Newbie, help. Bipap Numbers Scewing To Centrals?

[PatriotPartner]

Just Joined. Bipap Aircurve 10 AUTO. 16/12 Pressure.

Just loaded sleepyhead

SYMPTOMS: After 2 years good compliance at around 2 or 3 AHI, suddenly Ive got major headaches and breathing problems.
My heart checks out good, but I do have asthma, which has been "mild" so far.

NUMBERS:
LAST 30 DAYS COMPOSITE AVERAGE

AHI 9.1

CENTRAL A1 7.5 (never had central numbers show up before)

Ti 1.35 IE1-1.8 Sportcyc 98.5% RR16 mv 9:5 L/min

QUESTIONS
1. I increased the Pressure today to 18/14. ??? Smart?

2. What might cause sudden centrals?

3. Is it possible my mask is leaking even though it says compliant???

4. My AIRCURVE can be set to AUTO. Good idea? What pressures?

*****Note, Im trying to get an emergency consultation and sleep test.
Last one was 3 years ago.
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[PatriotPartner]

OK. I was able to get data for a BAD day with AHI high and UNSPECIFIED APNEAS.

AHIApnea Hypopnea Index 11.61
ResMed AirCurve 10
VAutoModel 37051 - 23172423058
PAP Mode: VPAP-S
EPAP 12.0 IPAP 16.0 (cmH2O)
Date Sleep Wake Hours
2/5/2019 12:59:00 08:37:00 08:25:00
Large Leak 0.00%
Clear Airway 3.82
Obstructive 5.84
Unclassified Apnea 1.91
Hypopnea 0.04

Event Breakdown

Statistics
Channel Min Med 95% Max

Please Note This day just contains summary data, only limited information is available .
Machine Settings

ModeCPAP Mode VPAP-S
EPAPExpiratory Pressure 12.00 cmH2O
IPAPInspiratory Pressure 16.00 cmH2O
PSPressure Support 4.00 cmH2O
Session Information

[Pugsy]

Welcome to the forum.

The bulk of the AHI shown appears to be obstructive in nature...about 2/3 OAs and hyponeas and 1/3 central.

Usually more pressure is what we suggest for the obstructive stuff....now the centrals won't necessarily reduce with more pressure so we just keep an eye on them and see how many you have once the obstructive stuff is reduced.

If it were me I would change over to auto mode and do EPAP min 12 and PS of 4 and make IPAP max 25 and see what the machine wants to do. You may only need more pressure part of the night instead of all of the night. Just give the machine some room to do what it is designed to do and see what happens. You will start the night out with 12/16 like you are used to and then once asleep the machine takes over and increases or decreases as needed.

As for why the apparent change in AHI....gained weight??? Change in meds??? Sleeping more on your back???
Could be any number of things.

[PatriotPartner]

Great idea, but what exactly is PS 4??
Should be in the clinicians menu easy enough to change.

Tonight I'll either go with the increased pressure, or
take your idea for AUTO 25/12

See what it spits out tomorrow.

Thanks.

Do BIPAP number USUALLY eventually need to be increased provided no
other changes?[/color][/size]

[Pugsy]

PS is nothing but the difference between EPAP (exhale) and IPAP (inhale) so with your S mode settings of 12/16 that means PS is 4.
You don't see it but it's there by default.

In Auto mode there is a setting for PS to be set at that you can see.

Pressure needs changing like yours seem to have changed...usually if it is just age and saggy tissue related it's more of a gradual change if it changes at all.
And I haven't seen any of your old reports either.

It might simply be that you are sleeping more on your back now than you used to for some reason. It's common to need more pressure when we are on our backs...or maybe sleeping better and getting more REM sleep where pressure needs can change sometimes a lot.
Medications can also impact the airway patency sometimes...muscle relaxers or some pain meds or even some anti anxiety or depression meds can impact things.

[palerider]

ANNOYING FORMATTING

Do please stop screwing with the formatting.

[PatriotPartner]

Thanks, sorry for the formatting, I prefer larger fonts and in blue color.
Easier to read than this cryptic spidery mess mostly read
by older people.

PUGSY, I did what you said. AUTO Bipap. 25/12 range.

RESULTS: Data shows i need just under 18 IPAP, and 14.4 Epap.

1. Most obstructional apneas now gone, but getting about a 3 AHI for "centrals"

2. Is 3 a manageable number for centrals?

3. I still feel pretty crappy waking up most days

4. I seem to go into centrals only about an hour into sleep, in REM?
The first hour is perfect.

[Pugsy]

From what I have read REM isn't normally associated with centrals unless maybe they are post arousal centrals that get flagged from the normal to have happen wake up that people can have at the end of a REM cycle.

