AirFlow reduction ???

[Rubicon]

What is TECSA?

Treatment-Emergent Central Sleep Apnea. Current trendy term for (usually) relatively high xPAP pressures in susceptible individuals (see Loop Gain).

In your case with your set parameters at Full-Boat APAP, the algorithm started chasing something (probably inappropriately- might be fixed FL) and then TECSA showed up when you buried the needle:

Is that some thing I should press my cardiologist for or press my pulmonologist?

IIWY I'd explain it to both of them.

[ozij]

@ozij:

So you have a cardiologist. How long has he been treating you? Known the details of you heart's condition? What do you mean by "pointed out"?

[...] He left me with the impression unless the pattern is reported and analyzed on "his hospital's" equipment he considered it (OSCAR and Resmed) a consumer toy, much like a smart watch reporting oxygen and sleep stages.[...]

I think the two of you may be having a real mis-communication problem.
Nobody in their right mind treats ResMed's reports as systems for reporting either oxygen saturation or sleep stage. Nor is it a diagnostic machine.
On the other hand, if the doctor put you on APAP, he must trust the machine's basic ability identify your air flow and to respond to it.
If you were trying to use the machine's data to confirm a diagnosis of anything from either doctor, now wonder it didn't work.

([...] his counter was that FDA approves it for safety, but FDA makes no claim that home based machines are reliable medical diagnostic tools - they are treatment tools not diagnostic. I realized that I was in over my head, and did not push this any farther)

He's right. And all you see on the machine's report is treatment emergent central sleep apnea, which, as it's name hints emerges only when you're using CPAP, and if Rubicon's image is from your data, it shows the TECSA emerge only when your pressure is very high.

@ozij:

Did the home sleep studies study your breathing while you were on CPAP?

I seem to recall that the 2020 home sleep study had a nasal cannula, but there may have been some doubt about it accuracy because I tend to mouth breath when really relaxed. I know for a fact the the home sleep study done Dec 2022 did not have anything to measure my breathing/air flow (no mask, no cannula)

In other words, both sleep sudies did not use Continuous Positive air pressure the therefore had no way of showing the occurence of TECSA.

@ozij:

The sleep doctor who put you on an APAP can't seriously distrust ResMed's ability to track you breath flow.

The sleep doctor (pulmonologist) seems to have no problem "believing" the AHI values that HE gets from Resmed's cloud (or I should say that's where I "think" he gets them) He told me that none of the data that he gets from Resmed's Airview say anything about "pattern breathing" or CSR. (So, apparently his view is if the data doesn't come from Resmed Airview, it is suspicious)

Access detailed data at your convenience. Online data reports provide up to 365 days of therapy data and up to 90 days of detailed data, so you can take a comprehensive look into your patient's therapy and progress whenever you need them.

Your detailed airflow data is only there for the last 90 days (for the doctor) He won't see the flow and its patterns after 90 day.

I've observed them sporadically after I started with CPAP two years ago, and they have continued sporadically up to and after my last sleep study a year ago,

If they're sporadic maybe you doctor doesn't get to see them on the detailed data, when he views it and maybe they're that sporadic that they're a non-issue.
Did you have any such occurrences within 90 days of your meeting with the sleep doctor?
How often is "sporadic"? At which pressures?

I would sure hope that after two+ years of CPAP use (at 98% compliance) my system would have become used to CPAP.

That rather depends on how frequently your APAP is driven the heights of pressure that induce TECSA. Maybe it so rare that you never can get used to it - and don't have to because

the algorithm started chasing something (probably inappropriately- might be fixed FL)

Meaning: it could be your machine was reaching those heights for no good, fixable reason. The "flow limitations" that cause the machine to zoom for some people are not caused by anything higher pressure can change.

Who set up your pressure parameters, and when?

[ChicagoGranny]

In your case with your set parameters at Full-Boat APAP, the algorithm started chasing something (probably inappropriately- might be fixed FL) and then TECSA showed up when you buried the needle:

And all you see on the machine's report is treatment emergent central sleep apnea, which, as it's name hints emerges only when you're using CPAP, and if Rubicon's image is from your data, it shows the TECSA emerge only when your pressure is very high.

In this case, I would lower the max from 20.0 to 15.0 and check the data after each night.

[Bobo97272]

It was the cardiologist who directly poo-poo'd the OSCAR report, and specifically made the analogy to a smart watch, IIRC saying something like just because the smart watch reports sleep stages and oxygen doesn't qualify it to be considered a serious medical device.

The sleep MD had a bit of a different response
1) the data that he gets from Resmed (by AirView?) does not show him nearly the same level of breath-by-breath plot-data. He showed me a printout of my AirView report for a specific day, and indeed he is right, his Resmed data is of much lower resolution than OSCAR data. (For example, in OSCAR we can see a flattened or notched inhalation curve, he can not see that same detail from his feed from Resmed (resmed's servers???) So, for example. he cannot see that the instant before a hypopnea there was an possible arousal.

2) So, why can't he just use my OSCAR reports...... because he can't "trust" a consumer software program that has not passed scrutiny of the hospital. (reluctantly, I see his point)
@Ozij:

In other words, both sleep sudies did not use Continuous Positive air pressure the therefore had no way of showing the occurence of TECSA.

Correct, neither sleep study used any kind of CPAP device or any sort of mask during the study

if Rubicon's image is from your data, it shows the TECSA emerge only when your pressure is very high.

No, that's not my data in the the image Rubicon posted. I think he was trying to illustrate an example, but my data looks like this (in the same format as Rubicon's)

Did you have any such occurrences within 90 days of your meeting with the sleep doctor? How often is "sporadic"?

