 12:30 onwards. I had a bit of congestion in the nose during the night. I also decided to try the Wellue/Viatom SPO2 tracker.
Image

01/01/2021
Pressure was CPAP 7cm. I slept on my back. It took me a while to fall asleep, around 1AM probably, but I may have been drifting in and out of sleep. I was getting a bit itchy around the nose from time to time so was fiddling a bit, and went to the toilet once. I decided to switch off the ramp since the pressure was so low anyway. In the morning I was sort of drifting in and out of sleep.
Image

General sleep feelings:
It sometimes takes me an hour or two to fall asleep (perhaps just poor sleep hygiene, i.e., looking at screens too close to bed time). It's definitely better than a week ago, but still getting used to it.
I do find myself fiddling with the mask from time to time.
I generally wake up early in the morning (like 5-6am say) and then turn on a video on youtube and then drift in and out of sleep until I get out of bed.
I do notice I have always had dry/chafed lips.
I certainly feel more refreshed than I was at the start of the trial (I was really struggling to sleep), but don't feel that well-rested.

I have another 2 weeks on this trial (the shop is very busy this period and is encorcing strict 4-week trials, so I might try use a trial with a different company since my next appointment with my sleep physician is only at the end of February. Does anyone have any experience with trialling directly from ResMed in Australia? It seems like they are happy to offer trials for longer than 4 weeks.

Does anyone have any advice/comments? Thanks in advance!
Trialing AirSense 10 auto with N30 mask

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Julie
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Re: MiAmigo's CPAP thread

Post by Julie » Sat Jan 01, 2022 5:45 pm

Is your machine an auto (should say on the front)? If it is, why are you on a fixed pressure?

MiAmigo
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Re: MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 5:51 pm

Sorry, I forgot to mention that. The machine is an auto, but after the first few couple of days on 5-15 auto, the sales rep said my centrals were a bit concerning (around 27 centrals per hour according to the machine) so they decided to switch it to fixed pressure 8 (then more recently to 7)
Trialing AirSense 10 auto with N30 mask

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Pugsy
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Re: MiAmigo's CPAP thread

Post by Pugsy » Sat Jan 01, 2022 5:55 pm

Your AHI on the diagnostic sleep study.....38.3....what was the breakdown of that AHI in each category
Central
Obstructive
Hyponea

Looks like you still have a problem with centrals but you also had some centrals during the diagnostic sleep study....so even without cpap you were having centrals. So I don't think cpap is causing them but might be making them worse.

Are you on any medications of any kind? If so, what?

What altitude do you live at?

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zonker
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Re: MiAmigo's CPAP thread

Post by zonker » Sat Jan 01, 2022 6:00 pm

MiAmigo wrote:
Sat Jan 01, 2022 5:09 pm
Happy new year!
<snip>
Does anyone have any advice/comments? Thanks in advance!
welcome to the zoo!

i must say a big thank you for taking the time to type all of that in. it's refreshing to see a newbie take the time to do the work. and you've gotten oscar already. well done, you.

and you've named your thread a therapy thread! i think you've actually been doing some reading here on the forum. :wink:

about that oscar graph, though. the next time, could you format it like this, as member grumpy here suggests?-
"The easy way to set the OSCAR (v1.2) graphs in the preferred order and format:

1. Go to View menu - Reset Graphs - Standard

2. In View menu, turn on Sidebar

3. Again in View Menu turn off Daily Calendar and Pie Chart

4. Set Graph Height in File Menu -> Preferences -> Appearance Tab
The default should be 180.

On my setup, when set to 80, I get really squished up graphs.

At 192, the 5 graphs (flags, flow rate, pressure, leak, flow limit) are nicely spaced out.

At 160 I also get snores as the bottom graph.

