Central Apneas on Remstar Pro ?

[Guest]

First Off, HAPPY THANKSGIVING !!

I have a question. Although my sleep study was 5 weeks ago, I just yesterday had the follow up visit with sleep doctor and went over results. They called me just 2 days after study and said I had severe OSA, shared some numbers, and ordered the CPAP. I just did not know the exact results until yesterday. My AHI avg was 69 during sleep, with major snoring and O2 sat as low as 50%. During titration, which showed 10 as the optimum pressure, the avg went from 69 to 16, all of which were centrals. He prescribed pressure of 10 since it eliminated all OA's, all hypopnea's, and all snoring. He said they address the OA's and H's, and usually the centrals go down with them. If not, they would then treat central's in other ways.

My question is: On the Remstar Pro M series, using Encore Viewer, is there a way to detect or identify centrals? My best 1 week avg of the last 5 weeks showed AHI of about 5. That's true figures from the software, not the LCD. If I am still having central's, does it show up as OA's or H's? Is it in the 5? The doctor didn't really answer the question, as all he would say is the only accurate way to identify centrals is in a sleep study. But in your experience, do they tend to show up as anything in particular in the Pro M series data ?

He was satisfied with my results and said AHI below 10 would be satisfactory after only 1 month, considering I started at 69, and around 5 was already at a succesful rate. He said that was particularly true since my average time with the machine was higher than most in 5 weeks. He said over 4 hours avg is compliant and considered therapeautic, although at least 5 hours is desired. My avg was close to 7 hours with several days close to 8. He said that is better than avg this early in treatment as most are struggling to hit 4-5 hours. I have worked very hard to get the AHI to 5 and leaks to 40 (should be 31). He said with the other results, don't worry too much about leaks as they were not severe. He prescribed Flonase to help with leaks and a sinus issue, and said just keep doing the same and come back in 6 weeks for follow up.

[Wulfman]

First Off, HAPPY THANKSGIVING !!

I have a question. Although my sleep study was 5 weeks ago, I just yesterday had the follow up visit with sleep doctor and went over results. They called me just 2 days after study and said I had severe OSA, shared some numbers, and ordered the CPAP. I just did not know the exact results until yesterday. My AHI avg was 69 during sleep, with major snoring and O2 sat as low as 50%. During titration, which showed 10 as the optimum pressure, the avg went from 69 to 16, all of which were centrals. He prescribed pressure of 10 since it eliminated all OA's, all hypopnea's, and all snoring. He said they address the OA's and H's, and usually the centrals go down with them. If not, they would then treat central's in other ways.

My question is: On the Remstar Pro M series, using Encore Viewer, is there a way to detect or identify centrals? My best 1 week avg of the last 5 weeks showed AHI of about 5. That's true figures from the software, not the LCD. If I am still having central's, does it show up as OA's or H's? Is it in the 5? The doctor didn't really answer the question, as all he would say is the only accurate way to identify centrals is in a sleep study. But in your experience, do they tend to show up as anything in particular in the Pro M series data ?

He was satisfied with my results and said AHI below 10 would be satisfactory after only 1 month, considering I started at 69, and around 5 was already at a succesful rate. He said that was particularly true since my average time with the machine was higher than most in 5 weeks. He said over 4 hours avg is compliant and considered therapeautic, although at least 5 hours is desired. My avg was close to 7 hours with several days close to 8. He said that is better than avg this early in treatment as most are struggling to hit 4-5 hours. I have worked very hard to get the AHI to 5 and leaks to 40 (should be 31). He said with the other results, don't worry too much about leaks as they were not severe. He prescribed Flonase to help with leaks and a sinus issue, and said just keep doing the same and come back in 6 weeks for follow up.

Glad to hear you're getting some good sleep and sufficient hours each night.

I went back to one of your logged-in posts to see what mask you wear......
Mask: Mirage Swift LT Nasal Pillow CPAP Mask with Headgear

It's true that the only real way to detect centrals is in a sleep study. These machines determine "events" by airflow, so to them, an apnea is an apnea. However, looking for clusters of apneas in your reports or using Encore Pro Analyzer and looking at the Average Apnea Duration may help.

With regard to getting your numbers down.......

Your mask.......make sure you're not losing air out your mouth. Taping your mouth shut or using a full face mask are the other options. Mouth leakage means your therapy is compromised.

Sleep position? If you sleep on your back, that's the worst position for apneas. Try side-sleeping.

Do you have GERD? (or acid reflux?.......many people with sleep apnea also have it) It can also affect the apnea/hypopnea numbers seen in the reports.

Statistically, the pressure of 10 cm. is the dividing line where Centrals will start showing up. Pressures above 10 cm. can possibly produce more centrals. That's why the ResMed Autos use the A10 algorithm.......they won't pursue an apnea UNLESS it's preceded by snores or flow limitations.

