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digitalsaw
Unread post  Post subject: New CPAP User - Do I Have the Right Machine?  |  Posted: Sat Jun 27, 2020 5:55 pm

Joined: Sat Jun 27, 2020 5:47 pm
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Great to find this forum.
So, I'm new to CPAP but just got my very first machine and had a good night's rest last night for the first time in a long time. However, I wanted to ask you folks if you think I have the right machine for my diagnosis. I've attached my Sleep Study which was done in home. A friend of mine (who used a CPAP machine as well) noted that I had a fairly high amount of Central Sleep Apnea episodes and suggested I look into a different machine that handles that. I wanted to get your thoughts.
Thanks in advance.


Attachments:
sleep study notes.jpg
sleep study notes.jpg [ 117.74 KiB | Viewed 247 times ]
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Respirator99
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sat Jun 27, 2020 7:10 pm
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Location: Australia
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G'day Digitalsaw, welcome to the forum.

Looking at the main takeaway from your report, you have the following indices:

Obstructive apnea index: 15.7
Central apnea index: 12.0
Mixed apnea index: 1.2
Unclassified apnea index: 1.7

So your total apnea index is the sum of all of these = 30.6

Your hypopnea index was 30.2, and this gives you a total apnea-hypopnea index (AHI) of 60.8. This is actually pretty bad (the clinic where I was diagnosed classifies anything over 60 as "very severe") so it's good that you've been diagnosed and can now start treatment.

The proportion of central apneas is high - nearly 50% of all apneas. Taken on its own, the central index is sufficient to warrant treatment, and to start the process towards an adaptive servo-ventilator (ASV) type machine. The process (in the US) typically involves starting on a CPAP/APAP machine. If that fails, try a bilevel machine and if that also fails then graduate to an ASV.

The theory appears to be that it's worth trying the cheapest machine first - who knows, that might solve the problem. But if it doesn't, let's try the next machine before we finally get to the one which is pretty much guaranteed to treat you properly. And along the way "they" will want you to have a couple more sleep studies at a few thousand dollars a pop. At this stage I could start a rant about vested interests maximising their profit and lazy insurance companies going along for the ride. But I wont. ;)

In your shoes (and assuming you have insurance and an approachable sleep doc): I'd start with the CPAP/APAP and see how it goes. I would also start discussions with the doc, pointing out that you are concerned at the high proportion of central apneas and ask what his/her intentions are relating to the centrals. Ensure there is a defined path towards an ASV, and find out for sure what your insurance requirements and benefits will be. You may be asked to take a titration test on a bilevel machine - ask / insist that this test also includes an ASV. That way, when the bilevel doesn't work, you will have already been tested on an ASV.

Good luck on the journey ahead.

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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sun Jun 28, 2020 5:02 am

Joined: Sat Jun 27, 2020 5:47 pm
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Thanks for the great advice Respirator99. I pushed to get the machine without an in-clinic titration test because I knew it had to be pretty bad and that a home study would identify this. Because of this clinic's extreme back-log in titration tests it was going to be mid-July before I could have one so I pushed once again to have them give me a prescription based upon the home test. I just finished my second night on the ResMed 10 AutoSense with a nose mask (see my profile for the specifics). I have had two great nights sleep. Now, I just put in the SD card last night so I'm going to get the results and learn how to run it through OSCAR but it is all new to me so I will be relying upon folks like you to walk me through (great thanks!).
The one thing I will say is I know most of my Apnea was related to weigh gain. I, like so many others, struggle with my weight. I had lost a lot of weight about 5 years ago and my wife said my snoring actually 'stopped'. So, I realize I need to help myself by getting back to exercise and better eating. However, because of that result I am surprised at the Central Apnea results. In my other research I have read that sometimes a CPAP machine will eliminate the Central Apnea so I am going to see if that is the result. Additionally, we are making some changes to our eating and I'm hoping to drop pounds which I know will help.
Thanks again for the great advice. I'll keep you guys posted and share results.
Cheers!


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LSAT
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sun Jun 28, 2020 5:33 am

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You can get a lot of AHI information on your machine's Sleep Report. Go into settings and change the setting on ESSENTIALS to PLUS.


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optimalsleep
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sun Jun 28, 2020 7:10 am

Joined: Wed Jun 10, 2020 5:47 am
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OSCAR would be beneficial

https://www.sleepfiles.com/OSCAR/

It's the new version

It would be very helpful to break down as your therapy progresses to make changes in machine settings.


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Pugsy
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sun Jun 28, 2020 11:43 am
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The reason the cpap/apap machines are the first go to machine even when someone has a higher than wanted central apnea count along with a OSA diagnosis is sometimes it works (along with the it's cheaper reason).

If you didn't have OSA...ASV type of machine would be a better choice but sometimes cpap can fix things well enough that progression to the higher end more expensive machine isn't needed.

Won't know until you try it.

Which AirSense 10 model machine did you get? Hopefully it is the model that will differentiate between central apneas and obstructive apneas so that you can monitor the effectiveness of your therapy.
The base model AirSense 10 CPAP model....it can't...so I hope you don't have that model.

OSCAR will give you the data you need with any of the other AirSense 10 models....So if you have the Elite or AutoSet...get OSCAR and follow Respirator99 instructions and post your detailed reports...we can figure out pretty quickly if you need a different machine or not.


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optimalsleep
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Sun Jun 28, 2020 2:46 pm

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good place to start.. yes. OA could cause CA. Saying that.. start with CPAP. Monitoring progress on OSCAR to see where CA's are at once OA's are managed.


