What To Do? Self Titrating

[Pugsy]

While it is commonly thought that IF (big if) pressures are going to trigger centrals that it is higher pressures that do the triggering, it isn't necessarily written in stone. Often if a person is going to have centrals as a respond to cpap pressure it can and will happen at lower pressures too. I have seen a truckload of centrals at a pressure of 5 too.

For now I don't think your centrals are related to pressure at all. I think that they are most likely related to the machine flagging awake/semi awake breathing irregularities as centrals.
Let's see what happens when the obstructive stuff (those OAs and hyponeas and snores and Flow limitations) are better prevented and you need more baseline pressure to do that. It's very possible that those centrals are related to arousals or maybe even sleep onset (where a central happening is normal and we don't worry about them unless we see a truckload of them and you never can get to sleep).

Fix what is known to need fixing and see what's leftover. We don't fix centrals with this type of machine but at this point I don't see the centrals as needing fixing anyway. I know that you were concerned about centrals even before you decided to do the DIY thing but I don't think (at least from what is seen here) that even if all your centrals were the real deal that they warrant doing anything any differently at this stage.

For people reading this thread....OP is doing the DIY thing for diagnosis and treatment. No formal sleep studies to draw upon.
I think the diagnosis part is pretty clear. The machine wanting the pressure to go up there and stay up there is pretty clear in terms of obstructive apnea. It want's to try to prevent airway collapses. Now we just need to tweak the pressures so that things are more optimally addressed and then see what is leftover in terms of potential centrals that might or might not be troublesome.

Remember...some centrals are normal anyway and we don't worry about them even if they are the real deal.
Centrals are only a problem if they present themselves in large numbers or cause desats or cause a person to not be able to transition to sleep.
Since the machine will also flag awake/semi awake breathing irregularities as centrals, we also have to remember that as a total newbie to this therapy it is possible that multiple awakenings are increasing the central count and the centrals may not even be a "real" central.

[palerider]

Should I be concerned with raising it too much, too fast with the Clear Airway events? I've been reading higher pressures can induce Centrals?

Okay. I'll give it whirl, pale.

as lsat and pugsy said, the pressures are already up there, and you shouldn't worry about compSA until it actually presents itself. so far, you've had relatively few centrals, and, as pugsy says, it's more likely just effects of your starting to get used to treatment.

if it were me, I'd set max pressure at 20 to get more data sooner, but I can quite understand if you want to take it slower.

I'm thinking you may end up with a minimum of 11 or more, but that's just a guess at this point

[squid13]

If you set it to 20 it will only go as high as it needs to go. Just because it's set to 20 doesn't mean that it's going to go there. I totally agree with PR.

[Pugsy]

The original max setting of 12 was just to get an idea where the pressure wanted to go and limit wild changes just in case big changes caused sleep disturbances. Gotta get the sleep first to see what is going on when we sleep.

The max is being pegged out for the bulk of the night though and thus it does warrant an increase along with the minimum pressure. It's possible that with more minimum pressure better preventing the airway collapse that the machine may not need so much maximum but it hurts nothing to open the max up and see where the machine wants to go now that we for sure know that this person most likely has OSA.
The machine won't go where it doesn't think it needs to go without a good reason. Limiting the max would be a possibility if it is determined that when/if the machine wanted to go higher that the going higher caused a problem (like centrals or aerophagia or sleep disturbances) so cross that bridge if and when it needs to be crossed.

So I would also open the max to 20 and see where it wants to go and if it causes a problem then consider limitations if the need arises.

[joeshmoe90]

A few things:

I can't find the Flow Limitation Graph. Is that a problem?
I set the machine to 9.0 min and 15 max, but the data shows it set at 6 and 15 still. Edit: 12, not 15
Also it looks like the day/date is behind. How do I change that?

As far as changing the pressure and how I slept...meh. Definitely a noticeable change though. It seemed harder to fall asleep and I think I woke up a lot. But I assume that's to be expected. I had ear pressure to the point that I had to pop them after waking. I got used to eventually.