How many centrals are considered "too many" and warrant concern....doctors won't do much except shrug their shoulders until people are seeing at least 5 per hour average...every hour through the night...and every night.
Having 2 or 3 clusters of centrals during the night with long periods of no centrals in between but the density of the clusters brings up the average...would need to see the pattern of those clusters first. There's more to this stuff than just a number...there's when they occurred and how often and how prolonged.

Now there are situations with some people (very small minority) where the Pressure Support can actually trigger centrals so if you are seeing the centrals pretty much spread out over the entire night then it wouldn't be impossible for PS to be a factor in your centrals.
To experiment with reducing the PS would be an option to try if the centrals worry you a bit. 3 per hour normally worry a doctor though.

First you need to determine if the centrals are real or not...go here and watch all the videos.
http://freecpapadvice.com/sleepyhead-free-software
If you weren't asleep....doesn't matter how many you had because you have to be asleep for them to matter.
If you weren't asleep...then we look at why you weren't asleep for figuring out how to optimize both your therapy and sleep quality.

If you aren't feeling so great...the first thing I usually look at is the sleep quality itself and go from there. If your sleep quality is off...you are going to feel like crap no matter the AHI.

[palerider]

Thanks, sorry for the formatting, I prefer larger fonts and in blue color.

If you want large fonts and blue color then change your browser defaults, and the world can be your oyster... and the rest of us can read in peace

2. Is 3 a manageable number for centrals?

3. I still feel pretty crappy waking up most days

4. I seem to go into centrals only about an hour into sleep, in REM?

2) yes.
3) give it some time.
4) Maybe just some disturbed sleep.

[PatriotPartner]

Thanks Pugsy. I appreciate you. This stuff is literally life and death, not like some gossip board of no consequence.

1. Brilliant. Exactly. The "clusters" or severity of events is just as significant and valid and catastrophic as the averages.
I mean, I might be asleep 7 hours and average a 3 centrals.....but the centrals predominantly occur in that last hour.

Which
could mean actually a 21 for that hour, in other words, youre NOT breathing---youre getting waterboarded, you are damaging
your autonomic nervous system, and you may feel out of breath all day.

2. Other Triggers: Yes. This stuff is all syngergistic. Looking for the underlying cause of something can get quite complicated.
We mostly think of Symptoms.

Example: I was eating prunes last night out of a bag (eat a few a day). I read the label today. it says
"Preserved by potassium sorbate...". Which when you google it can CAUSE all kinds of other problems,
and who is to say that it doesnt contribute to "centrals" via some other path?

[Pugsy]

I might be asleep 7 hours and average a 3 centrals.....but the centrals predominantly occur in that last hour.

Which could mean actually a 21 for that hour, in other words, youre NOT breathing---youre getting waterboarded, you are damaging
your autonomic nervous system, and you may feel out of breath all day.

I wouldn't automatically assume that they were the real deal but instead I would take the time to evaluate the events to see if they looked like they were flagged when I was really asleep or if I was awake or not.
Remember they only matter if you are asleep. Awake flagged stuff simply doesn't count.
Awake breathing is highly irregular when compared to asleep breathing. We pause our breathing all the time while awake and don't ever notice it and it doesn't hurt us. Hold your breath for 10 seconds...that's a 10 second central apnea...did it hurt you to do it?

It's quite common to have periods of time where we were awake or semi awake during the last hour of the night (or the beginning of the night too) and the machine only measures air flow...it has no way to know if you are asleep or not or if that irregular breathing it wants to flag is awake breathing or asleep breathing.

When I see a large cluster of anything at the beginning or ending of any known awake time...my first thought is SWJ sleep/wake/junk and it doesn't matter except that it points to not being fully asleep. If we aren't asleep....none of what we see pertains to sleep apnea.

[Pugsy]

BTW.....depending on the operating system and browser on your computer and how you set up the viewing you can alter how you see it without altering how we see it.

I changed my viewing to much larger fonts than normal because that's why my eyes need. So while I see it larger...it doesn't force you to see it larger as well.

When you change the font size to your preferred larger font....they get massive on my end. When I see it they take up half the screen with just 2 lines. Highly annoying.

If you don't like how you see the text here....change the viewing size of the page....it's rare that I loose my preferred magnification.
Keep zooming in until you get the text the way you want it.

I make this

fonts zoomed out.JPG

Look like this on my end and I don't force you to see my preferred font size.

fonts zoomed in.JPG

[PatriotPartner]

I edited all the text down to black normal.

On AUTO.......my pressures are going to 19 now (and 15 exhale). The machine is trying to do its job.

**My "events" are so awful, that it involves not breathing for about 45 seconds and then
falling out of bed, ripping the mask off, not knowing where i am, and
being waterboarded.

I dont really carry about 'averages".

Its all the isolated events of cessation of breathing and being thrown awake.

It takes me a solid hour to feel human after those.

[palerider]

I edited all the text down to black normal.

You missed one: viewtopic.php?p=1294944#p1294187

Let's see some screenshots.