Do I need to see my sleep doc again??

[palerider]

Thanks for the advice, I'll try it tonight and see if it improves. May I ask why you guys made those specific recommendations? Thanks!

much like pugsy says, I eyeball the pressure chart, and see where pressure starts going down, then you have events, and that causes the pressure to go back up. you can get an idea of where you start having trouble, looking at the pressure trace, and usually want to set the pressure a little above where you start having events.

look at enough reports, and you start to get a bit of a feel for it.

like pugsy says too, I tend to be a bit more aggressive, usually looking for a bit faster adjustment to where I think the 'zone' is while she likes to take it a bit easier, we usually don't differ too much in our recommendations, and when we do, I look long and hard and what she's saying to see what I can learn from her.

I suggested lowering the PS a little to see if it cuts down on the centrals. it might, or it might not make any difference... and if you want to experiment more slowly, that's fine too..

[Pugsy]

I looked at the centrals and I looked at 4 hours and assumed not the greatest of nights on the machine.
If you had a lot of little wake ups those centrals may not even be real. So I thought "treat what is obviously needing better treatment" and deal with the leftovers once the obstructive stuff is better taken care of. The centrals could be awake/semi awake centrals secondary to arousals from the Obstructive stuff. That's why I didn't go down the reduce PS road just yet to see if the centrals would reduce...at least just yet. I am not yet convinced that they are something that needs worrying about at this point and won't be unless I see too many of them and the OA stuff is well treated.

[tps7c]

I can't thank you guys enough for looking at my data and making those recommendations, as well as providing explanations that make sense and ease my anxiety about playing around with these settings. You have restored my faith in humanity!!

[palerider]

I can't thank you guys enough for looking at my data and making those recommendations, as well as providing explanations that make sense and ease my anxiety about playing around with these settings. You have restored my faith in humanity!!

also, while an AHI of 7.8 isn't a good number, it's not bad at all for a first night.

[tps7c]

hello all! Well, I managed 6 hours on the machine last night. Let me clarify - I'm not having a problem adjusting to the mask or machine, it's my crazy schedule for the next few weeks. I work until about 9:30 or 10pm, drinking a cup or three of coffee until as late as 8pm. Then by the time I can fall asleep, it's between 1-2 am. This madness won't last much longer, lol. Below is a link to the screenshot from last night, and it seems although my OSAs went down, my centrals went up. I bumped the epap up to 8, the ipap to 16, and left the ps at 4. Maybe the next thing to try is to decrease the ps to 3, as you guys suggested? Or do I try a few more nights at the current setting? Thanks to all of you!!!

http://i.imgur.com/hiIAlCG.png

[palerider]

hello all! Well, I managed 6 hours on the machine last night. Let me clarify - I'm not having a problem adjusting to the mask or machine, it's my crazy schedule for the next few weeks. I work until about 9:30 or 10pm, drinking a cup or three of coffee until as late as 8pm. Then by the time I can fall asleep, it's between 1-2 am. This madness won't last much longer, lol. Below is a link to the screenshot from last night, and it seems although my OSAs went down, my centrals went up. I bumped the epap up to 8, the ipap to 16, and left the ps at 4. Maybe the next thing to try is to decrease the ps to 3, as you guys suggested? Or do I try a few more nights at the current setting? Thanks to all of you!!!

http://i.imgur.com/hiIAlCG.png

if it were me, I'd try lowering the PS and see, might need to go lower than 3, but experimentation will tell.

you're pretty good with the other numbers, and you're certainly in an adjustment period. last night might have been just a 'bad night'... we don't have enough data yet to tell.

[tps7c]

Well, I got a full 8 hours on the machine last night, and my AHI was only 3.5!! I took your advice and changed the PS from 4 to 3. I'll post a link to last night's data below. One thing I noticed was a CA that lasted almost 30 seconds! Is that something to be concerned about? Thanks all!!!

http://i.imgur.com/ntvHTqr.png

long central apnea:

http://i.imgur.com/wDM0W6a.png

[Pugsy]

One 30 second apnea of any kind all by its lonesome isn't going to hurt anything. It's when you get a truckload of them all bunched together that there can be a problem.
Hold your breath for 30 seconds...that's pretty much what a 30 second central is.
If you were wearing a pulse oximeter and watched the reading while holding your breath and even for a while afterward, it wouldn't even move.

Now if you had a 30 second apnea every minute for 10 minutes...that's a different story.

[tps7c]

Pugsy - you know what is really scaring me? I had untreated/undiagnosed sleep apnea for 10 or 15 years. The unknown damage I've done to my body is a scary thought

[palerider]

Well, I got a full 8 hours on the machine last night, and my AHI was only 3.5!! I took your advice and changed the PS from 4 to 3. I'll post a link to last night's data below. One think I noticed was a CA that lasted almost 30 seconds! Is that something to be concerned about? Thanks all!!!

I'm thinking you'll need to raise epap to 10, but why don't you try going to 9 tonight, and see how things are.