5. Reset Graph Heights in View menu. This step may not be always necessary."

no need to redo what you've done. just please to follow those steps on the next batch.

it's going to take a bit of time before you get that well rested feeling. there are a minority of folk that take to this like a duck to water and feel better immediately. these people should be lined up against a wall and ER, i mean, most of us don't get the good results at once. patience, gentle being.

we DO have aussie folk in here regularly so maybe they can help with the resmed australia question.

on the centrals, i'll let my betters comment. not qualified as those haven't ever been in my experience anything to deal with.

good luck and keep at it!

ETA: i see good pugsy is already on the centrals!
people say i'm self absorbed.
but that's enough about them.
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MiAmigo
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Re: MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 6:04 pm

The overall breakdown (after weighting rem and nrem) was
Central 17.4
Obstructive 11.5
Mixed 1.2
Hypopnoea 8.3
RERA 0

I am not on medications apart from antihistamines. I live in Melbourne, so around 30m/100ft

Re: zonker, thanks for that! I’ll play around with that for next time! I wasnt sure if having a 4k monitor would require different settings
Trialing AirSense 10 auto with N30 mask

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Pugsy
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Re: MiAmigo's CPAP thread

Post by Pugsy » Sat Jan 01, 2022 6:25 pm

You had a lot of centrals even before starting cpap....technically a diagnosis of mixed or complex sleep apnea (where you have both central apneas and obstructives in numbers that are concerning).

The ResMed AirSense 10 AutoSet is a fine machine for obstructive stuff (those obstructive apneas and hyponeas) but it's not able to do anything with the centrals.
Now if the centrals just started AFTER you started cpap then we might try some tweaking or opt to give things some time to settle down but when people have enough centrals to be a problem when they aren't on cpap at all...it's unlikely it will ever calm down.

You need a machine that is able to deal with both obstructive apnea stuff as well as central apnea stuff.

As you can see by your report....not really any OAs or hyponeas to speak of but a lot of CAs...clear airway apneas and that's OSCAR's term for central apneas. If you were using ResMed's Rescan software or looking on the machine's read out...they are called central apneas.

This is most likely your best option for a machine that can deal with complex sleep apnea.
https://www.resmed.com/en-us/healthcare ... ve-10-asv/
You need a machine that will force you to breathe when you are having a central apnea and simply not breathing and the AutoSet simply can't do it.

Sorry but your guy can reduce the pressure all he wants but it's not going to help.
I don't know what all is involved down under in getting a specialized machine but I suspect that is what is going to need to occur. The AutoSet will deal with the OAs and hyponeas quite effectively but it is totally unable to deal with the centrals.

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MiAmigo
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Re: MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 6:39 pm

Thanks pugsy! For whatever reason, on the sleep comments summary for the sleep study, they only mentioned "severe OSA" (even though central were quite high on the scoring. They did say "clinical correlation is required) and said "CPAP is recommended". I went to see a sleep physician, and I feel like they didn't actually look at the breakdown into centrals and obstructive, they just looked at the number 38.5. The appointment was pretty short, and the original prescription was 2 weeks on auto followed by 2 weeks at 90% CPAP. So perhaps this was their standard practice.

As for the ASV machine, I will try book a follow up appointment soon with the sleep physician and ask about that.
Trialing AirSense 10 auto with N30 mask

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Pugsy
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Re: MiAmigo's CPAP thread

Post by Pugsy » Sat Jan 01, 2022 6:50 pm

Yeah, cpap is pretty much always the first try because on a rare occasion cpap does fix things but obviously not going to get lucky in your case.

Time to rattle the sleep doctor's cage and put his feet to the fire.

Though there is one extreme long shot you could try....make your machine a bilevel machine (of sorts) by turning EPR on (set to 3) and see what happens. Here in the US the next step after cpap/fixed single pressures...it's a bilevel machine where you have 2 distinct pressures one for inhale and one for exhale. It might work, it might do nothing, it might make the centrals worse but it's a cheap easy experiment to make.

Do you know how to turn on EPR and set it to 3? It's easy and something anyone can do.
This manual explains how if you don't know how.
https://www.respshop.com/manuals/ResMed ... %20her.pdf
I would sure at least give it a try because I don't know if you have insurance or not but those ASV machines are very pricey.