The first session with the machine, I woke up feeling FANTASTIC. Odd, considering it was set so low. I hardly felt any pressure prior dozing off. I literally jumped out of bed, made coffee and went to work on laminating and routering a counter top that we have been putting off for at least 2 years. I haven't had that much sustained energy in quite some time. Now, I back to feeling kinda "blah". I know. I takes time.

[Pugsy]

Respironics machines don't do flow limitation graphs. Instead FLs are flagged in the top Events graph on the right.

If this is last night's report you just posted dated July 13 then the date is correct. It's dated as to when the therapy session/sleep was started. Looks like some early brief segments yesterday afternoon/evening to test things briefly with major sleep session starting at around 10 PM.

[joeshmoe90]

I was testing it during the day, but I didn't actually go to bed and close my eyes until after midnight this morning. Oh wait.... I was online and watching TV with the mask on around prior to midnight. I guess I should be removing the SD Card when I'm sitting around testing the mask and pressures so it doesn't look like I'm trying to sleep?

[Pugsy]

Removing the SD card won't totally prevent awake TV watching machine use showing up on the reports because as soon as you put the SD card back in the machine the machine will put everything but flow rate graph right back on the SD card.
It's best to just make a mental note of the times when you know you were awake and maybe just mention it when showing your reports images...like in this one from last night...real sleep never happened until around the 12:30 AM segment began.

[joeshmoe90]

Got it. Bring on the night!. LoL

[joeshmoe90]

Didn't do so good this time. Could only keep the mask on for a few hours. I kept waking up while on my back. Turned over onto my stomach for a while towards the end, but that turned into leaks galore. Shut the machine off and fell asleep on my frontside.

[joeshmoe90]

Hey, guys.

When would I need to use the ramp feature?

[Julie]

If when you put on the machine you find the scripted (low auto setting, or plain Cpap) pressure too much to manage right away, you hit the ramp button to start the pressure lower and gradually it works up to the set pressure over whatever time period you program in... getting you used to the blowing, though depriving you of the full pressure effect therapeutically til it levels.

[tedburnsIII]

Would it be at all helpful to see a Respiration chart/graph (if such exists with SH) to determine if OP was breathing during the numerous Clear Airway/mixed apnea events reported?

[palerider]

Would it be at all helpful to see a Respiration chart/graph (if such exists with SH) to determine if OP was breathing during the numerous Clear Airway/mixed apnea events reported?

ap·ne·a ˈapnēə,apˈnēə/
noun Medicine
temporary cessation of breathing, especially during sleep.

[Pugsy]

Would it be at all helpful to see a Respiration chart/graph (if such exists with SH) to determine if OP was breathing during the numerous Clear Airway/mixed apnea events reported?

That would be the flow rate zoomed in on a breath by breath in SleepyHead or wave form graph in Encore.
I wasn't going to both with those yet until he reports actually getting good solid blocks of sleep which he isn't getting now.

There's a real good chance that those CAs/centrals are awake/semi awake breathing artifacts because he is having a LOT of wake ups from general adjustment to all this.
I already asked about those 2 particularly ugly clusters..the first one right about 1:00 and we think that he wasn't yet asleep and the other at 2:45 he reported that he was likely awake.

The first to short sessions shown he never went to sleep..

The wave form/flow rate will definitely show a reduction/cessation of air flow but it's difficult to determine wake status from the air flow graphs. It takes a practice eye to tell the difference and mine isn't that practiced (that I am all that comfortable with stating with any certainty).
But sense he is reporting numerous wake ups fiddling with the mask and stuff...we know there's a lot of awake/semi awake SWJ (Sleep/Wake/Junk) already and until he can say I slept a solid so and so time frame it really wouldn't help much to look at it.

At this point he is slowly increasing the minimum because raising it quickly caused sleep problems too. Just not comfortable and was fighting breathing with the machine.
We are keeping an eye on the centrals/CAs but not too worried at this time because there's a logical reason for them at this time. Will worry later if they are still present and no logical reason for them.