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Sierra

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

Sierra
Joined Jul 2018
Bio

CPAP: AirSense 10 AutoSet

Set to CPAP Fixed Mode

Pressure 11 cm

Ramp: Auto

Ramp Start: 9 cm

EPR: 2, Full Time

Mask: ResMed AirFit P10 Nasal Pillow

Canada

While your AHI has gone up a bit, the overall results look pretty good. Your hypopnea is low, which has been high before and the flow limitations look closer to normal. RERA is gone. CA events are up some, but sometimes when waking up that can happen. Some call it Sleep Wake Junk.

I noticed that since Dec 3 the pressure has been switched back to fixed CPAP mode. This is OK and does not seem to be having a big impact on apnea events as your OA component is zero. However, having it in Auto mode gives more information when trying new machine settings. You can see when the machine thinks you need more pressure. When you get flow limitations it may increase pressure some to reduce them. Being in Auto is a good flag to determine whether or not the pressure is set high enough. While it may be of benefit going to fixed for the long term, for now it would be better to leave it in Auto. To some degree having a machine in Auto is like getting a sleep lab titration test each night if you look at the OSCAR data each day. My long term setting is a fixed pressure, but my wife is using a fairly narrow band between min and max in Auto.

On masks the P10 is a very minimalist nasal pillow type. The weakness has been the flimsy headgear, but I see that ResMed claims to have improved it and the method used to adjust it. My wife uses a slightly less minimalist nasal pillow mask called the Fisher & Paykel Brevida. It has a little better headgear, but it is kind of personal preference between these two. Have a look at them both if the clinic has them.

Going forward I would suggest putting the machine back in Auto with a minimum of 15 cm and max of 20. And I would increase the EPR to 3 cm. I know that didn't work out before, but I think the cervical collar is making a big difference and EPR at 3 may not have been the cause of the poor results. So I would try it. If this works then I think the next step is to start reducing the minimum pressure in 1 cm steps to see at what point OA events start to become a problem again. The 15 cm may be higher than necessary, but it is a good safety net until the EPR setting is finalized. Reducing pressure may also reduce the CA event frequency.

The way things are looking now I don't think you need a sleep lab titration test nor a BiPAP machine. However, if the Tachypnea does not not go away with the increased EPR then I think you should see a specialist doctor about it. Probably start with a pulmonologist.

Is see that the company that makes this breathing simulator, IngMar Medical, makes 35 different standard patient models, but claim they can be easily tweaked based on specific needs. There is a Kussmaul Breathing pattern listed but not the specific Cheyne-Stokes Respiration. But they provide a link to contact them for specific requests.

The ResMed AirSense 10 does detect and report CSR, but it is not always accurate. Have a look at this thread which shows some sleep reports from an AirSense 10 reporting CSR (areas highlighted in green). I believe a standard CSR is waxing and waning breathing effort with central apnea events between them. The events reported in this thread do not have the smooth waxing and waning, and also have obstructive events between each cycle instead of central events. To me a true CSR pattern is a sine wave of smooth breathing effort with CA events between more of them. In other words breathing effort is reduced until there is no flow, and there is no obstruction.

The Phillips DreamStation machines report Periodic Breathing instead of specifying it as CSR. I'm guessing that the reason is that their detection method is really not specific enough to be sure it is CSR. ResMed are reporting it, but perhaps not always correctly.

I am a mechanical engineer, and not a medical professional, but CSR would seem to be easy to simulate. You would just use a slow sine wave function to drive breathing effort. The speed of the wave and time between waves would need to be about 12 seconds or so to allow the apnea machine time to identify a central apnea event. Here is an example from my personal sleep reports of what I believe a true CSR event looks like. In this case the ResMed has identified it correctly as CSR.

Hope that helps some,