I personally wouldn't be concerned about a single long CA, or even a few of them over the course of the night, I'm interested in what Pugsy says about that. you might need to lower PS even more, but you're probably getting close to good settings, and that's when it's time to slow down and let things average out for a few days, just making small changes.

[Pugsy]

Coulda/shoulda/woulda...not much we can do about the past but we can try to make the best of the future.
I try to use my energy for things I can fix now....and try not to dwell on coulda/shoulda/woulda stuff because it causes unneeded stress and worry and there's not a damn thing I can do about it anyway.

Oh....I am not going to advise any more dialawingin at this time...too many changes all at once and we don't have any sort of baseline to go on.
I don't think the centrals are related to PS at all. If it were then I think there would be a whole lot more of them...but one or two nights with 2 major changes and only 1 night with a good 8 hours of sleep...

You can do what you wish though...like I said earlier..PR is more aggressive than I am and while I will be aggressive when it is clearly needed...AHI of 3 something with about half of it Central...I would leave things alone and get some more nights at these settings because we know they can work...and see what happens after a week or so. There's no urgent need to change anything and if you keep changing more than 1 thing at a time you don't know which change caused a change (if there is a change).

The reduction in centrals shown here...could have easily been a reduction in OA arousals and it might have been the arousals that were causing the centrals...and by fixing the arousals better then the centrals reduced.
The PS triggering centrals thing....very, very rare and I am not going to go down that road with someone with only 2 nights of reports and really only 1 with enough hours for good evaluation.

So PR....It hasn't been proven to me that the centrals are related to PS...so I don't want to go down that road. It could have just as easily been the poor sleep itself that reflected the centrals...fix the poor sleep and the centrals get fixed at the same time.

[tps7c]

Well, I got a full 8 hours on the machine last night, and my AHI was only 3.5!! I took your advice and changed the PS from 4 to 3. I'll post a link to last night's data below. One think I noticed was a CA that lasted almost 30 seconds! Is that something to be concerned about? Thanks all!!!

I'm thinking you'll need to raise epap to 10, but why don't you try going to 9 tonight, and see how things are.

I personally wouldn't be concerned about a single long CA, or even a few of them over the course of the night, I'm interested in what Pugsy says about that. you might need to lower PS even more, but you're probably getting close to good settings, and that's when it's time to slow down and let things average out for a few days, just making small changes.

Thanks Palerider! I'm new to reading this type of data - can you tell me what you are looking at in the data that makes you think I need to raise exhale pressure to 10?

[tps7c]

Coulda/shoulda/woulda...not much we can do about the past but we can try to make the best of the future.
I try to use my energy for things I can fix now....and try not to dwell on coulda/shoulda/woulda stuff because it causes unneeded stress and worry and there's not a damn thing I can do about it anyway.

Oh....I am not going to advise any more dialawingin at this time...too many changes all at once and we don't have any sort of baseline to go on.
I don't think the centrals are related to PS at all. If it were then I think there would be a whole lot more of them...but one or two nights with 2 major changes and only 1 night with a good 8 hours of sleep...

You can do what you wish though...like I said earlier..PR is more aggressive than I am and while I will be aggressive when it is clearly needed...AHI of 3 something with about half of it Central...I would leave things alone and get some more nights at these settings because we know they can work...and see what happens after a week or so. There's no urgent need to change anything and if you keep changing more than 1 thing at a time you don't know which change caused a change (if there is a change).

The reduction in centrals shown here...could have easily been a reduction in OA arousals and it might have been the arousals that were causing the centrals...and by fixing the arousals better then the centrals reduced.
The PS triggering centrals thing....very, very rare and I am not going to go down that road with someone with only 2 nights of reports and really only 1 with enough hours for good evaluation.

So PR....It hasn't been proven to me that the centrals are related to PS...so I don't want to go down that road. It could have just as easily been the poor sleep itself that reflected the centrals...fix the poor sleep and the centrals get fixed at the same time.

Thanks Pugsy! I guess I'll let things sit as is for a few more nights and see what the results are. Thank goodness for you all you people on this forum!! Hopefully someday I'll be able to return the favor to a newbie like myself!

[palerider]

Thanks Palerider! I'm new to reading this type of data - can you tell me what you are looking at in the data that makes you think I need to raise exhale pressure to 10?

if you look at the pressure curve, you can see where the pressure dips down, and then you have an issue of some sort, and it goes back up... the 10 was my best eyeballing of where your pressure would usually drop to before it'd jump back up.

if you want to let it set for a couple more days, as Pugsy suggests, that's fine too. you're not doing bad at this point.

[palerider]

So PR....It hasn't been proven to me that the centrals are related to PS...so I don't want to go down that road. It could have just as easily been the poor sleep itself that reflected the centrals...fix the poor sleep and the centrals get fixed at the same time.

that could very well be, I have seen pressure support (either through EPR, or bilevel) exacerbate centrals in some more sensitive people, and I s'pose I look for that more than I might ought to... it is very early days for our new friend here, and he's doing pretty well as it is.