Does that help?


Den

[JohnBFisher]

... My AHI avg was 69 during sleep, with major snoring and O2 sat as low as 50%. ...

Remember, the AHI value is per hour!! If you wonder why you feel so poorly after sleep, your O2 saturation levels help explain a lot. It's pretty scary, isn't it?

... During titration, which showed 10 as the optimum pressure, the avg went from 69 to 16, all of which were centrals. He prescribed pressure of 10 since it eliminated all OA's, all hypopnea's, and all snoring. He said they address the OA's and H's, and usually the centrals go down with them. If not, they would then treat central's in other ways. ...

Yup. It's pretty normal for central apneas to appear when Positive Airway Pressure (PAP) is initially introduced. Essentially the PAP tinkers with the blood chemistry that controls breathing. As your body adjusts to the increased pressure during sleep, the number of central apnea events should decrease to an acceptable level.

... My question is: On the Remstar Pro M series, using Encore Viewer, is there a way to detect or identify centrals? My best 1 week avg of the last 5 weeks showed AHI of about 5. That's true figures from the software, not the LCD. If I am still having central's, does it show up as OA's or H's? Is it in the 5? The doctor didn't really answer the question, as all he would say is the only accurate way to identify centrals is in a sleep study. But in your experience, do they tend to show up as anything in particular in the Pro M series data ? ...

Your doctor is mostly correct. It appears newer generation machines can infer the number of central apneas. I suspect it measures suble differences between obstructive and central events. However, it is normally only determined when the sleep lab measures the effort your body makes to breathe. (The straps around your chest and stomach area measured that). No effort to breathe and a long pause in breathing means there was a central apnea.

So, would it appear as OA or H? Well, the H (hypopnea) measures the time there is breath, but it is restricted. Hypopnea comes from the Greek roots hypo- (meaning low, under, beneath, down, below normal) and pnoe (meaning breathing). Then you can infer the OA is Obstructive Apnea. In this case apnea comes from the Greek word apnoia, where the prefix (a-) means without and the root (-pnoia) means breathing.

Clearly your machine can not differentiate between an obstructive or central event. So, any central apneas would appear in the OA component of the measurement.

... He was satisfied with my results and said AHI below 10 would be satisfactory after only 1 month, considering I started at 69, and around 5 was already at a succesful rate. He said that was particularly true since my average time with the machine was higher than most in 5 weeks. He said over 4 hours avg is compliant and considered therapeautic, although at least 5 hours is desired. My avg was close to 7 hours with several days close to 8. He said that is better than avg this early in treatment as most are struggling to hit 4-5 hours. I have worked very hard to get the AHI to 5 and leaks to 40 (should be 31). He said with the other results, don't worry too much about leaks as they were not severe. He prescribed Flonase to help with leaks and a sinus issue, and said just keep doing the same and come back in 6 weeks for follow up. ...

You have done very well indeed. An AHI of 5 is essentially considered normal. And 7 to 8 hours per night this early means that you are working hard to make it work for you. Congratulations! You should see some improvements fairly quickly. And just with a chronic health condition such as diabetes, you will definitely AVOID problems by sticking to the therapy.

You will find that as your body gets adjusted to the pressure you will have very little problem with nasal congestion. Do you have a heated humidifier for your unit? If not, have him write a prescription for one. It will make the increased pressure much easier for you.

So, congratulations!

[Wulfman]

I missed something on the previous read. You said you're using Encore Viewer. So, Encore Pro Analyzer wouldn't work with Encore Viewer........unless you were to acquire Encore Pro.

At the end of your daily reports in Encore Viewer, there's a listing for: "Average Time in Apnea Per Day"
You might see what those numbers look like.


Den

[DoninOrlando]

Thank you for the replies. I hope you are all having a relaxing day and get a good nights sleep.

John: Yes the O2 level was particularly scary. He said that is very damaging to many areas and systems. I do not have bad helth other than overweight and had high cholesterol. My blood pressure is good and so is blood sugaars. No diabetes or other big issues. My OA's ae usually lower than H's so I guess centrals are under control. I guess that's why he was not concerned. I do have a humidifier but cannot stand it. I tried it again recently, on 1, at th urging of my DME and had my worst night since first night.

Wulf: You are correct about the mouth leaks. I know that is the problem. I have tried chin-ups, 3 chin straps, and other remedies. The only thing that works for me is 4" tape, but only for 3-4 hours. I wake up after that and the tape is loose and mouth leaking. It wakes me up so I know that is it. I have tried FFM's and hate them. Feel like I am suffocating. ANd feel the hot air on my face. Cannot fall asleep wit one. I am hoping the flonase helps. Maybe if nose is more clear leaks will be minimized. Doctor said same thing before I was going to ask it. I do alwys sleep on side. Sometimes it jiggles mask but still rarely leaks. I love the feel of Swift LT. I do have a hybrid on the way, along with a buckwheat pillow. I also just got a papcap. Although the chinstrap seems less effective, I can wear it all night so it help more than others.

