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A friend had his first night with a machine last night and posted his graph for me. He had a stroke last summer and has subsequently been diagnosed with apnea. https://gyazo.com/114dce439de5d30e945be51c89e92375

Obviously his apnea is not yet being adequately addressed, though he felt better in the morning. I am worried about the number of centrals. I wondered what others think. His starting pressure is obviously quite low (5) yet with his recent health history I don't think he should raise it w/o his treatment team's supervision. Would a bipap be better for him?

(BTW he and I discussed the large leaks. He thinks he didn't get the mask on straight after a bathroom break.)

First night with the machine, I suspect that the centrals are a result of restlessness...nothing else. Watch it over several days and see if they don't reduce. CAs can sometimes be Clear Airway events. Pugsy calls them Sleep/Awake junk. Just watch them.

He needs more minimum pressure for the obstructive stuff.
The centrals aren't really horrible and there's a chance that some of them are awake breathing or post arousal because an OA caused an arousal.
At this point what needs to be done is fix the obstructive stuff and see what happens with the centrals once the obstructive stuff is under better control.

At this point nothing screams out bilevel at this time unless he is having a lot of trouble exhaling against the pressure.

LSAT wrote:First night with the machine, I suspect that the centrals are a result of restlessness...nothing else. Watch it over several days and see if they don't reduce. CAs can sometimes be Clear Airway events. Pugsy calls them Sleep/Awake junk. Just watch them.

That sounds sensible, thanks.

Pugsy wrote:He needs more minimum pressure for the obstructive stuff.
The centrals aren't really horrible and there's a chance that some of them are awake breathing or post arousal because an OA caused an arousal.
At this point what needs to be done is fix the obstructive stuff and see what happens with the centrals once the obstructive stuff is under better control.

At this point nothing screams out bilevel at this time unless he is having a lot of trouble exhaling against the pressure.

OK. Yeah I'm hoping his treatment team raises his min pressure. Thanks Pugsy.

I had a stroke several years ago, and when I went on cpap this last summer, no doctor showed the slightest concern about the fact I'd had a stroke. Any doctor I spoke to simply reiterated that cpap is helpful to your body.

Though I have not had a stroke, earlier in my life with CPAP I had a condition called hemifacial spasm which one neurologist I was with compared to a stroke in how the facial muscles behaved. It was one of the primary drivers in my moving to nasal pillows instead of an FFM. If your friend has lost some facial muscle tone, he might be having difficulty getting an FFM to seal properly and consistently. I also found a chin strap was critically important in maintaining a good seal with the lips.

Good tips. He's actually using a Dreamwear mask but no chin strap.