Sleepy

[giseleharney]

I need to schedule another apt. with him if necessary question with an auto bipap does the unit not sense what pressure level is needed?
Here is a graph is this what you want

[Pugsy]

I need to schedule another apt. with him if necessary question with an auto bipap does the unit not sense what pressure level is needed?
Here is a graph is this what you want

The machine will adjust to pressures needed to deal with OAs, hyponeas, snores, flow limitations, but not for Centrals/CAs.
We don't treat centrals with more pressure from your current machine. A different machine is needed that goes about things a little differently.

This last image...a little too much zoomed in...can you get it zoomed out a little more so that maybe 6 to 9 flagged CAs show up?
I am looking for a certain waxing and waning of the breaths and so far I can't see it....which may be a good thing.

I don't know if the centrals are numerous enough to be a problem and it's something I think you should talk over with your doctor.
They do concern me because there's more of them than I would like to see...5 per hour average is more than I would want to see and not at least talk it over with the doctor.
If these centrals are related to your pressures (and you didn't have them before cpap therapy) then this may or may not be Complex Sleep Apnea going on. If it is then a pressure reduction might be one way to start trying to reduce the centrals and if that didn't work then maybe a different machine is needed.
That's why I asked all the questions about what your prior sleep studies showed....I was trying to figure out if these centrals were new to cpap therapy or if you had them even without cpap therapy. If you had them even without CPAP therapy then a reduction in pressure isn't going to help reduce them since the pressure didn't cause them.

[giseleharney]

Thanks for helping me out Pugsy here is the 1st readout from my sleep clinic and Cas

[Pugsy]

Thank you. The PB pattern doesn't look all that much like CSR...sort of but not as classic as I have seen.

Your sleep study showed some centrals but not an alarming number. You appear to be having more now which makes me wonder about their relationship to pressure. Pretty much primarily hyponeas though.

If it were me and I was in your shoes I think I would reduce the pressure to see if the centrals reduce.
I also would make arrangements to see the doctor about these centrals if I couldn't reduce them with less pressure or if less pressure did reduce them but made the OSA side of things worse.

For sure no increase in pressure though.
Since you are still experiencing centrals and there is something on the reports that could potentially be the culprit...I would try fixing the culprit.

Now I am NOT saying that Complex Sleep Apnea is at play here but it is suspicious for it. This video will explain it better than I can.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be
And while this video mentions the other type of machine often prescribed for this situation....even if what you are experiencing is indeed CompSA that doesn't automatically mean that it can't be managed with the type of machine you are using now.
In fact often the type of machine you are using now is what is tried first especially when the central index is on the low side or borderline (and yours is borderline).

The idea behind bilevel machines like yours is that sometimes we can find a nice narrow range where the OSA is treated and the centrals aren't so numerous and we also avoid the aerophagia issues you might have.

Your obstructive component of the AHI (the OAs and hyponeas) is really relatively low so in theory you should be able to lower the pressure somewhat and not have the obstructive component increase horribly....in other words you have a bit of wiggle room that could be tried.

It used to be that 10 cm was thought of as the common line where centrals could maybe occur but actually centrals can happen with any pressure (even as low as 5 cm) so the 10 cm rule isn't so hard fast but it's a decent place to start with.
In your case....IPAP at 10 max and maybe use 6 or 7 EPAP and see what happens.
Or if you aren't comfortable doing this on your own...get that appointment with your doctor ASAP.
There's no guarantee that the centrals will go away with less pressure but they might and that "might" is worth a trial IMHO.

If you are going to use auto mode...make it a limited range for sure just in case these centrals are related to pressure and don't use a high pressure support because it could make the respiration even more unstable.

[giseleharney]

Thanks for your recommendation Pugsy I will reduce the pressure and see what the results are.