question about pressure AGAIN

[oak]

i had pretty good results with my prescribed pressure of 9cm, but in the study they said they weren't too sure about the prescribed setting because i had no REM sleep. the reviewing sleep doc had suggested a pressure of 8cm in the report, but at the end of the report they changed it to 9cm. I have been sleeping with it set at 9 cm for a month.

i have been having AHI's under 3 on average, with very few leaks. in a little experiment, last night i put the machine on autoset with a bottom setting of 7 and a top setting of 10, to see if i could get the AHI's down even further. well, the avg AHI was 1.8 last night, but the interesting thing (to me) is that the pressure went up to 10 right away and stayed there after every time i took a bathroom break. does this mean i might need a bit higher pressure? should i try moving it up to 11 for a week?

sorry for the dumb question.

[RandyJ]

Some people have more events in REM sleep and therefore need more pressure at those times.

If you are not having centrals, I don't see why you can't increase the max a little bit, as long as you don't start having lots of centrals. Normally, the machine won't go higher than it needs to go.

[sawinglogz]

the interesting thing (to me) is that the pressure went up to 10 right away and stayed there after every time i took a bathroom break.

Did you turn the machine off when you got up, or did you take off the mask and leave the machine running?

If it thinks there's a leak, it's going to ratchet up the air as high as it can to try to compensate. Obviously, when you're not attached to the mask, that's a rather large leak.

What does SleepyHead show for the night?

[oak]

no i turned the machine off when taking a bathroom break and it ramped up (for all bathroom breaks) each time all the way to 10 and stayed at 10 while i was sleeping.
i am not the greatest at posting pics, but that is what sleepyhead shows.
no i dont have "lots" of centrals.
if it stays in a flat line at 10 during sleep, when set at 10, should i be raising the max pressure.

[oak]

[oak]

[sleepy_learner]

looks like the things are controlled pretty well.

[sawinglogz]

Interesting, so it was at 10 before you went to the bathroom too? (I only see the one break at 03:45.) What was your AHI prior to treatment?

I'll defer to the experts, but it seems to me like it would be reasonable to bump the max up to 11 to see what happens.

I'd keep an eye on those centrals, though. They don't look to be sleep-onset, and they might get worse with higher pressure. If they do, it might make sense to keep the max lower, maybe even try it down at 9. It may be that 9 is enough to cope with most of the apneas and hypopneas without inducing centrals.

How long are the centrals you're experiencing?

[oak]

i have questions too, but mainly right now i am asking about that max pressure setting.

I laid awake from 22:00 to 0:15. this is typical for me as I have insomnia. working on getting some med changes which hopefully will help.

yes the centrals are always when sleeping not at sleep onset.

some of the centrals previously looked like they lasted up to a minute. these on this current date are shorter, like 10 seconds long. will keep an eye on them.

i am also concerned because my pulse rate went up to 140 at times during the sleep study. cant afford an oximeter so will ask my new docs recommendation about that.(I have history of bypass and stents) old doc was not competent. i didn't ask about pulse rate because she wouldn't have had an answer.

i forgot what else you asked so if i missed anything let me know. oh ps: my untreated AHI was 46 or thereabouts. oh: about the setting of 9: i had centrals when set at a constant pressure of 9 for the first month of treament, too. no difference in the number of centrals, at least for this one night on auto.

[RandyJ]

Centrals can be a factor with certain anti-anxiety meds etc, so if you up the pressure to 11 and have even more centrals, you'll have to reevaluate.

[oak]

do you mean anti-anxiety/antidepressants can CAUSE centrals? i will be reducing antidepressants due to insomnia (i hope) at the end of August.

[sawinglogz]

i am also concerned because my pulse rate went up to 140 at times during the sleep study. cant afford an oximeter so will ask my new docs recommendation about that.

I got the CMS-50D+ for $70 (note the "+", the regular CMS-50D does not do overnight recording), which works fairly well but is uncomfortable after a few straight nights (being a clip-on). There are some slip-on models on that page as well, but they're more expensive.

If you have cardiac concerns, it's definitely worth getting an oximeter to make sure the few apneas and hypopneas that remain aren't so severe as to cause major pulse spikes.

i had centrals when set at a constant pressure of 9 for the first month of treament, too. no difference in the number of centrals, at least for this one night on auto.

Given that they don't seem worse at 10, and they're all fairly brief (10s or less), I don't see any reason not to try a max of 11 while you keep an eye on those centrals. I would try it if I were in your shoes.

Insert the usual disclaimer about not being a doctor, not being medical advice, etc.

[RandyJ]

do you mean anti-anxiety/antidepressants can CAUSE centrals? i will be reducing antidepressants due to insomnia (i hope) at the end of August.

There was a thread here a few months ago about drugs that affect the central nervous system and central apneas, so I believe the relationship can be causal. I'll do a bit of searching and see if I can find it...

That said, if your central index is less than 5, it's generally not something to be concerned about.

[RandyJ]

Here is one possible thread I was thinking of. The discussion was about Klonopin specifically:

viewtopic.php?f=1&t=81824&p=776520&hili ... ea#p776520

[oak]

thanks Randy, I have taken Klonopin and Xanax and other anti-anxiety meds before but do not take them now due to brain fog issues and because anxiety has subsided. I know they have CNS effects. SSRI and SNRI antidepressants are what i am taking now and what i am trying to get off of due to insomnia issues. dont know if they have CNS effects and would therefore cause or contribute to Central Apnea events, but I hope to find out at the end of August when I see my pdoc, as i am virtually convinced now that Effexor is contributing big time to my insomnia of two hours per night. I refuse to ADD meds to get to sleep, and of course that will be what he first recommends, being an MD and all