Newbie's first post-Sleep Onset Central Apneas & Other ?

[riley525]

I tried your idea, Robysue. I lowered my PS Min from 4 to 2 & raised the Epap to 8. While I did have too many obstructive apneas, I had the fewest number of Centrals ever. The iPap did not get stuck either. I have had the 4 bipap difference since I began this fun in September. But one night is not enough to see if there is a true pattern here yet.

[robysue]

I tried your idea, Robysue. I lowered my PS Min from 4 to 2 & raised the Epap to 8. While I did have too many obstructive apneas, I had the fewest number of Centrals ever.

What was the AHI and what was the breakdown into OAI, CAI, and HI?

But one night is not enough to see if there is a true pattern here yet.

You are correct. You need at least 3 or 4 nights, and probably more like a week or so of data to really detect a meaningful trend.

[riley525]

7.3 ahi, 4 C, 31 O, 12 H.

[robysue]

7.3 ahi, 4 C, 31 O, 12 H.

Even though this AHI is still a bit too high, I'd leave the settings where they are for a few more days to see if the obstructive events remain a bit too high, but the CAs stay nice and low.

If the AHI is still too high because the OAI + AHI > 5.0 after about three or four nights of using the new settings, it's time to tweak the settings. At that point I would recommend doing nothing more than a 0.5cm increase in the minimum EPAP pressure setting while leaving the max IPAP pressure alone. If the after using that change for 3-4 days, number of CAs remains low and the OAI + AHI > 5.0, then increase the minimum pressure setting by 0.5cm again.

In other words, as long as the number of CAs remains low, you can try increasing the minimum EPAP pressure setting by 0.5cm every 3-4 days until you get the overall AHI < 5.0. I would only increase the max IPAP when the max IPAP - min EPAP = 3.0. But that's just me; others would say to increase the max IPAP along with the min EPAP.

I would encourage you to make one very small change to the min EPAP every 3-4 days simply because if you increase the min EPAP pressure setting too much or too frequently, you may just wind up back where you started with a whole bunch of CAs.

[riley525]

So I have gradually increased my EPAP to 9 and my AHI numbers have been at or below 5 for the last 8 days. 3 days were at 1 or less. Last night I had a bad stretch of about 15 minutes. With 17 obstructive during that timeframe, a 24 second one and 3 or so around 15 seconds long. Also had the periodic breathing flags during that time. Below is an overview shot of the whole night and a zoomed in shot of part of the bad section. Since I have been on the machine, I have had a couple days a week with these bad sections. Now with my higher settings the bad sections are not lasting as long and so far happened only once this week. My centrals have been down too, yeah! Should I tweak my settings to reduce the bad section? I probably was on my back instead of my side. Raise the max IPAP from 18 to 20? Raise the max pressure from 4.5 to 5 or? I have been waking up when the pressure gets to 18 but I might have anyway because it only is up that high when things are bad. Dealing with minor air swallowing issues due to increased pressures but nothing too bad. Been feeling great, lots of energy! Thanks for your thoughts!

[Pugsy]

I think if it were me I would just increase the max IPAP and see what happens.
I don't think increasing the PS to 5 will help much. I think more EPAP is probably the ticket and with the machine being able to go higher with IPAP then EPAP will get pulled up along with IPAP. I don't see the need to do more EPAP over the entire night though...just let IPAP go up and it will drag EPAP up only when needed.
The machine won't go up to the max unless it thinks it has a good reason and obviously it thinks it has a good reason.
Should the increase cause more aerophagia issues that creates a significant problem then I would back off and just let these ugly (but short lived) clusters slide by since they aren't happening all that often and you report feeling good.
If you were seeing multiple ugly clusters each night or every night instead of once or twice a week then maybe a different discussion.

If it were me I would at least try letting the machine fight with more ammunition during these ugly cluster times.
So the only thing I would change would be max IPAP.

[riley525]

Thanks, Pugsy. I will try raising the max IPAP. It's just weird how a person can have 5 or 6 good nights and one bad one, for no obvious reason...

Also, is there a website you can recommend that you can buy a new mask without a perscription? Thanks!

[OkyDoky]

Also, is there a website you can recommend that you can buy a new mask without a perscription?

Not Pugsy here, but I have bought mask parts on Ebay and CPAP.com and you can put them together. And I have bought full masks on Amazon. All without an RX. I do have my RX but with these it was not required.

[riley525]

Thanks OkyDoky! I don't have a copy of my perscription, they just contacted my DME. I don't really want to deal with the doc until I get my pressures nailed down. I am not sure how happy they will be that I have tweaked it myself.

[palerider]

Thanks, Pugsy. I will try raising the max IPAP. It's just weird how a person can have 5 or 6 good nights and one bad one, for no obvious reason...

that's because there are a large number of variables involved in this equation. getting good sleep is not a simple thing.

[Pugsy]

Check EBay for whatever replacement parts you need or if you are wanting the entire package you might check Amazon.
If you are wanting a totally new mask...you can build a complete mask easily with EBay parts (but you need to know all the parts) or you might find a complete package on Amazon.

[Okie bipap]

I have purchased several masks on eBay. If you look carefully at what they have listed, you can often find complete masks for sale.

[riley525]

Thanks to your help, I had my first week with no Ahi's above 5! However, they have been replaced with flow limitations. I had about 17 FLs during my 7.5 hours of sleep last night. I had about the same number the night before. What adjustments do people make for an increase in flow limitations?

[robysue]

Thanks to your help, I had my first week with no Ahi's above 5! However, they have been replaced with flow limitations. I had about 17 FLs during my 7.5 hours of sleep last night. I had about the same number the night before. What adjustments do people make for an increase in flow limitations?

It really depends on how you're actually feeling and wether the FL genuinely contribute to feeling bad. And keep in mind that 17 FL in 7.5 hours of sleep is only 2.27 FL/hour, which may not be enough to be an issue.

But if they bother you, you can try bumping the minimum pressure up by 1cm for a few days. If the FL are real and represent an airway in danger of collapsing, there should be less of them. If the number of FL go down with the increase in min pressure, you can try bumping it up again in another few days. However, if the number of FL remains about the same after 1 or 2 increases to your min pressure, then they might not actually be real and more pressure may not do a damn thing to fix them.

I've learned that mo matter where I set my min EPAP and max IPAP, the FLs are probably going to remain about the same, but they're going to keep driving my IPAP up to max IPAP and that will trigger the aerophagia. So I tend to just not worry too much about them.

[riley525]

My AHI numbers have been below one if I wear the foam collar, with no foam collar they hop back up to 3 to 5. I have kept my settings the same for the last 2 months. My question has to due with the constant up and down of the IPAP as shown in the attached chart. For the most part it goes from 11 to 13 all night. It doesn't wake me up or anything but wondered what your thoughts are on this.