jgudnas treatment thread

[jgudnas]

So I've been on the pap for a wee over a month now, getting the settings dialed in, and most nights my AHI is less than 2, and i can write off a few of the events as SWJ.
But in general, most of the events i have are CA's (or at least that's what the Resmed classifies them as), with very few OA's reported. (initial sleep study saw 45 AHI). overall my oscar averages are 1.25 CA vs .55 OA, 1.89 overall

But what i have been experiencing relatively consistently over the last few weeks are series of centrals occurring just as i am falling asleep. I am generally somewhat aware they are happening, or become aware when the O2 ring buzzes to remind me to breath, and have experienced a few where I actually get that wakeup jolt and heavy breathing - I'm much more aware of the what and why now, so these events are interesting in a way.
Now yes, i have read through the forums and realize that this can be a common occurrence when starting treatment, and i only have a little more than 4 weeks of oscar data to stare at, so perhaps i should just ignore it for a while longer, but I am trying to deal with the centrals a bit.
I have been at an 8-11 setting now for a few weeks with an EPR of constant 2, which has resulted in good results generally. I am trying again to try EPR of 1 (tried one day before and had a poor result). last night was attempt #2 at EPR of 1, and i had an AHI of 5.28, but the bulk of that was still CA's 5 minutes into sleep. (but this was about the worst bout of CA's i've seen yet).
( Note on settings; i went from 8.4 min to 7.4 min when i adjusted the epr from 2 to 1, just to keep the epap pressure at the same line. i'll bump my min back up to 8 tonight and see if it affects anything tremendously)
There are some days i have very few CA's, most days have 2-5 range during that first 30 minutes, and some are more like 10-12). So far, both days i've had EPR of 1 have had lots of CAs early. I will stick with it a few more days anyway just to see.

So the question I suppose, what (if anything) can I try to alleviate the centrals I am having. Obviously my options are limited by my machine, as it's just the AirSense 10 Autoset.

attaching shots of both days with EPR of 1.

imgur link for more dailys:
https://imgur.com/a/3XZzjaL

edit: renamed thread. from "Centrals after falling asleep"

[zonker]

So I've been on the pap for a wee over a month now, getting the settings dialed in, and most nights my AHI is less than 2, and i can write off a few of the events as SWJ.

if you could, it would be best if you stayed in one topic. you can have one titled "jgudnas therapy thread" or some such. this way the experts here can keep better track of you and has been said or tried.

also, as to oscar charts? too much info crowded into yours. forum friend, grumpyhere, has some very concise instructions on how your charts should be formatted-

"The easy way to set the OSCAR (v1.2) graphs in the preferred order and format:

1. Go to View menu - Reset Graphs - Standard

2. In View menu, turn on Sidebar

3. Again in View Menu turn off Daily Calendar and Pie Chart

4. Set Graph Height in File/Preferences/Appearance
The default should be 180.

On my setup, when set to 80, I get really squished up graphs.

At 192, the 5 graphs (flags, flow rate, pressure, leak, flow limit) are nicely spaced out.

At 160 I also get snores as the bottom graph.

5. Reset Graph Heights in View menu. This step may not be always necessary."

as to the the subject of your post, i'll step aside and let someone more knowledgeable answer.

good luck!

[jgudnas]

the other thread is on apneaboard, not here, but good to know it's seen... and yes i only have the one thread there as well. although no feedback or answers there, so i posted here too..

yea my screenshots are busy, i have the benefit of 4k screens, so additional info.. thanks for the feedback though.

[Pugsy]

You do have 2 threads here talking about centrals.

It's common to have what are called sleep onset centrals but not the numbers you are having (if that is what you are having).

There's not much you can do about it with this machine except to try turning EPR off and see what happens.
You probably should alert your doctor to this development and see what he might want to do. Now he might just want to give it time but he should at least be aware because your O2 pulse ox is setting off the alarm and that means you are having enough centrals to cause significant desats....and that's a problem.

A few centrals here and there isn't a big deal....unless you have enough centrals to cause desats and the desats are a problem.

While you can probably see the graphs easily....they are too tiny for most of us to really evaluate. We don't need or want all those graphs. Just stick with the basics and that's really all we need and if we need something else we can just ask.
I suggest resizing the graphs so the basic graphs are larger on the main detailed report.
See this thread for examples.
viewtopic/t158560/How-to-post-images-for-review.html

Probably no need to redo this one though....we can see the ugly cluster of centrals well enough.

I don't know that turning EPR off will do much...I seriously doubt it but it is about the only change you can make that stands any sort of chance of reducing the centrals. It all depends on what is causing the centrals in the first place. Sometimes EPR causes it...sometimes it doesn't. Sometimes they just pop up and we don't know why.

[zonker]

the other thread is on apneaboard, not here, but good to know it's seen... and yes i only have the one thread there as well. although no feedback or answers there, so i posted here too..

yea my screenshots are busy, i have the benefit of 4k screens, so additional info.. thanks for the feedback though.

no it's here-

https://www.cpaptalk.com/viewtopic.php? ... 1#p1390551

i don't frequent apneaboard.

