Interesting, Hmmmmm

bkdraft · Post by **bkdraft** » Mon Mar 14, 2011 3:16 pm

Got a copy of my sleep study today, In first 3 hours I had 59 obstructive hypopneas, 0 central hypopneas and 0 mixed hypopneas. Next 3 hours were on the cpap at 7.0 cm and I had 0 hypopneas.
Now, been on the S9 Autoset for 3 nights, only had 1 obstructive total and the rest have been Centrals, average AHI of 5.7. My machine is set at auto 4-12.
RT suggested going back to cpap and set for recomended 7.0 cm and see how things go. Just thought it was odd that the sleep study showed all obstructive and no centrals and now my S9 shows all centrals and only the one obstructive.

Also did a oximentry on Saturday night, lowest Sp02 was 87%, but shows I had 211 desatruation events of less than 3 minutes duration. Desaturation event index (number of events per hour): 20.5

Comments?

Pugsy · Post by **Pugsy** » Mon Mar 14, 2011 3:22 pm

What does your daily detail report look like? Where is the pressure wanting to stay at? Are you waking often during the night?

If pressure is triggering the centrals straight cpap might be a good way to go and see if the centrals ease up. Some people do have a threshold where increases in pressure bring out some "centrals". Sometimes this goes away, sometimes people do better with straight cpap or apap with a very narrow range.

Wulfman · Post by **Wulfman** » Mon Mar 14, 2011 3:30 pm

bkdraft wrote:Got a copy of my sleep study today, In first 3 hours I had 59 obstructive hypopneas, 0 central hypopneas and 0 mixed hypopneas. Next 3 hours were on the cpap at 7.0 cm and I had 0 hypopneas.
Now, been on the S9 Autoset for 3 nights, only had 1 obstructive total and the rest have been Centrals, average AHI of 5.7. My machine is set at auto 4-12.
RT suggested going back to cpap and set for recomended 7.0 cm and see how things go. Just thought it was odd that the sleep study showed all obstructive and no centrals and now my S9 shows all centrals and only the one obstructive.

Also did a oximentry on Saturday night, lowest Sp02 was 87%, but shows I had 211 desatruation events of less than 3 minutes duration. Desaturation event index (number of events per hour): 20.5

Comments?

Not much mystery there (to me). Set your machine according to your RECOMMENDED pressure.

Den

HoseCrusher · Post by **HoseCrusher** » Mon Mar 14, 2011 4:08 pm

Your oximetry data indicates that your obstructions have not been eliminated.

Lizistired · Post by **Lizistired** » Mon Mar 14, 2011 5:05 pm

So why is the machine set at 6-12? Just to see? I think it would make more sense to run a week or so at the prescribed pressure before you experiment.

rested gal · Post by **rested gal** » Mon Mar 14, 2011 5:12 pm

I agree with Den. I'd set the autopap for CPAP mode at a pressure of 7 (the pressure your sleep study recommended.) Use it that way for a week and see what the results are. You might be pleasantly surprised. Or you might see that you want to bump it up to 8 for another week of CPAP mode.

If you're going to continue using the machine in auto mode, I'd set the minimum pressure at 7 and leave the maximum pressure where it is, on 12.

The minimum pressure setting is the important one to set right with an autopap, imho.

I'm not a doctor, or anything in the health care field. But here are my thoughts about the importance of the "minimum" pressure setting when using an autopap in Auto mode:

Results: 1st night with Auto A-Flex (topic started by TSSleepy)
Two nights graphs posted using pressure range 4 - 20 and 10 - 20
viewtopic.php?p=348963#p348963

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

Wulfman, DreamStalker, and ozij explain why autopaps make changes slowly.
December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218

I wouldn't be a bit concerned for the time being about the machine registering a few "clear airway apneas." Those may, or may not, really be "central apneas." And even if they are, they might be perfectly benign centrals. A handful of centrals, even every night, are no big deal. They can be "sleep onset" centrals -- quite normal. They can also happen when a person is turning over during sleep...again, normal.

Links to Central Apnea discussions
viewtopic.php?p=22702

bkdraft · Post by **bkdraft** » Mon Mar 14, 2011 5:45 pm

I have already set it to cpap and 7, will see how that does. Thanks for all the replies and suggestions.

bkdraft · Post by **bkdraft** » Tue Mar 15, 2011 5:56 am

Setting back to cpap and 7 cm did not help,

Apnea index: 9.2
Obstructive: 0.6
Central: 8.1
Unknown: 0.4
Leak
Medin: 0.0
95th Percentile: 22.8
Maximum: 31.2

Pugsy · Post by **Pugsy** » Tue Mar 15, 2011 6:10 am

Wonder how much that leak is affecting things? Your 95% leak of 22 L/min is awful close to the 24 L/min that Resmed says is the line where the data and machine can be severely impacted by leak. Meaning looking at the detailed report from the software and see if the events are occurring when the leak is large. If they are, then it could be that the events are happening because of ineffective pressure due to leak. Also are you using EPR? If so, at what setting. EPR can affect the numbers if it reduces the exhale pressure enough to let some events sneak by.

If it wasn't for the "centrals" your AHI would be quite acceptable. If they can't be blamed on leak then they might be pressure triggered centrals or might be sleep onset centrals. Sometimes with time these settle down but if you can't find a reason for them then I would think this needs to be brought to your doctors attention and see if he/she is concerned about them.

bkdraft · Post by **bkdraft** » Tue Mar 15, 2011 6:26 am

Very few events where the leak was the worst. Where there were the most events, leak was very low.
EPR is set at 3, Full time.

Pugsy · Post by **Pugsy** » Tue Mar 15, 2011 6:33 am

EPR of 3 means that during exhale the pressure is dropped by 3 cm which gives you 4 cm of pressure for time during exhale.
Might try less EPR (lower the EPR) and see if the "centrals" go away.

While these may not be anything to worry about I would suggest that if the "centrals" persist much longer that you bring this to the attention of your doctor just to make sure. Random centrals can usually be explained but 5 or 6 an hour is more than random and warrants a discussion with the doctor.

bkdraft · Post by **bkdraft** » Tue Mar 15, 2011 6:56 am

Here is part of my chart:

Lizistired · Post by **Lizistired** » Tue Mar 15, 2011 7:19 am

Can you post the flow and leak lines with the event line?

bkdraft · Post by **bkdraft** » Tue Mar 15, 2011 7:36 am

Wulfman · Post by **Wulfman** » Tue Mar 15, 2011 10:42 am

bkdraft wrote:Setting back to cpap and 7 cm did not help,

Apnea index: 9.2
Obstructive: 0.6
Central: 8.1
Unknown: 0.4
Leak
Medin: 0.0
95th Percentile: 22.8
Maximum: 31.2

At a pressure of 7 cm., you shouldn't even need to have EPR turned on. I would suggest turning it off.
From the looks of your reports, it would appear that you may be sleeping on your back (clusters of apneas).

Den

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