New APAP User AHI Issues & New OSCAR user

Hello,

A little about me: I was diagnosed with Apena a few weeks ago and picked up the Airsense11 on Thurs Feb 16th. I was diagnosed with a 49 AHI, my oxygen gets down to 70% at time, high blood pressure and I was also told that my sleep is very fragmented. For years I figured I had Apena but I ignored it, you know the stigma behind these things and the thought of having to wear a mask every night. Anyhow after years of waking up gasping for air (sometimes very scary moments where I though death was upon me) , constant head congestion type of felling (pressure felted in my head) and I memory loss sometimes I feel like I'm forgetting more then I am remembering or I sometimes loose concentration when someone is talking and I don't absorb the information.

The good thing is within 1 week I feel better for sure, I don't feel tired before the day is finished where I used to nap. My pressure in my head seems to subsided which probably also had effect my blood pressure but I haven't checked that yet. I feel better waking up regardless if I got 4 or 5 hours of sleep or a full 8 hours of sleep. So I am headed in the right direction.

So this forum was recommended when I posted on Reddit, also the use of OSCAR was also recommended so here I am.

I machine is the Airsense11 and my pressure range is set between 6 and 17. I currently am using the Phillips Dreamwear Silicone Pillows which I really like and I also have a cushion as well that I used for a few days. In a few weeks my doctor has requested my information from the machine so I'm not sure if I should mess with settings yet or not. I did speak to my APAP supplier and I believe they may be upping my pressures.

Today I woke up in surprise when my machine said 38.5 AHI and since I have gotten the machine it has ranged from 1.5 at the lowest and 16.57 at the highest until last night when it shot up to 38.5. I'm not sure why this happen as according to the MyAirApp I did well and everything like leakage, pressure etc were all good. I do need to spend sometime reading this data and figuring out how to read it and really understand the information, until then I would like to ask for some information from the pros here on the forum.

Thank you in advance and thank you to the Reddit user posted the information on Oscar and this website.

https://imgur.com/a/H9TAdOO

So last night (not on the screenshot) I was down to 1AHI, I did swtich to the nose pillows and I have a 0 for leak rate

JonnyMac wrote: ↑

Thu Feb 23, 2023 9:23 pm

The good thing is within 1 week I feel better for sure, I don't feel tired before the day is finished where I used to nap. My pressure in my head seems to subsided which probably also had effect my blood pressure but I haven't checked that yet. I feel better waking up regardless if I got 4 or 5 hours of sleep or a full 8 hours of sleep. So I am headed in the right direction.

The good news is that you are already seeing a real benefit from CPAP therapy. That will make it much, much easier for you to stick with it while you are doing the inevitable dial winging needed to genuinely optimize your therapy.

So this forum was recommended when I posted on Reddit, also the use of OSCAR was also recommended so here I am.

Get Oscar installed and yank your machine's SD card so that Oscar can read the data. Just remember to put the card back in the machine before you go to bed.

We'll be able to help you make sense of the Oscar data.

I machine is the Airsense11 and my pressure range is set between 6 and 17. I currently am using the Phillips Dreamwear Silicone Pillows which I really like and I also have a cushion as well that I used for a few days. In a few weeks my doctor has requested my information from the machine so I'm not sure if I should mess with settings yet or not. I did speak to my APAP supplier and I believe they may be upping my pressures.

I understand the reluctance to change settings before your follow up appointment. Not everybody is confident enough to risk a wet noodle beating from a sleep doc who makes a fuss about a patient tampering with the therapeutic settings.

Do be aware, your DME (the APAP supplier) can in fact change your machine's therapeutic settings using the built-in cellular modem. Some people are not bothered by this, but others are. If you do change your settings yourself, you will need to monitor them at least occasionally to see if they are mucking around with your (desired) settings without your permission. If that does happen, you'll have to decide what to do.

Today I woke up in surprise when my machine said 38.5 AHI and since I have gotten the machine it has ranged from 1.5 at the lowest and 16.57 at the highest until last night when it shot up to 38.5. I'm not sure why this happen as according to the MyAirApp I did well and everything like leakage, pressure etc were all good.

