Passported's CPAP Therapy

Hello! So happy to have found this community. Story so far: husband a longtime snorer. Went in to ENT this year and had balloon sinuplasty, septoplasty and turbinate reduction for deviated septum, began allergy drops. This definitely has helped with breathing and congestion issues. Then ENT ordered an at-home sleep test and results quite discouraging with "severe sleep disordered breathing events", oxygen desats, overall AHI of 35.9, central apneas, obstructive apneas, et al.

My husband began CPAP last week and we are trying to dial in settings. Best result so far is AHI 8.60

Tried the F20 full face, husband wanted to try nasal mask so switched to N30i which didn’t work well, or felt weird to him, back to F20. He thinks his nose is still not optimal and he mouth breathes some at night, so for now, the full face mask seems best.

Historically, he sleeps for around 5 hours at night, then if he can, go back to take a nap for a couple of more hours in the late morning. I asked him if the CPAP was making him feel more rested and he didn’t think so yet.

CPAP was delivered by Aeroflow with factory defaults (sigh). Based on our cpaptalk readings so far, we have upped the minimum pressure from 4 to 6 and turned response to standard from soft. EPR Full Time, 3 cmH2O.

Medications: Tamsulosin, Omeprazole. Flonase and Azalastine spray at night before bed.

July 15 Oscar data
https://imgur.com/WotZk82

Sleep study album with Oscar data
https://imgur.com/a/6NGyFk8

Edit to add Sleep HQ link:
https://sleephq.com/public/244e97c3-f80 ... 84954070cf

Does your husband report waking often during the night or does he think he sleeps soundly for the most part?

Just asked him. He *thinks* it takes him a long time to get to sleep but that he sleeps okay. I think historically he actually drops off pretty quickly. If he’s getting aroused during the night he seems unaware of it.

So, they jumped in and did the surgery before doing a sleep study?
I guess there's a downside to "good" insurance.

Yes, that’s what happened. I have the nose/septum CT scans if they are helpful at all. Pretty messed up septum likely as result of an injury as a toddler. He has a scar on his nose and story that goes along with it. So he’s never known decent nose breathing until now. Medicare is the insurance.

So most of his flagged events are those central apneas (CAs on OSCAR when means clear airway apneas)....the airway is open but no effort is being made to breath. Hold your breath for 10 seconds....that's pretty much a central apnea or how it works anyway.

This machine can't treat or deal with central apneas. It's only designed to deal with obstructive apnea events (OAs and hyponeas). About the best you can do is reduce or eliminate EPR in hopes of reducing centrals and that ONLY works if EPR is the trigger for the centrals. I am not so sure that your husband's centrals are caused by EPR....they could also simply be arousal related centrals where the machine mistakes awake irregular breathing for asleep breathing (remember the machine only measures airflow because it can't measure sleep status) and gives us a false positive flagging for a central. Often referred to a sleep/wake/junk here.
I wonder because I see OAs flagged before some central flagging...did the OAs cause an arousal and thus cause a false positive SWJ flagged central????? Entirely possible.

If my husband I would attempt to deal with the OAs first because they could be causing a problem and they need to be dealt with anyway. Deal with the OAs and then see if the centrals reduce or not.
I would increase the minimum pressure a little more (the machine goes up and stays up anyway) and see if preventing the OAs ends up reducing the centrals....it's not impossible by any means.
Probably around 8 or 9 minimum (maybe more) is needed.

If no joy...then we need to do more work and learn to figure out awake vs asleep flagged events and then decide on a course of action.

The concern, to me, is the home sleep study shows central apneas. If they are “real” and not arousals, then we’ve perhaps got the wrong kind of machine. And we have to wait 3 months through this CPAP trial due to Medicare rules to get prescribed something else.

Anyway, one thing at a time.

Tonight’s science experiment is minimum pressure to 8 or 9 and leave on EPR as is so we isolate the effect of raising min pressure? Or go ahead and turn off EPR?

