High Central AI on Resmed sleep report

[Pugsy]

CFlex at 3 won't make or break the deal...besides that's Respironics exhale relief and you have a Resmed machine and it does EPR and while they are both forms of exhale relief they go about it differently.

You could add 3 EPR to your current settings to see what happens if you wish. That sort of mimics a bilevel pressure machine and a plain bilevel machine might be first consideration if these are CompSA centrals.

I thought about mentioning it but I have also seen where EPR use makes them worse but it is not common at all....one of those really rare things. So I was a bit torn about mentioning that option and instead thought back way up and start with a minimal pressure and work from there just to see if the centrals still were occurring.

So you might just try adding EPR at 3 to your current settings to see what happens but remember the machine can't go below 4 cm so it won't kick in fully until you reach 7 cm pressure...up to then you only get part of the 3 cm.

[Pugsy]

Wow...look at the REM sleep you got once they put the mask and machine on you.

[somnolentdoc]

Thank you for all your help Pugsy.

So then CPAP can improve sleep architecture as well? I had a couple really good nights two weeks ago where I woke up feeling about as good as I've ever felt and the AHI was 4.5ish. Of course then I lurk here and see people achieving <1 AHIs. My perfectionist streak....

I just checked my machine and I had the EPR on 4....

One thing I'd like to ask the sleep specialist is why an AHI of 6.5 would be acceptable when it's still high enough to cause sequelae and it's still classified as mild OSA. Or is this just part of the process of getting well?

I know I've been out of state in school but no one here (in Denver) has made any mention of following up with the data.



So now I'm torn. I adjusted the EPR setting down from 4 to 3 like you suggested. I just am not sure if I should convert to CPAP at 11 cm H2O and see what happens or do as you suggested and try at 6 cm H2O.

The study has my AHI still in the 20s at 5 cm H2O...

[kaiasgram]

I just checked my machine and I had the EPR on 4....

somnolent, on the S9 the EPR options are 1, 2 and 3 or Off. Can you clarify what you did with EPR? 4 is a pressure setting but not an EPR option.

[somnolentdoc]

I'm sorry I misread that it was off and I set it to 3.

In other words, I just invented my own setting for S9. Maybe I should apply for a patent?

[kaiasgram]

I'm sorry I misread that it was off and I set it to 3.

In other words, I just invented my own setting for S9. Maybe I should apply for a patent?

[Pugsy]

I would try current settings being the same with EPR at 3. Might get lucky. What that will do is lower the overall pressures a bit and the non sustained higher pressure on inhale might just work. Often the first line of defense when centrals are too numerous is a regular bilevel machine (as opposed to the high end ASV bilevel machine) which allows for a bigger spread between inhale and exhale and sometimes that's sufficient to ward off unwanted centrals that are related to pressures. If we see the centrals increase dramatically...well we will have learned that wasn't the way to go. Odds are with us that it won't though.

And yes, cpap use is supposed to improve sleep architecture. I didn't get much REM at all before cpap therapy. Every time I would slip into REM sleep stage my OSA events would come on fast and furious (53 per hour in REM compared to 12 per hour in non REM) and kick me right out of REM sleep...no wonder I felt like crap. Sleep architecture was in the toilet. That and I simply didn't get but 4 or 5 hours of crappy sleep.

[somnolentdoc]

And yes, cpap use is supposed to improve sleep architecture. I didn't get much REM at all before cpap therapy. Every time I would slip into REM sleep stage my OSA events would come on fast and furious (53 per hour in REM compared to 12 per hour in non REM) and kick me right out of REM sleep...no wonder I felt like crap. Sleep architecture was in the toilet. That and I simply didn't get but 4 or 5 hours of crappy sleep.

Wow. Okay. I take solace in knowing these things can improve. Boy do I really feel like a numbskull for not addressing this when I was diagnosed.

With residency I know I'm look at getting 4-5 hours of sleep when I'm on the wards but gosh darn it it's going to be quality 5 hours of sleep.

I think I'll hang out on pubmed and do a literature review. Low and behold there is an abstract on CompSAS being associated with a provent nasal apparatus.