If your AHI is lower AND you are feeling better with the pressure change, that generally means you are on the right track, as long as your doc(s) are on board with that, if all you are doing is treating sleep by preventing airway instability. My only concerns are (1) sometimes, in my opinion, too much credit is given to the home-machine numbers as far as differentiating centrals from obstructives, (2) attempting to assess successful sleep treatment from mere breathing statistics is a difficult thing to do, and (3) if a constant higher pressure is needed to stabilize the airway, sometimes it is worth it to give the body time to get used to that in a way that any centrals that occur get a chance to eventually dissipate on their own. But that is nothing more than my understanding based on what I've read as a patient. There are pros on this board who know much better than I do about such things.padster wrote: . . . it's exactly what i've been doing ie. "lowering pressure to get rid of few centrals". It's lowered my AHI and i think i feel better compared to when the pressure was at 7-9cm, but i hope it hasn't caused any undetected OSAs. Do you know what's the best way to figure out if a particular case is one where it's counterproductive to lower the pressure?
As for home sleep tests, to me the only especially good use for them is to verify cheaply that a person needs PAP. A home test can't rule out OSA, only rule it in. And when it comes to diagnosing a complicated sleep problem, nothing beats a lab/center PSG. A lab titration allows a human to see your reaction to pressures tried, for example. I understand that not everyone is in a position to get a lab titration for one reason or another--especially in certain countries. BUT, if you have documented the elusiveness of your being able to find the right pressure for you, that may make a powerful argument for being an exception to the rule and getting a lab PSG.
Please don't allow my words to get in the way of the very good help you are getting here from some very knowledgeable people, though. I throw in a few things here and there in an attempt to balance, but I have yet to see Pugsy, for example, steer anyone down any dangerous road. She does amazing work here, in my opinion.
I very much admire your approach and am sure you are going to get to the bottom of your sleep difficulties and are going to be able to get the best sleep possible.
My take in summary is that an open-airway apnea, as marked by a home machine, may, or may not, truly be a central. (Only a lab PSG can definitively call an event a central event.) And some find they feel better with a pressure slightly higher than what is needed to get rid of apneas and hypopneas. However, if you are feeling better with less pressure and your AHI is lower, I cannot argue with success. Your road to better sleep seems to be smoothing out, in that sense.
