Change pressure settings yourself during compliance period?

[dream321]

The bulk of your AHI on this report above is ClearAirway/Central and more pressure won't fix it with your machine and could potentially make things worse.

Instead you need to try to figure out if those CAs/centrals are real or if they are awake/semi awake breathing irregularities getting flagged by mistake.

Do you have a lot of wake ups and awake time spent with the mask and machine on? In other words are you sleeping soundly or waking often fiddling with things???

I can't see the machine's actual settings...the pie chart is in the way (turn it off in Preferances/Appearance tab).

Looks like you are using Flex at maybe 1 or 2 and ramp starting at 4 cm for a short period of time.
What are the machines actual settings? Minimum and Maximum??

My settings are 6-16cm and I have it set on auto-ramp. I do notice that I do move around a lot as I sleep, and also adjust the mask. I might be doing things unconsciously while I'm sleeping too. My sleep study had no central sleep apneas, yet I never got beyond stage 2 sleep (didn't sleep much, I was very uncomfortable), and I have plenty of REM at home.

[Guest]

I do move around a lot as I sleep, and also adjust the mask.

Each nite before bed set to your highest pressure used. Don the mask and lay in your sleeping position then with air pressure on adjust the mask so it doesn't leak. The straps tend to stretch over time so adj. may be needed in the future.

[ajack]

if it was my chart, I'd run 10 minimum because of the OA and max 13, the 95% because of the CA.
I'd keep this number till my CA settled down, if they werent there originally, they are probably from 'new to cpap' pressure and will settle within 1-12 weeks. then readjust the pressure, to give a higher range.

[dream321]

if it was my chart, I'd run 10 minimum because of the OA and max 13, the 95% because of the CA.
I'd keep this number till my CA settled down, if they werent there originally, they are probably from 'new to cpap' pressure and will settle within 1-12 weeks. then readjust the pressure, to give a higher range.

Is it common to have CA in the beginning?

[chunkyfrog]

Yes, quite frequently.
We are awake more than usual when we are finding our "cpap groove".
If we are not asleep, our uneasy breathing, sometimes called "sleep-wake junk" can be registered by the machine as open apnea..

[Pugsy]

Is it common to have CA in the beginning?

Yes and no and depends on if the CAs/centrals are "real" or not.

First the cpap pressure triggering centrals...those would be real centrals and it can happen in 10 to 15 % of the people put on cpap.
Commonly thought of as maybe being related to higher pressures but it can happen just as easily with pressures as low as 6 cm.
Sometimes it will go away on its own but normally will take several months not a couple of weeks..if it goes away at all.
For those people cpap seems to trigger some breathing instability where they blow off too much carbon dioxide and the levels don't build up like they should to tell the brain to send out the "breathe" command. People often think it is the oxygen levels in the blood that dictate the brain telling the body to breathe but it's really carbon dioxide levels instead. The CO2 levels have to get to a set point before the brain wakes up and tells the body to breathe.

It's normal to see a few centrals on these reports...it's normal to have what we call a sleep stage transition central or sleep onset central.
These are real and normal and not usually a problem unless a person keeps having them so often they keep getting bounced out of sleep.

Hold your breath for 10 seconds...that's pretty much the way the central works...no air is moving but the airway is open.
When we are awake/semi awake and tossing and turning our breathing is much more irregular than when we are sleeping. These machines can't tell if you are awake or not....they just measure air flow so sometimes that awake/semi awake irregular breathing will cause the machine to flag some sort of apnea event and most commonly...central but it can get confused and call it OA sometimes.
We call these apnea flags occurring while awake or semi awake as SWJ...Sleep/Wake/Junk.
While it can sure mess up the AHI numbers and make it hard to evaluate things we have to mentally remove any SWJ numbers from our evaluation process. Problem being that sometimes it's hard to distinguish subtle differences between awake and asleep for some people.

I don't normally get too excited when a newbie comes here with some sporadic centrals like yours. Especially when they are so knew that they are still in the wake up easily fiddle with the mask part of things. Heck I think it took me 3 months to stop waking up 20 times a night just to feel the mask on my face.