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MiAmigo
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Re: MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 6:58 pm

Pugsy wrote:
Sat Jan 01, 2022 6:50 pm
Do you know how to turn on EPR and set it to 3? It's easy and something anyone can do.

I would sure at least give it a try because I don't know if you have insurance or not but those ASV machines are very pricey.
I think it’s already on epr 3cm, at least thats what it says on the sidebar in OSCAR.

As for the cost, yeah look super expensive. In Australia most insurers seem to only give a $500 rebate every 5 years for CPAP…
Trialing AirSense 10 auto with N30 mask

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Pugsy
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Re: MiAmigo's CPAP thread

Post by Pugsy » Sat Jan 01, 2022 7:10 pm

Well...I first thought EPR was off because I didn't see 2 pressures on the pressure graph but I guess with 7 cm and 3 EPR it goes down to 4 cm on exhale and we can't see a line on 4 cm.

So okay then...turn EPR off and see if that makes any difference. I doubt it but again...worth trying.
If you can't handle EPR being off totally...set it to ramp only and use the ramp feature by turning it on and set it for approx how long it takes you to fall asleep.

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If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

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Julie
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Re: MiAmigo's CPAP thread

Post by Julie » Sat Jan 01, 2022 7:29 pm

A lot (? most) of antihistamines can keep you from sleeping well, so I'd look into the side FX of each and see what you really need, if changes are possible, etc. etc.

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Respirator99
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Re: MiAmigo's CPAP thread

Post by Respirator99 » Sat Jan 01, 2022 9:50 pm

G'day MiAmigo.

As a gross generalisation, sleep doctors and technicians never consider central sleep apnea. They know about obstructive apnea, but that's as far as their consciousness extends. Consequently they diagnose obstructive apnea, even when there's a bunch of centrals staring them in the face.

There's no special procedure for getting an ASV machine here - they're just expensive and the medical fund rebate will be the same for an ASV as for a simple CPAP. Strangely, ASV is the one Resmed machine that's cheaper in Oz than the US (once you take the exchange rate into consideration). There is a guy on Gumtree in Rouse Hill NSW who has a lot of Resmed machines at good prices. I don't know anything about him, but he's been around for a while and is presumably legit. https://www.gumtree.com.au/s-ad/rouse-h ... 1274636789

One other thing to consider - your dealer should sign you up for Resmed's Sleepvantage program. It's free and provides an extra 3 year warranty on the machine. https://www.sleepvantage.com.au/
* Download Oscar
* Oscar help
* An alternative to Oscar - try SleepHQ

I have no medical training or qualifications. Take my advice for what it's worth.

MiAmigo
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Re: MiAmigo's CPAP thread

Post by MiAmigo » Sat Jan 01, 2022 10:18 pm

Thanks Pugsy for the recommendation. I'll discuss reducing/removing EPR when I speak to the sleep technician in a couple of days (I'd happily change it myself but given it's still on a trial I'd rather let them do it).

Re Julie: thanks, I'll look into it! Unfortunately where I am hayfever is pretty horrible, but we are getting closer to Autumn so I might be able to start reducing use sometime soon.

Cheers Respirator99 for the tips! Good to see another aussie around here.

Based on the comments above I'll try changing EPR (so I'll have exhausted basically all the options available on the AirSense 10 Auto), then try get an appointment with my sleep doctor and see whether I can get a trial on the AirCurve ASV instead.
Trialing AirSense 10 auto with N30 mask

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Re: MiAmigo's CPAP thread

Post by chunkyfrog » Sat Jan 01, 2022 11:24 pm

Julie wrote:
Sat Jan 01, 2022 5:45 pm
Is your machine an auto (should say on the front)? If it is, why are you on a fixed pressure?
The machine name is on the Oscar data page, on the left side, near the top.
I had to zoom in on my tablet.

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