I've had these episodes both before meeting with the sleep MD as well as after. They seem to occur randomly, but there is seldom a 10 day stretch that does by without at least one or two, that last (variably) from 15 minutes to an hour or more.

@Chicago:

I would lower the max from 20.0 to 15.0 and check the data after each night.

Max pressure is already set to 15, my average pressure for the past year has been 9.2, and 95% pressure is 10.8

[Rubicon]

if Rubicon's image is from your data, it shows the TECSA emerge only when your pressure is very high.

No, that's not my data in the the image Rubicon posted.

It's not?

Is that a different Bobo97272?

viewtopic.php?f=1&t=185937&p=1432124#p1432124

[palerider]

2) So, why can't he just use my OSCAR reports...... because he can't "trust" a consumer software program that has not passed scrutiny of the hospital. (reluctantly, I see his point)

His "point" is "go away, you bother me"

But, if he wants to be an ass, then get a copy of ResScan™ which is Resmed's official software, slurp the data into that, and take your notebook in and say "look at this, fuckwit".

No, Resmed machines don't transmit the high rate data (Flow rate and mask pressure), so he can't *see* breathing.

He could look at your varying tidal volume, one would think, if he cared, which it seems he doesn't.

[ozij]

then get a copy of ResScan™

Or, bring along your machine and SD card ask him why he doesn't use ResScan
https://www.resmed.com/en-us/healthcare ... t/resscan/

Or maybe just look for a doctor / clinic who does know and use ResScan

[Bobo97272]

It's not?

OPPS, your quite correct, that is an image I posted a year ago. In response to that image I got a private message from another forum member who suggested that I eliminate the EPR and lower the max pressure to 15 to try to avoid the very abrupt increase in pressure and consequence that may arise from such sudden pressure increase.
So I did that and that particular scenario all but disappeared, however the waxing waning punctuated with many hypopneas that I posted in this thread continued to be a feature of my breathing.

The conversations I've had with my Docs about these hypopneas and breath patterns have occurred in the past several months, after I had stopped EPR and lowered the max pressure. I initiated the discussion with the docs, - in the sense of - What's going on here? As I said, i showed OSCAR examples of this to my pulmonologist first, and then to my cardio.

The image I posted at the start of this thread is representative of my experience over that last (almost) year.

[Bobo97272]

2) So, why can't he just use my OSCAR reports...... because he can't "trust" a consumer software program that has not passed scrutiny of the hospital. (reluctantly, I see his point)

His "point" is "go away, you bother me"

But, if he wants to be an ass, then get a copy of ResScan™ which is Resmed's official software, slurp the data into that, and take your notebook in and say "look at this, fuckwit".

No, Resmed machines don't transmit the high rate data (Flow rate and mask pressure), so he can't *see* breathing.

He could look at your varying tidal volume, one would think, if he cared, which it seems he doesn't.

Generally speaking I seem to get a better response from people if I don't call them "fuckwit" or suggest that they are uncaring morons. That usually, in my experience, brings an abrupt end to a discussion.

[Rubicon]

Treatment-Emergent Central Sleep Apnea. Current trendy term for (usually) relatively high xPAP pressures in susceptible individuals (see Loop Gain).

You could also probably use SleepHQ and effectively present your case.

Note above. It would appear that 8.0 cmH2O is "relatively high" in your case.

That said:

1. How big a problem is this really?

2. Specifically, it's not the pressure that initiates the TECSA chain-- it's a ventilatory disturbance. Higher pressures and/or EPR contributes to the loop tho.

3. An ASV will probably kill 'em. That'll require some legwork, and worse case ~$3K if nobody buys your act.

[Bobo97272]

Treatment-Emergent Central Sleep Apnea. Current trendy term for (usually) relatively high xPAP pressures in susceptible individuals (see Loop Gain).

You could also probably use SleepHQ and effectively present your case.

Note above. It would appear that 8.0 cmH2O is "relatively high" in your case.

That said:

1. How big a problem is this really?

2. Specifically, it's not the pressure that initiates the TECSA chain-- it's a ventilatory disturbance. Higher pressures and/or EPR contributes to the loop tho.

3. An ASV will probably kill 'em. That'll require some legwork, and worse case ~$3K if nobody buys your act.

MANY MANY THANKS Rubicon,
I've learned a lot on this thread!
1) As to my initial question about Resmed's " H rules":
Baseline window (excluding events) is 100 seconds, a short term widow may be 8 seconds.
H Criterion is > or = 50% reduction (from baseline) in peak flow rates that persists for 10 seconds or longer.
Tidal volume changes may be misleading.

2) TECSA is initiated by respiratory disturbance, other factors (elevated pressure, EPR) may excerbate that loop-cycle

3) As it applies to my specific therapy, because of it's sporadic nature urgent change is probably not warranted at this time. (if episodes and their duration increase maybe look at it again)

4) Key phrase you used: " in susceptible individuals". I may be a susceptible patient, but seemingly not consistently so. (reinforces point #3; watch it, but for now don't panic!)

Again, my thanks and may you have a great New Year.

[ChicagoGranny]

Did you ever say how you are feeling? Energetic? No excess sleepiness? Fatigued but not stressed at bedtime?

[palerider]

Generally speaking I seem to get a better response from people if I don't call them "fuckwit" or suggest that they are uncaring morons. That usually, in my experience, brings an abrupt end to a discussion.

Use whatever words you feel appropriate for people that are doing you a disservice by not *actually* attending to your heath issues.

Or don't, it's entirely up to you.

[Applecheeks]

And I learned something as well. Unless your Doc pulls your SD card, there is no way for him to see the detail that you are seeing with OSCAR.
No wonder I get this "look" of "how come you have this fine detail and I don't?"