We could go into a lengthy discussion about zooming in on the flow rate breathing pattern to see if it looks like SWJ or not but that's a lot of work and not always easy to spot and since we already know there's a good chance it's SWJ...wait and see what happens once you are sleeping more soundly is usually what I suggest. If those centrals are SWJ centrals once you are sleeping more soundly they will probably reduce considerably.
If they don't or they worsen then we have a different discussion but your doctor would still want to give it time anyway because sometimes even the real centrals will go away once the body doesn't respond with the unstable breathing that triggers the centrals in the first place.

So we don't totally ignore the centrals...but we don't panic either....we keep one eye on them all the while continuing working on treating the obstructive stuff optimally and cross our fingers that the centrals reduce on their own.

More pressure won't reduce your centrals and I don't know that you need more pressure for the obstructive stuff...might not hurt to try a little higher minimum since once your pressure goes up it tends to stay up there anyway...maybe reducing the obstructive stuff might impact the centrals IF (big IF) the centrals are related to an arousal caused by an obstructive event. I have seen it happen.
I don't know that your centrals are post arousal centrals...but it wouldn't be impossible.

[ajack]

It's common enough and some have it bad. I would think your 7 an hour isn't that bad for now. all the machine knows is your breathing paused without obstruction and you had a clear airway at the time, which may or may not be a real central apnea.
early adaption to cpap can have excess o2 and the co2 has to build up, before a breath is triggered. Others can be a deep breath followed by a pause.
zoom in on each clear airway and see what they look like. you could post your sleephead chart.

[zoocrewphoto]

It looks like it is automatic so why change them at all ?

Automatic does not mean perfect settings. Having a start pressure that is too low can mean that lots of events sneak through while the machine slowly gets up to the needed pressure. Having a max too high could allow the pressure to become uncomfortable. Having a range too wide could mean lots of ups and downs which tend to both some people. Lots of reasons why a set range might be bad for one person if it works well for somebody else.


This person's ahi is double the medical ahi for treated, and most people do better under 2 or 3. Getting an ahi of 10 is better than untreated, but is not good.

Clearly, the settings are not ideal yet. Why make the person suffer when some tweaking of the settings can produce much better results? Lots of people quit cpap because they can't get comfortable with the cpap, or they don't feel any better within a few weeks. This is the most important time for them to be successful. Just because most doctors insist on them waiting, doesn't mean that WE can't help them succeed.

[palerider]

I want to change the setting to start out higher because most of the apneas start in the single digits. So I'm thinking changing it to 10cm-16cm

you're on the right track

however, I'd also turn down the EPR setting.

[dream321]

This person's ahi is double the medical ahi for treated, and most people do better under 2 or 3. Getting an ahi of 10 is better than untreated, but is not good.

Clearly, the settings are not ideal yet. Why make the person suffer when some tweaking of the settings can produce much better results? Lots of people quit cpap because they can't get comfortable with the cpap, or they don't feel any better within a few weeks. This is the most important time for them to be successful. Just because most doctors insist on them waiting, doesn't mean that WE can't help them succeed.

I'm not suffering. I haven't felt so rested in 25 years, even with having AHI 10 (if it's really actually that) This machine is a blessing. I want to make sure I'm getting proper treatment from it nonetheless.

[zoocrewphoto]

This person's ahi is double the medical ahi for treated, and most people do better under 2 or 3. Getting an ahi of 10 is better than untreated, but is not good.

Clearly, the settings are not ideal yet. Why make the person suffer when some tweaking of the settings can produce much better results? Lots of people quit cpap because they can't get comfortable with the cpap, or they don't feel any better within a few weeks. This is the most important time for them to be successful. Just because most doctors insist on them waiting, doesn't mean that WE can't help them succeed.

I'm not suffering. I haven't felt so rested in 25 years, even with having AHI 10 (if it's really actually that) This machine is a blessing. I want to make sure I'm getting proper treatment from it nonetheless.

If you are doing great, why ask about changing your settings now rather than waiting for the doctor appointment? It sounded like something was bothering you, and you wanted to go ahead and fix it now rather than wait.

[dream321]

If you are doing great, why ask about changing your settings now rather than waiting for the doctor appointment? It sounded like something was bothering you, and you wanted to go ahead and fix it now rather than wait.

Because it was bothering me. 10 AHI is considered to be apnea that needs treatment.