Emergent(?) Central sleep apneas on BPAP

[unputdownnable]

I've been struggling with finding a reasonable BPAP setting to improve my symptoms and reduce central apneas. When I use larger IPAP/EPAP (such as 11/6.5) I start getting aerophagia and waking up a lot.
When I reduce to IPAP/EPAP to 10/5.5 I start getting central apneas and waking up with headaches and unrested. Any suggestion of what to try to find a better setting?

The report pictures are for the last two nights where I woke up unrested and w/ headaches. My sleep titration study suggests I have to use 8-14 cmH2O APAP, but increasing IPAP/EPAP to 11/6.5 for example gives me bad aerophagia.

http://drive.google.com/file/d/1bnLnMBR ... sp=sharing
https://drive.google.com/file/d/1PdsnoB ... sp=sharing
https://drive.google.com/file/d/13uhDHZ ... sp=sharing

Remark. My machine is not supported by OSCAR, so I'm sharing the reports generated from the icodeconnect service.
Device: BPAP AUTO GII BMC T-20A Ser.
Mode: S
Mask: Phillips Nasal DreamWear
Ramp: 5min
I Sense: 8 (sensibility)
E Sense: 7 (sensibility)
Hose length: ~1.75m (no bacterial filter)

[Pugsy]

So how many central apneas are you having?
Per hour average?
All night?

What is the AHI breakdown?

[unputdownnable]

So how many central apneas are you having?
Per hour average?
All night?

What is the AHI breakdown?

Please, look at the 3rd link I sent, it has all that. (just fixed it, since I could not attach images).

[Pugsy]

What makes you think you have emergent central apneas or a problem with centrals even?
A little over 1 per hour average isn't near enough centrals to make criteria for that diagnosis. In the USA people need to have at least 5 per hour average.
It's normal to have a handful of centrals.
Are you sleeping soundly or waking often?

Where are you located?

[unputdownnable]

What makes you think you have emergent central apneas or a problem with centrals even?
A little over 1 per hour average isn't near enough centrals to make criteria for that diagnosis. In the USA people need to have at least 5 per hour average. It's normal to have a handful of centrals.
Are you sleeping soundly or waking often?

Where are you located?

In my 3 previous sleep studies no centrals were reported. In the nights that I woke up feeling great with BPAP, it coincided to have no centrals reported, and the nights I wake up w/ symptoms I have those multiple centrals. It's just my current sense based on recent observations, but no diagnosis.
Im waking up too often. In Canada.

[Pugsy]

BTW even if you did have a lot of centrals....more pressure with your machine is useless...won't help reduce them at all.
Back off on your pressure settings. You don't need as much as you are using.

[unputdownnable]

BTW even if you did have a lot of centrals....more pressure with your machine is useless...won't help reduce them at all.
Back off on your pressure settings. You don't need as much as you are using.

Right, I was planning to reduce pressures even more to try. Thinking about trying 9/5 tonight.

[unputdownnable]

BTW even if you did have a lot of centrals....more pressure with your machine is useless...won't help reduce them at all.
Back off on your pressure settings. You don't need as much as you are using.

May I ask you a question. When you are on pressure X cmH2O on CPAP and you move to BPAP, would X be the EPAP or the IPAP setting? Or it's not this linear? It's been hard to find explanations online.

[Pugsy]

BTW even if you did have a lot of centrals....more pressure with your machine is useless...won't help reduce them at all.
Back off on your pressure settings. You don't need as much as you are using.

May I ask you a question. When you are on pressure X cmH2O on CPAP and you move to BPAP, would X be the EPAP or the IPAP setting? Or it's not this linear? It's been hard to find explanations online.

You can't really make a bilevel pressure setting equal a cpap pressure setting unless you set EPAP to equal IPAP.
Now if you were using some sort of exhale relief on the cpap then that creates a bilevel situation and you set your PS to match the exhale relief and you have to be careful. Exhale relief comes off of IPAP and PS gets added to EPAP.

Example...using a 3 cm exhale relief on a 8 cm cpap setting you have 8 on inhale and 5 on exhale.
To get equivalent on the bilevel machine you would set EPAP to 5 and IPAP to 8 with PS of 3.

[unputdownnable]

BTW even if you did have a lot of centrals....more pressure with your machine is useless...won't help reduce them at all.
Back off on your pressure settings. You don't need as much as you are using.

May I ask you a question. When you are on pressure X cmH2O on CPAP and you move to BPAP, would X be the EPAP or the IPAP setting? Or it's not this linear? It's been hard to find explanations online.

You can't really make a bilevel pressure setting equal a cpap pressure setting unless you set EPAP to equal IPAP.
Now if you were using some sort of exhale relief on the cpap then that creates a bilevel situation and you set your PS to match the exhale relief and you have to be careful. Exhale relief comes off of IPAP and PS gets added to EPAP.

Example...using a 3 cm exhale relief on a 8 cm cpap setting you have 8 on inhale and 5 on exhale.
To get equivalent on the bilevel machine you would set EPAP to 5 and IPAP to 8 with PS of 3.

Thanks, it makes sense! I also just read that on a split-night PSG study they would first perform a CPAP titration for half of the night and for the other half proceed with BPAP titration as if it was a full night BPAP (so ignoring the results from CPAP and starting as a fresh new BPAP titration).
https://www.researchgate.net/publicatio ... ileContent