It would help us help you if we knew what the breakdown of the large AHI's are. In other words, what's the AHI, the AI, and the CAI that are all reported on the machine's LCD? The MyAir app does not report the breakdown of the AHI, and so you really need to either look at the sleep report on the LCD or download the data into Oscar.

And here's the reason we need that data: If the OAI and/or the HI is way too high on too many days, then you probably need a higher minimum pressure setting. But if the CAI is way too high on too many days, then additional pressure may make the problem worse. And we also have to tease out whether a whole bunch of events are being scored during times when you are likely awake or drifting back and forth between wake and light sleep.

I do need to spend sometime reading this data and figuring out how to read it and really understand the information, until then I would like to ask for some information from the pros here on the forum.

Post your data and we'll help you figure out what it means. Read Pugsy's thread on posting images to get instructions on how to use a site like imgur.com to host your images and what parts of the detailed data are most useful to us.

JonnyMac wrote: ↑

Fri Feb 24, 2023 8:38 am

https://imgur.com/a/H9TAdOO

So last night (not on the screenshot) I was down to 1AHI, I did swtich to the nose pillows and I have a 0 for leak rate

There's the image:


That's a nasty cluster of CAs mixed with OAs between 2:20 and 4:20, with most of the events listed as CAs.

Any chance you were awake or drifting back and forth between wake and sleep during that time?

Could you zoom in on the two hour period between 2:20 and 4:20 to give us a closer look at what those events look like?

And then could you zoom in on a couple of 10-15 minute periods to give us a much closer look at what's going on? I would suggest posting a screen shot that shows 3:00-3:10 and another screen shot that shows 3:55-4:10.

Hopefully Rubicon might drop by and give his opinion of what that zoomed in data indicates.

I'd also suggest letting your sleep doctor know that your machine is recording a whole lot of CAs on the nights when your AHI is way too high. That could indicate that you may be in the small minority of obstructive sleep apnea patients who have some problems with so-called treatment-emergent central apneas. For most of these people, the problem resolves by itself in a few weeks.

No I do not remember being up at that time, most of the time I don't when I wake up. I know my Nest Sleep Sensing hub tells me I have been awake but I have no conscious knowledge of this.

I do know that I feel way better that's for sure, I notice not being tired throughout the day is one of the most noticeable things so far and it's only been a week. I agree, seeing benefits this early on makes me feel so much better going for the sleep study that I put off for so long. I was worried I wouldn't like this and wouldn't keep going but it's hard to ignore the positive effects I am getting. Last night (which I haven't uploaded to Oscar) was the best so far down to 1 AHI, and a perfect score from the MyAirApp. I do wish the app would show all the same information that is shows on the actual unit itself I don't know why they don't, but that is why I decided to put a memory card in the unit after a few days of owning the AS11 so that I could upload to Oscar (or SleepHQ if I decide to go that route as well).

I will let my doctor know about my higher CAs, I was reading up on this and seen that somethings this is cleared up in a few weeks. I did talk to my DME (in Canada they are a ADP supplier) and I think they will be making a change but I'm not sure if they need permission from the doctor first or not.

Ok so here are the time stamps zoomed in.

Turn off EPR if you can....see what happens.
I don't know that it will reduce the number of centrals you are seeing but it is about all you can do with this machine that might help.

If you can't turn EPR off...try setting EPR for "ramp only" and make use of the ramp feature....or maybe just reduce EPR to 1 and see what happens.

Pugsy wrote: ↑

Fri Feb 24, 2023 5:00 pm

Turn off EPR if you can....see what happens.
I don't know that it will reduce the number of centrals you are seeing but it is about all you can do with this machine that might help.

If you can't turn EPR off...try setting EPR for "ramp only" and make use of the ramp feature....or maybe just reduce EPR to 1 and see what happens.

And if you can't turn it down/off, do it anyway. You look like you're one of the relatively small minority that EPR causes problems with.

Pugsy wrote: ↑

Fri Feb 24, 2023 5:00 pm

Turn off EPR if you can....see what happens.
I don't know that it will reduce the number of centrals you are seeing but it is about all you can do with this machine that might help.

If you can't turn EPR off...try setting EPR for "ramp only" and make use of the ramp feature....or maybe just reduce EPR to 1 and see what happens.