I am hoping time helps the rest of issues. Perhaps once the Flonase kicks in, and I get more comfortable with chinstraps and maybe the Hybrid, leaks will lower. I am slowly kicing the Afrin, nwo that I have flonase. IF it doesn't work he said we will try Nasonex next. I have had chonic sinus issues for years. Never mattered before I had to inhale from a leafblower. But he said the sinus issue may be causing the leaks also, so is treating that first, and not worried about leaks for now.

Avg time in apnia's per day seems low Den. Was avging more per hour than all night now.

[Wulfman]

OK. Sounds like you're working on everything.
Are you doing any nasal rinses/cleansing before bedtime?
As far as humidification goes, have you tried it with the humidifier OFF (but with water in the tank)? (called "passover")
That's what I've been doing since I started and it keeps my nasal passages open but without any heat/warm water. I couldn't stand the heated humidity, either.


Den

[JohnBFisher]

... I do have a humidifier but cannot stand it. I tried it again recently, on 1, at th urging of my DME and had my worst night since first night. ...

Ah! Another person after my own heart. My sinuses also play the cha cha on me when the humidity changes. You might want to try just having water in the humidifier, but no heat (passover mode). It sometimes helps me. But if it doesn't don't worry. Fortunately, we all seem to be part Vulcan, since we happily practice "Infinite Diversity in Infinite Combination (IDIC)". In otherwords, what works for me may not for you. The trick is to find what works for you.

... I am hoping time helps the rest of issues. Perhaps once the Flonase kicks in, and I get more comfortable with chinstraps and maybe the Hybrid, leaks will lower. I am slowly kicing the Afrin, nwo that I have flonase. IF it doesn't work he said we will try Nasonex next. I have had chonic sinus issues for years. Never mattered before I had to inhale from a leafblower. But he said the sinus issue may be causing the leaks also, so is treating that first, and not worried about leaks for now. ...

I finally gave up on a nasal mask and went to a full face mask. It helped more than anything else I did.

By the way, you may find that with proper therapy (and when you lick the leak problems) you will have much fewer problems with your sinuses. If you have problems with chest colds they may also decrease. Keeping the airway open and working helps reduce such infections. At least that has been my own experience.

[Guest]

John: Yes I do leave water in the tank for passover humidity. If the hybrid does not work for me I guess I will have to go to a FFM. How do you like your Ultra Mirage ? Any issues ?

Den: Yes I have tried nasal rinses. I occasionally use a netti pot but it only relieves nasal symptoms for maybe an hour. I have tried other ones like the premixed one in a can with less results. How do you like your Quattro ? Any issues ? Do you recommend it? That will be my next course of action, (FFM) if the hybrid does not work well.

[JohnBFisher]

... If the hybrid does not work for me I guess I will have to go to a FFM. How do you like your ... Any issues ?

I have a Quattro full face mask. Unfortunately it leaks a lot for me. So, when I pick up my new machine I will talk with the RT to see if we can find a better fitting mask.

Of course, with the cost of the new ASV machine (and humidifier), I may need to pick up a new mask form CPAP.com, since the machine will completely eat up the allowance for durable medical equipment. And then the mask cost will definitely be cheaper from CPAP if I will have to pay for it, anyway.

[DoninOrlando]

Thanks John,
I am thinking about the comfort gel. It seems pretty popular according to cpap.com. Sorry about the posts not being logged in. I never notice until after I post. I have all my computers set to auto log in but sometimes it works and sometimes it does not.

[Wulfman]

John: Yes I do leave water in the tank for passover humidity. If the hybrid does not work for me I guess I will have to go to a FFM. How do you like your Ultra Mirage ? Any issues ?

Den: Yes I have tried nasal rinses. I occasionally use a netti pot but it only relieves nasal symptoms for maybe an hour. I have tried other ones like the premixed one in a can with less results. How do you like your Quattro ? Any issues ? Do you recommend it? That will be my next course of action, (FFM) if the hybrid does not work well.

I have a Quattro, but have only worn it for a few months in 2007. It's "OK", but my first choice is the one I started out with......the Ultra Mirage Full Face (UMFF). At times when I wore the Quattro, it didn't seem like there was as much air flow or ventilation and that I was retaining (re-breathing) too much carbon dioxide inside my mask and didn't feel as refreshed.
I liked the feel of the seal on the Quattro......nice and comfortable and flexible, but to me it seemed like ResMed tried to make a cheaper version of the UMFF when they introduced the Quattro. Originally, the Quattros had leaky elbows in the front of the mask but apparently that's been remedied in more recent times.

PS. I fixed the leak in the elbow on my mask with Teflon plumbers tape.


Den