Why can't I get my AHI down?

[bonjour]

The more you push me the more I'll learn

It's possible your machine doesn't have them.
Under File / Preferences
Make sure everything in the left column is checked

Also chect the events tab, again everything in the left column is checkedn

Then click the OK button in the lower right corner

[zimm4er]

Everything in the left column is checked. So what do I change, how long do I stay at a change before saying, this is not working? 5 days? 7 days?
Actually I do have an appt with a different doc, but closest appt is April 30th.

[bonjour]

I would raise my EPAP from 14.0 to 14.5cmH20 and eval for 5 days, to make sure any change is a change and not a daily variation. ONLY this change. This is targeting your Hyponeas. An expanded view of your UA events MAY provide additional insight.

By limiting to one change at a time there is little doubt of the cause of any change.

You need to look for increases in ANY events.

[zimm4er]

Got it. Will let you know what happens. Thanks

[Pugsy]

This particular model ResMed machine doesn't use separate categories for central apneas and obstructive apneas. They all get lumped into the general "apnea" basket which SleepyHead calls "unknown" apneas because the machine hasn't given them a special name. I have the same thing happen with my ResMed Adapt machine.

If they are obstructive in nature we would assume they will reduce with more EPAP (the lower pressure setting) but if they are central in nature then more pressure won't help.
If your entire diagnosis was central apnea with no real obstructive apneas then I don't know if more pressure is going to help things at all but I doubt that more pressure will cause more pressure in your situation (it can for some people) since your central apnea wasn't caused by cpap pressure in the first place.

I don't think changing the respiration rate will help. It's just there to breathe for you when you don't breathe on your own enough.

Your situation is where it would be really helpful if the machine would/could tell us the category of event it is flagging.. ResMed just doesn't do the separate categories with this type of machine.

[zimm4er]

Two nights with increased pressure to 14.6. 14.5 wasn't a choice. My AHI has been in the 3's. I have some OSA, but my central sleep apnea developed after my heart attack. I started having this shortness of breath, which is a sign of central sleep apnea.
Will post actual pics in 5 days, to see where to go next. Thanks
.

[Pugsy]

ResMed machines don't do 0.5 cm increments (Respironics do) so your choices are 0.2 cm increments.
14.6 is close enough to 14.5. The 0.1 cm difference is insignificant.

[zimm4er]

So, 5+days on increased pressure to 14.6, Tell me what you think???? Thanks

[zimm4er]

Should i increase my pressure to 15.2? Or do something else. Thanks

[zimm4er]

New charts

[zimm4er]

Pugsy or bonjour, can you look at my new graphs?
Or should I start another post? Thanks

[Pugsy]

I think a little more is what I might do but you are getting to a point where it may be that more pressure may not help all that much. And remember....we don't know for sure if some of those UAs are maybe centrals. Just be careful with the increasing and watch to see if the UAs start to increase consistently.

Do you know if your obstructive apnea happens to be worse on your back or in REM sleep?
The pattern of the groupings of OAs and hyponeas suggest a REM stage sleep pattern.
You can google "sleep stages" and look at the normal hypnograms to get an idea when we normally expect to have REM sleep.

My OSA is worse in REM sleep so I have some considerable experience with this. In fact about 5 times worse in REM than in non REM so that's why I look at the potential REM patterns maybe a little more than others as a potential explanation for why the pressures work well some parts of the night and not other parts.
In REM sleep I have been known to need 6 to 8 cm more to get that airway to stay open.

I think at this point I would consider trying adding another 1 cm to the IPAP too. See if an additional little more IPAP along with the little more EPAP would clean things up a bit more.

[bonjour]

It's your original report of Centrals that has us skittish.
I'll go with Pugsy here.
Make all your changes slow and methodical.

Can you post some exploded views of a couple of your Flow Rate chart around your UA event? So we can see the individual breaths.
That may or may not provide additional insight.

good sleeping.

[palerider]

I'm curious why you've got what is arguably the most advanced resmed machine (ST-A) but are using it in dumbed down mode... did anybody explain that to you?

[Pugsy]

I'm curious why you've got what is arguably the most advanced resmed machine (ST-A) but are using it in dumbed down mode... did anybody explain that to you?

I have had similar wonderings but I figure that there must have been a reason for these settings and with the history of centrals and a heart attack maybe they are being super cautious. We don't know cardiac function here or ejection rate or in all honesty just how critical those are anyway.
So that's mainly why I am being ultra cautious here. Too much that I don't know and for sure don't know how important it might or might not be.
Sounds like the centrals were related to the beginning of cpap therapy and not necessarily a problem if cpap wasn't added....so a complex sleep apnea diagnosis but they are maybe being ultra cautious because of the centrals and the other history.

Without knowing more particulars I am a bit leery of going down my usual more drastic "let the machine sort it out" route.
The history of heart attack bothers me.
I kinda wish this machine was of the Air Curve variety...so that CSR would/could be flagged by the machine if it were happening.