Ok so I turned EPR off initially after seeing your post, it just seems way to restrictive and I didn't like that. I couldn't get to sleep with it light that felt like I was breathing and exhaling through a straw.

So I turned the EPR to setting #1 which I felt more comfortable at, still seems harder to exhale but in the interest of bringing on my central apenas I did it. Here I'd what I got.

Pressure: 10
Total AHI: 0.4
OSA: 0.1
CSA: 0.0

Doesn't make sense the AHI is higher then those 2 combined numbers. But the good thing is it says I had no CSAs lastnight. So seems like turning the EPR down worked, I'll give it a few more days to see if this is consistent.

I did turn on Ramp Up for the EPR after waking up to see if they makes this easier to get to sleep.

If I shut off the EPR for the machine but turn on the timed ramp up with that do anything?

I know the ramp setting specially for EPR will disappear from the menu when I turn off EPR.

Thank for the advice everyone.

palerider wrote: ↑

Fri Feb 24, 2023 7:00 pm

Pugsy wrote: ↑

Fri Feb 24, 2023 5:00 pm

Turn off EPR if you can....see what happens.
I don't know that it will reduce the number of centrals you are seeing but it is about all you can do with this machine that might help.

If you can't turn EPR off...try setting EPR for "ramp only" and make use of the ramp feature....or maybe just reduce EPR to 1 and see what happens.

And if you can't turn it down/off, do it anyway. You look like you're one of the relatively small minority that EPR causes problems with.

Of course it happens to me lol

Is there a reason why EPR affect some and not others?

Seems like setting 1 so far (1 night) has allowed me to use it while also getting rid of the CSA.

Curious about how/why Cheyne Stokes seem to be so automatically downgraded to 'centrals' - what if he really is having C-S's and needs to see a doctor? I get the Sleep-wake junk thing when a few show up when drifting off or beginning to awake, but real C-S's may indicate real problems that need addressing. How do you know the difference without more input from e.g. cardiologists?

JonnyMac wrote: ↑

Sat Feb 25, 2023 5:28 am

So I turned the EPR to setting #1 which I felt more comfortable at, still seems harder to exhale but in the interest of bringing on my central apenas I did it. Here I'd what I got.

Pressure: 10
Total AHI: 0.4
OSA: 0.1
CSA: 0.0

Doesn't make sense the AHI is higher then those 2 combined numbers.

Those are number from the ResMed screen. The difference is HI - which for some reason, ResMed doesn't report on the screen.

JonnyMac wrote: ↑

Sat Feb 25, 2023 5:29 am

Is there a reason why EPR affect some and not others?

Yes, there is a reason but no one seems to know exactly why it happens or the predictors for it happening to some people and not others. We also don't know why it happens in just one or two segments of the night and not other parts of the night or maybe not every night.

Central apneas happen when the brain doesn't send the signals to breathe. The brain looks to the level of carbon dioxide in the blood as to make the decision to breathe or not. Sometimes using EPR or Pressure support will cause some people to blow off too much carbon dioxide so the levels don't get high enough for the brain to know to send the signal to breathe.

You might try EPR at 2.....see if that is your line in the sand. 3 EPR causes a problem and 1 EPR seems to work and we don't know what would happen with the 2 setting.
I have a friend who gets about 15 centrals an hour with pressure support of 4 and essentially zero with pressure support of 3. Sometimes it just takes a minor change....sometimes it takes a big change.

Julie wrote: ↑

Sat Feb 25, 2023 5:42 am

Curious about how/why Cheyne Stokes seem to be so automatically downgraded to 'centrals' - what if he really is having C-S's and needs to see a doctor? I get the Sleep-wake junk thing when a few show up when drifting off or beginning to awake, but real C-S's may indicate real problems that need addressing. How do you know the difference without more input from e.g. cardiologists?

Since turning off/down EPR seems to have essentially reduced worrisome centrals down to nothing then that means the problem causing the Cheyne Stokes stuff is respiratory related and not cardiac related....why not try easy and simple first before going down the "OMG CSR flagged events in masse there must be some sort of cardiac problem causing it" road and the panic that could/would cause.