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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Mon Jun 29, 2020 7:25 am

Joined: Sat Jun 27, 2020 5:47 pm
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Thanks for the great comments and advice.
I have a ResMed 10 Autosense Autoset which, per my research, does indeed record Central Sleep Apnea episodes. I put an SD card in it on Saturday so I have two nights data and will go a couple more nights and then pull it and see what the data says.
I'm not sure if the MyAir app is very accurate but I have had scores of 88, 100, and 93. The only deductions have been through the usage hours. And, I'm feeling night-and-day better! Didn't experience any fatigue yesterday until around 9:30 PM which is typical as I get up at 5 AM.
So far, so good!


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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Mon Jun 29, 2020 7:42 am

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I found this pretty detailed article that identifies the ResMed Autosense Autoset handles both pretty well.

https://www.noinsurancemedicalsupplies. ... eep-apnea/


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Respirator99
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Mon Jun 29, 2020 6:16 pm
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Location: Australia
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While that article does include some reasonable information, I think the discussion of central sleep apnea is at best misleading, and in parts is downright wrong. The most basic error is the implied assertion that an AutoSet is designed to treat both obstructive and central apnea - it is not! In fact it is specifically designed to do NOTHING when a central apnea is detected and diagnosed. Its algorithm is all about detecting obstructive apneas and their precursors (snoring, flow limitation) and applying additional pressure to prevent them developing into an apnea.

When an apnea occurs, the Autoset will try to determine what type of apnea it is, by a process called the forced oscillation technique (FOT). Basically the FOT is a low frequency, low amplitude pressure oscillation superimposed on the steady pressure. You can usually see these oscillations in the flow chart on Oscar if you zoom in close. If the airway is closed (obstructive apnea) the FOT returns a different waveform compared to an open airway (central apnea). In both cases, the Autoset will hold its current pressure and wait out the apnea. If it's an obstructive apnea, pressure will be increased immediately after breathing resumes, to prevent the onset of further apneas. On the other hand the machine will not raise pressure after a central apnea, as that is counter-productive and can make the central apnea worse.

An Autoset can actually make central apneas worse by reducing the CO2 concentration in the blood below a certain threshold. The brain has a "sensor" which indirectly measures the CO2 level. Once the level reaches a certain threshold the brain will send a "breathe now" signal to the lungs. If the CO2 level is artificially depressed (as often happens with patients new to apnea therapy) the brain says to itself "CO2 levels haven't reached the threshold, so there's no need to breathe just now". This situation is more prevalent when using an APAP machine with EPR set to a high value.

So, while an Autoset machine may lower central apnea, this is only as a byproduct of its efforts to prevent obstructive apnea. There is no guarantee it will work, and it may actually make things worse. It's also well known that central apneas can be quite inconsistent under APAP treatment, giving you excellent results some nights, and dreadful results on others. The only machine which is designed to treat central sleep apnea is the adaptive servo-ventilator (ASV).

As I said in an earlier post - give the Autoset a try (it just might work) but be prepared to escalate the treatment to ASV if required.

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optimalsleep
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Mon Jun 29, 2020 7:17 pm

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wow, I wish I could get a response like that on my thread.... maybe I should post an article like that.


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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Tue Jun 30, 2020 12:02 pm

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A lot in that response Respirator99. That was very insightful. It is frustrating to hear there is such misinformation out there.
I just got my report from ResMed via my RRT and CPAP Therapy Coach. I'm including them here. It looks like the machine is directly impacting my Central Apnea as well which is good.


Attachments:
AeroCare 4 Day Report .pdf [103.65 KiB]
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Respirator99
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Tue Jun 30, 2020 6:00 pm
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Joined: Mon Apr 27, 2020 1:06 am
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Location: Australia
PAP Mask: Resmed Airtouch F20
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Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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I admit to being very surprised in a good way. Those results are excellent!

If you can maintain that level of usage and AHI your treatment should be very successful. The question now is "How do you feel?" Are you comfortable with the mask, and is your sleep refreshing?

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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Wed Jul 01, 2020 7:32 am

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I feel a tremendous amount better. Very little fatigue at all. Other than my nostrils being a little tender in the mornings I sleep so well with the mask. Night and day!


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Respirator99
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Wed Jul 01, 2020 6:07 pm
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Joined: Mon Apr 27, 2020 1:06 am
Posts: 76
Location: Australia
PAP Mask: Resmed Airtouch F20
PAP Machine: Resmed S9 VPAP Adapt
Humidifier: Resmed H5i
Pressure Setting: Min EPAP: 8.0 Max EPAP: 11.0 PS Min: 3.0 PS Max: 8.0

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Excellent! That's great news.

So if things stay that way, your machine is doing its job very well. I would not make any changes now - just relax and enjoy the ride.

_________________
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Pugsy
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Wed Jul 01, 2020 9:06 pm
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Yep. One of those situations where cpap/apap happens to take care of centrals as well as the obstructive apneas.
I know it doesn't make a lot of sense sometimes and we don't know but maybe taking care of the obstructive apneas stops the unstable breathing that is the trigger for the central apneas.

All I know is that sometimes it works and that's why so many people have to at least start with cpap....sometimes it works and it looks like you are one of those people.

Sit back, use your machine and enjoy the new ride and feeling better.
I also see no reason to change a thing.


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digitalsaw
Unread post  Post subject: Re: New CPAP User - Do I Have the Right Machine?  |  Posted: Thu Jul 02, 2020 8:39 am

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Thanks guys. I'm surprised and thankful as well. Last night I scored 100 on MyAir with .2 events per hour. It's going great and I could not be happier. I'll stay in touch.


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