The central apnea index for the sleep study was less than 5....not horrible and not enough to immediately start worrying about them and/or needing a different machine. If it were say 15 per hour index instead of less than 5 we might have a different discussion.

My personal opinion....deal with what the machine does best to start with and then see whats left over to deal with after the obstructive stuff gets reduced.....and then we start thinking about centrals if they are still worrisome.

There is a lot of truth to the "give it time" thing that the doctors would want to do when someone first starts cpap therapy and has some potential problems. A lot of time, as the body adjusts, things settle down and become not so worrying.
That's why insurance won't normally go for the fancy and very expensive machine used to deal with both centrals and obstructives from the very onset of therapy. Insurance companies don't want to spend the extra money unless they are forced to.

Whatever changes you might make.....remember keep your changes to a minimum in number because if you go changing more than one thing at the same time you won't know which change caused what results.

Also...you might want to get familiar with the free version of SleepHQ because if you use it and post the report it is interactive and we (forum members) can zoom in and see if those flagged events look like false positive arousal SWJ or if they look like real asleep events. That's the "extra work" I mentioned above that we might be needing to do.
Don't get the paid for version of SleepHQ though...it's a lot more than you need. The free version will do what is needed.

Well, your words are encouraging, thank you for sharing your time and expertise. Last night was only day 3, so early days.
Here is the SleepHQ link. Let me know if there is some other way to share it that works better.

https://sleephq.com/public/244e97c3-f80 ... 84954070cf

Well, we forgot to put the SD card in the machine last night so don't have full data. But the MyAir app says he got down to 5.7 events per hour so, definitely headed in the right direction. Only change was increasing minimum pressure to 8.6 as a test, up from 6.

passported wrote: ↑

Mon Jul 17, 2023 10:34 am

we forgot to put the SD card in the machine last night so don't have full data.

That's Murphy's Law in action.
I have done it myself quite often. Make a change...want to see the results only to find out no card in the machine and have to wait another night.

BTW....you can get the breakdown of that AHI off the machine's LCD screen...you just have to go a little deeper into the sleep report you see on the screen.

It's really important to know the breakdown into each event category so we can best evaluate the results.
Like which type of event may have been reduced???? Kinda important.

The more info section on the LED screen sleep report seems to be averages:
Avg. Usage 4.7 hrs
Used Hrs 28.1 hrs
Pressure, 11.7
Leak 19L/min
AHI 10.7
Total AI 10.1
Central AI 4.9.

Anyway, onwards to tonight and Actual Oscar Data.

Make sure you choose the "1 day" option on the "More Info" part in the screen. Push the round button and you'll have a choice of "Month Week Day".

Last night's results. 9 minimum pressure resulting in fewer events OAs and CAs. AHI of 5.61.

OSCAR
https://imgur.com/a/9CdJIpe

EDIT: SleepHQ:
https://sleephq.com/public/02bd780b-ce5 ... a397fc6c55

Keep the settings here for a week or so? Or try any tweaks? He hasn't complained about the pressure setting being increased. Seems to be adapting to CPAP pretty well.

Please redo the SleepHQ link....the one you provided wants me to sign in so it's your account link.
Please do a "public" link.

Looks like all the AHI is central apneas now (only one OA flagged)... I need the SleepHQ page report so I can zoom in on those centrals to see if they look like SWJ centrals or real asleep centrals.

Always, always include a subjective feelings report when you post a report. This is critical...numbers don't always tell the whole story. How did she sleep???? and how does she feel???

If real asleep centrals....we can try reducing or eliminating EPR and we can maybe try fixed pressures.
If those centrals are mainly arousal/awake related SWJ flags...we try to figure out how to sleep more soundly so as to lessen the chance of the machine flagging SWJ stuff.

Bear in mind that an occasional real asleep central is actually normal to see and no reason for worry.
We worry when we start seeing a lot of them or they seem to be causing a problem.