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Squishmish
Unread post  Post subject: Cheyne Stokes Respiration and CA on EncoreAnywhere  |  Posted: Thu May 17, 2018 9:42 pm

Joined: Thu May 17, 2018 6:52 pm
Posts: 3
Location: Sydney, Australia

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Hi, I've sent this message to TheLankyLeftist but it's sitting in the outbox (I don't know how to fix this). If anyone could give me insight, would be lovely!

I'm a therapist and looks at CPAP data on a daily basis. I just want a better understanding on the data regarding Cheyne Stokes Respiration and CA. I just want to know what is the acceptable amount of CSR and CA's in a patient's data.
When I see quite a lot and when the AHI is not controlled, we've just been advised to tell the patient to follow up with a sleep physician.
I've watched your video on CSR and understand that a bi-lvl machine might be suitable for these patients.
However, one of my patient has been seeing a sleep specialist/neurologist and they seems to just advise the patient to use for longer rather than changing any settings or any machines- it's been the same recommendation for maybe half a year.

I just want to know how alarmed I should be when seeing a lot of CSR and CA's in a patient's data. Are you able to guide me through the data attached? It shows what I've discussed above


Attachments:
20180518 CSR CA.PNG
20180518 CSR CA.PNG [ 204.31 KiB | Viewed 344 times ]
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TheLankyLefty
Unread post  Post subject: Re: Cheyne Stokes Respiration and CA on EncoreAnywhere  |  Posted: Thu May 17, 2018 10:46 pm
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Joined: Mon Aug 15, 2011 10:22 am
Posts: 4635
PAP Mask: Practically tried them all.
PAP Machine: Use Phillips Respironics System One APAP with Aflex for mask testing
Humidifier: None
Pressure Setting: When testing, I use APAP with a range of 5-10

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Lanky "Leftist"? What the hell? I'm a political statement now? :lol:

Squishmish wrote:
I just want to know what is the acceptable amount of CSR and CA's in a patient's data.
The devil is in the details. Are these "real" or not? That's the first question. Then once that is as accurate as can be you can either to by your medical directors interpretation of the numbers. For me in dealing with the online community I go by how the person is feeling. If they are feeling great and not feeling fatigued during the day, then all is well. If not, then there is some work somewhere to be done.

It's important to know the leak value which isn't provided here. Just from what I'm seeing it looks like they are too high. They do well when the pressure is at the lowest threshold (looks like 9cmH20?) Anything above that and central apneas are seen. These could be from mouth leaking that is not interpreted correctly by the machine....but we really don't know.

Looks to me like a static pressure of 7 or 8cmh20 would be beneficial. I don't know if there is data that shows those pressures won't work though. If that is the case then bilevel would be the next option. If they have Aflex on, have them turn it off.

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Squishmish
Unread post  Post subject: Re: Cheyne Stokes Respiration and CA on EncoreAnywhere  |  Posted: Sun May 20, 2018 8:46 pm

Joined: Thu May 17, 2018 6:52 pm
Posts: 3
Location: Sydney, Australia

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Definitely hidden political statement there!

That puts my mind at ease for my future patients thank you
Yes usually we work on leakage first and from memory, my patient didn't have a significant amount of leakage.


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Pugsy
Unread post  Post subject: Re: Cheyne Stokes Respiration and CA on EncoreAnywhere  |  Posted: Mon May 21, 2018 4:43 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 684
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Looking at the wave form graphs in Encore might help you decide if the flagged events are real or are related to arousals and not necessarily real.

This person has almost all arousal breathing flagged events.
Image


and does the flagged PB breathing look like this
this person has a problem with real CSR and real heart issues and ended up going on one of those special high end machines.
Image


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