Sierra

I have never bothered to sign up for MyAir because I think the reporting is not useful for the reasons you give. All it gets is the basic compliance data that is sent wirelessly to the MyAir website. Instead I use SleepyHead to view the detailed data. You can get a little more detailed report from the machine itself if you go into the Clinical Menu and set the Essentials to Plus. But, SleepyHead is still much better.

Well the general assumption is that all hypopnea is obstructive in nature, even though very few labs actually verify that. And in most cases that assumption is correct. The CAI of 14.7 should have been a red flag to them however.

Yes, providing they are prescribing a good APAP like the ResMed AirSense 10 AutoSet, it will report central apnea frequency. However, you will have to ask them to set it up with the enhanced sleep report menu. The other option is to view your results in SleepyHead. The Respironics Dreamstation Auto should be similar. To my knowledge the Fisher & Paykel SleepStyle machine does not identify central apnea so you will want to avoid that one.

I hope you have an arrangement to return the machine if it does not work for you. If central apnea turns out to be a significant problem then it probably won't.

That is a fairly clear explanation. The key numbers are:

Sleep time: 244.5 minutes, or 4.08 hours.

Apnea events and the events per hour index:

Obstructive apneas: 10 , OAI: 2.45

Central apneas: 60, CAI: 14.7

Hypopneas: 118, HI: 28.9

They said 0 obstructive hypopneas, and 0 central apneas. However, they kind of have to be one or the other. Probably what this really means is they did not classify the 118 apneas. It probably has to be done manually and they didn't do it.

What does this mean? I would be concerned about the high central apnea component, and that it might go up with CPAP or APAP treatment due to the pressure used. If you go ahead with the titration test they are recommending, it should be very telling. They may find that when pressure is increased then the central apnea may increase, and if those hypopneas are central in nature, they may increase too, or not decrease. I would go ahead with the titration test, and then question them very carefully about the results, and/or get a second opinion. You do have a condition that needs attention and treatment, but it is not totally clear what is the best way at this point. There are ASV machines that are more appropriate for treatment when central apnea is the dominant component of a high AHI. Something to discuss when you get your titration results.

Do you have some way of posting an image of the sleep study report? If you have an image file you just left click on it and drag it into the body of a post.

Some of the terms you have uses are not familiar to me. AHI is standard and the 46.1 fits you in the severe apnea range. It would include all apnea types and hypopnea. Stage R AHGI is a term I do not recognize. Your event count does not make a lot of sense. Say that you slept for 6 hours and had 60 central apneas then the CAI (central apnea index, events per hour) would be 10 (60 divided by 10). However the obstructive index would only be 1. This would mean that the majority of the other events that make up the AHI would have to be hypopnea, and they have assumed they are obstructive in nature.

In any case, a CAI in the range of 10 is high, and cause for some concern. It is possible that some or perhaps many of the hypopnea events may be central in nature instead of the assumed obstructive.

You should get a copy of the sleep report and seek a second opinion on what it means. The issue is that standard obstructive apnea treatment using a CPAP or APAP is not very effective and can even aggravate central apnea.

Not a medical professional, but those are my thoughts based on what I know about it.

This is ResMed's Automatic (AutoSet) CPAP machine, or APAP. They really only make two. One is the standard AirSense 10 AutoSet, and the other is the AirSense 10 AutoSet For Her. With the automatic machine, you set the minimum and maximum pressure supplied on inhale (IPAP). During the night the machine raises and lowers this pressure to address obstructive apnea and hypopnea events. It ignores central apnea events.

A CPAP machine uses a fixed inhale or IPAP pressure, and does not adjust during the night.

A BiPAP machine have different flavours, but most are similar to an APAP, but they allow you to set both inhale (IPAP) and exhale (EPAP) pressures. And they allow the difference between the two pressures to be quite high. This can be used to assist breathing. Last they usually have a maximum pressure of 25 cm, instead of 20 cm like a regular APAP.

EPR or expiratory pressure relief is a ResMed term and feature. It reduces the exhale pressure by a set amount of 0, 1, 2, or 3 cm. Yes, this does essentially the same thing as a BiPAP machine that has a differential in IPAP and EPAP of the same set amount. EPR can be found on both APAP and CPAP machines.

But to get to the question you may be really asking, is which machine is appropriate for central apnea? My thoughts are that the first approach to central apnea is to minimize pressure, as pressure often aggravates the incidence of central apnea. To do that you want to avoid any differential between IPAP and EPAP, or avoid EPR. For that approach a CPAP with a fixed pressure can often get the best result, although an APAP can be adjusted to do nearly the same thing.

So why do you hear about BiPAP machines being used for central apnea? Good question that is difficult to answer. For the minimizing pressure approach they offer no advantage. However, they often have features that can detect that the person is not trying to breathe (central apnea), and then automatically cycle the inhale and exhale pressure by a large amount to help them breathe. When they are of that type and set up that way, they can help central apnea to some degree. However the machine that is best suited to addressing central apnea if it cannot be controlled to acceptable values (<5 AHI) is the ASV machine. It follows each breath and adjusts pressure on a breath by breath basis to maintain breathing. They are fairly expensive ($4000 or so) and carry some risks in using them.

Hope that helps some,

It is not uncommon for there to be apnea events when you are just waking up or going back to sleep. Some call this Sleep Wake Junk and dismiss it as noise. The CPAP machines generally do not start counting apnea events until after the ramp period is over, and at least in theory you are asleep. This is to avoid reporting noise and inflating the AHI number. On the EPR I will see if I can find the existing thread on the subject and bring it back for discussion.

Edit: I found the thread on EPR but it is closed for comments. However, here it is. It should give you more views on EPR than you really want to hear!

https://myapnea.org/forum/not-understand-epr-setting/1#comment-17050

It is always a good sign to see no central apneas in the sleep study. It does not totally eliminate the possibility that you will have them when under CPAP pressure, but it sure improves the chances that they will not be a problem for you.

When do you get your machine? Will they set it up for you?

It seems to me that sleep apnea and oxygen desaturation events are just two different ways of measuring the same issue. When you stop breathing then oxygen goes down. In the UK mild (5-15 AHI) does not qualify you for CPAP treatment. I guess the thinking is that it is not serious enough to treat. In North America it is more likely to be treated, as most insurance companies will pay if AHI is over 5.

It is far simpler to cut to the chase and just turn EPR off when sleeping. No math needed. There is a reason that ResMed has that option to do EPR on ramp only. When you are awake it makes sense, and when you are sleeping it does not. And there is a reason that F&P resisted offering an EPR setting until very recently with their last model.

Actually my suggestions have nothing to do with central apnea. The purpose of discontinuing EPR during sleep is to reduce the frequency of obstructive apnea. They are as likely to occur during exhale or the inhale/exhale transition, so using EPR reduces the effectiveness of the pressure which is preventing obstructive apnea. The reduced pressure also improves comfort.

And you do not have to do any calculations at to where to set EPR. Just set it at 3 cm. The machine will not go below 4 cm in any case. It self adjusts.