[jgudnas]

re zonker.
Sorry when you suggested the name "jgudnas therapy thread" that is actually what my thread on apneaboard was titled. i thought you were referencing the thread, not suggesting a title.
feel like i'm beating a dead horse here though.
the other thread you referenced isn't specific to MY therapy, it's a question about the machine and how it reads events.

[jgudnas]

Re. Pugsy

thank you for the feedback.

Regarding the screenshots, next time i will size them down, sorry about that. for these, you can right click, view image in new tab, and zoom to 100% size to see properly. I understand that's not ideal, so again, if i post additional images, I will size them down. The other thread is not treatment related, just a topic about how the machines decide what the events are. I figured that was a separate enough question to warrant a separate thread.

I will discuss with my doctor next time i see him, however being a general family physician, i doubt there will be much to say there, but who knows. I am not currently dealing with a sleep clinic, might re-evaluate that at some point in the future.
Some days i dont suffer any large string of CA's, about half of the days are smaller bursts like this, and these two are the worst examples. But since i've gotten the O2 ring, i would say i get one o2 saturation alarm almost every time i'm falling asleep. Funny, I didn't have a specific need for the ring, just wanted to see the data.

[Pugsy]

for these, you can right click, view image in new tab, and zoom to 100% size to see properly.

Actually I tried that but all I got was still small in vertical height graphs that were hard to evaluate because right click of my mouse doesn't give me option to resize anything. So I tried using "View" and zooming in and while it really impacted text...it didn't help me evaluate the graphs themselves mainly due to the overall scale involved. They just weren't tall enough...or tall enough to suit me I guess I should say. I am an old woman, set in my ways and all that stuff. For me to help people I need the information presented in a way that helps me help them so that I can offer my best thoughts. There is a reason behind my madness.
Fortunately the only graph I really care about now was the Events graph and I could easily see that ugly central cluster.
I really didn't/don't need to see anything else at this time.

I realized your other thread was a general question about how the machine functions and it's not that big of a deal to have it separate (to me anyway but it is to some others) but for the most part when newbies come here and start asking all sorts of questions we just like to keep them in one thread. Makes it a lot easier when we can see what you have previously asked about (even if it isn't a "therapy" question per se) and what responses you have already received. Just makes our work here a bit easier because people (myself included) don't want to work any harder than we have to and anytime we have to work less...we are much happier.

I was tempted to merge your other thread with this one because it actually does pertain to your therapy since you are having a truck load of what appears to be real sleep onset centrals but elected not to because it wasn't that big of a deal...for me. I saw it for what it was. But in the future when you have random or even off the wall questions about something we would appreciate it if you keep it in this thread at least for now. It's what most people like to see to make it easy for them to help you. I know a lot of forums are sticklers for creating a new thread for a new topic or question but here we tend to lean the other way.

Again not that big of a deal for me anyway but it is a big deal for some others and we just don't want 20 different threads with 20 different cpap or therapy related questions because then to do you justice we have to go reread all those other threads and while we could do it...most won't but if you stick all your discussion and questions in one or two thread people will take the time (hopefully) to read prior responses and reply as needed. Though I admit that often people don't bother to read what has already been said and they go and reply almost word for word what someone just said. That annoys the hell out of me...like I want to scream "did you bother to even read the prior replies" but it isn't the end of the world when it happens. Me...if someone has already said what I would have said then I don't bruise my fingers typing the same thing again.
Besides...right now I am having major issues with right hand/wrist and any typing I do causes major pain. I certainly don't want to go posting something that has already been posted.

So while I would appreciate sticking with this thread for now anyways (later on after a month or so) maybe start a new thread if a really new problem pops up.....I won't bust anyone's chops though...especially a newbie for multiple threads.
I just won't do that at first. It isn't that big of an offense ....to me anyway. I have no control over the others though.

I don't know why you have the ugly cluster some nights and not other nights and not the rest of the night.
It's something I have talked with some sleep techs about and I was told that sometimes it just happens and we don't know why. I have seen it happen like yours at the beginning of sleep and even randomly during the night but not every night and we can't figure out a trigger for them. When we can't figure a trigger causing the centrals then we can't come up with ideas to stop them. Sometimes EPR use is a trigger but normally when we see EPR causing them then we see a lot more centrals throughout the night. Sometimes higher pressures are the trigger but you had higher pressure several times during the night above and no ugly clusters...so we assume pressure isn't the trigger.
EPR and higher pressure the 2 most common triggers and once we rule them out we are sort of out of ideas.

Medications can sometimes suppress respiration...so that's a thought especially if someone is on pain meds which often suppress respiration and create the unstable breathing pattern that ends up causing the centrals.
Centrals are actually caused by an imbalance of carbon dioxide in the blood...blood gas exchange issue. Carbon dioxide levels need to be a certain level for the brain to send the signal to breathe...for some reason your carbon dioxide levels aren't getting high enough so you aren't breathing....but it's not happening all night so that's why I say your situation is more complicated. It's not following the normal pattern.

And why I say you should at least alert your doctor to this situation. Now he might just want to give it time to see if it sorts itself out and that's up to him because he knows a lot more about your overall medical history than we do.

I wouldn't worry about just a handful of sleep onset centrals but since you are having more than a handful and they are causing oxygen level drops....your doc needs to be in the loop.