Tyrone747's therapy

[palerider]

A pretty good night of sleep last night after I'm getting over a cold. I'm still getting a decent number of centrals but most of them are arousal related. Sometimes they aren't though so I'm wondering if perhaps I might have a case of mixed apnea?

If your *central* apneas are under 8 an hour or so, I don't even feel it's worth paying attention to, because they're not stressful to your body, like obstructives are.

Now if they're all happening post arousal, then maybe a little more pressure, if you're having flow limitaitions, might help.. or other things that might be disturbing your sleep.

[tyrone747]

A pretty good night of sleep last night after I'm getting over a cold. I'm still getting a decent number of centrals but most of them are arousal related. Sometimes they aren't though so I'm wondering if perhaps I might have a case of mixed apnea?

If your *central* apneas are under 8 an hour or so, I don't even feel it's worth paying attention to, because they're not stressful to your body, like obstructives are.

Now if they're all happening post arousal, then maybe a little more pressure, if you're having flow limitaitions, might help.. or other things that might be disturbing your sleep.

Thanks. Most of the centrals are post arousal. Do the flow limitations on that chart look 'bad' enough to cause arousals? One thing I've noticed is the higher EPR setting I run the less flow limitation I get. Does this indicate anything or is it normal?

[palerider]

A pretty good night of sleep last night after I'm getting over a cold. I'm still getting a decent number of centrals but most of them are arousal related. Sometimes they aren't though so I'm wondering if perhaps I might have a case of mixed apnea?

If your *central* apneas are under 8 an hour or so, I don't even feel it's worth paying attention to, because they're not stressful to your body, like obstructives are.

Now if they're all happening post arousal, then maybe a little more pressure, if you're having flow limitaitions, might help.. or other things that might be disturbing your sleep.

Thanks. Most of the centrals are post arousal. Do the flow limitations on that chart look 'bad' enough to cause arousals? One thing I've noticed is the higher EPR setting I run the less flow limitation I get. Does this indicate anything or is it normal?

Based on the fact that most of your centrals are post arousal, and they're happening when you're having flow limitations, I'd say that it's probably a good chance that they are related to the extra effort in breathing that flow limitations cause.

more pressure support can help with flow limitations (and EPR is, essentially, pressure support).

I'd suggest you keep edging the pressure up to reduce the FLs. they may be happening during REM cycles, and you may need more pressure at those times.

[tyrone747]

Based on the fact that most of your centrals are post arousal, and they're happening when you're having flow limitations, I'd say that it's probably a good chance that they are related to the extra effort in breathing that flow limitations cause.

more pressure support can help with flow limitations (and EPR is, essentially, pressure support).

I'd suggest you keep edging the pressure up to reduce the FLs. they may be happening during REM cycles, and you may need more pressure at those times.

Sounds good. How does pressure support help flow limitations? Is a flow limitation a calculated average of the resistance on the inhale and exhale so if you lower exhale resistance the flow limitation number goes down?

I'm right at the ragged edge of aerophagia territory so tonight instead of 9 EPR2 I'm going to try 10 EPR3. My titrated pressure is 7 so that should work well, both for my apnea, and as well as keeping the exhale pressure the same (7) for my aerophagia.

[palerider]

Based on the fact that most of your centrals are post arousal, and they're happening when you're having flow limitations, I'd say that it's probably a good chance that they are related to the extra effort in breathing that flow limitations cause.

more pressure support can help with flow limitations (and EPR is, essentially, pressure support).

I'd suggest you keep edging the pressure up to reduce the FLs. they may be happening during REM cycles, and you may need more pressure at those times.

Sounds good. How does pressure support help flow limitations? Is a flow limitation a calculated average of the resistance on the inhale and exhale so if you lower exhale resistance the flow limitation number goes down?

Flow limitations are a restrictions on flow *rate*, not necessarily flow *volume*. The pressure increase during inhalation can help increase that rate, and thus reduce the amount of limitation.

I'm right at the ragged edge of aerophagia territory so tonight instead of 9 EPR2 I'm going to try 10 EPR3. My titrated pressure is 7 so that should work well, both for my apnea, and as well as keeping the exhale pressure the same (7) for my aerophagia.

The extra pressure on inhale (10 vs 9) should help with the flow limitations.

[tyrone747]

Wew. Well that didn't work. Worst night I've had for centrals. I'm not sure if it's just the pressure increase, or the EPR increase, or both. I actually don't feel that bad this morning for how unstable my breathing was on paper. I'm not sure if I should continue at this setting and see if I adapt to it or just go back to 9 EPR2. The flow limitations do look less and aren't as densely clustered in REM phases.

[Jay Aitchsee]

One night is not a trend

[roadcycler]

Hi

I have been working at reducing my centrals as well. Have been on CPAP for 9 months and they have been slowly creeping up. I tried to increase my pressure which actually increased my centrals. So I put the pressure back to the original (6 ). Reading some of the comments on a different post I reduced my EPR from 3 to 2 and the centrals have gone down and my AHI has gone from down from 5-9's to 2-3's and am stoked about that.

[tyrone747]

How long did you wait to see if you could adapt before reducing pressure and EPR? I have a theory that it takes a little while for your brain to re-learn how to breath when you change pressure or EPR settings.

[roadcycler]

I stayed with the prescribed settings for 8 months. Was still feeling tired but better than before. I had noticed my centrals slowly increasing over the last 6 months but was unsure what was going on ( gaining some weight ) As per some of the posts I tried to increase my base pressure which is only 6 so quite low to 7. Stuck that out for a week but noticing my AHI and especially my centrals went up quite dramatically. So after a week reduced the pressure back down to 6 and the centrals decreased. This was also noted in some other posts that raising pressure could increase centrals. Then was digging around (try doing a search for central apnea, I could have found it in the FAQ or newbies go here and there was a detailed description of how EPR ( resmed) could affect the centrals. So for the last 2 weeks I have decreased the EPR from 3 to 2 and have noticed my centrals and chain stokes respirations have decreased. Haven't tried to reduce it to an EPR of 1 yet. I will have a dig around and see if I can find the post describing this.

Rob

[roadcycler]

ok this is the talk I went by. I don't know how accurate it is nor vouch for its validity by I was getting concerned so I was willing to try anything to see if it worked. Again it may just be me as centrals are all upstairs anyhow but after 2 weeks I feel that the placebo effect should have worn off. https://www.youtube.com/watch?v=1OQFESwNXm0 .

Rob

[palerider]

Wew. Well that didn't work. Worst night I've had for centrals. I'm not sure if it's just the pressure increase, or the EPR increase, or both. I actually don't feel that bad this morning for how unstable my breathing was on paper.

Do you feel *worse*?

I'd leave it for a few days and see, unless you feel substantially worse today compared to usual.

[tyrone747]

Nope I don't feel worse. Though I find my fatigue levels kind of have an inertia. Sleeping well for a while can last me for couple days even if the second day has bad sleep. And on the other hand a couple of bad nights in a row takes a while to recover from. I'll stay with the 10 EPR3 tonight then, for science.

[palerider]

Nope I don't feel worse. Though I find my fatigue levels kind of have an inertia. Sleeping well for a while can last me for couple days even if the second day has bad sleep. And on the other hand a couple of bad nights in a row takes a while to recover from. I'll stay with the 10 EPR3 tonight then, for science.

What you need to keep in mind is that centrals aren't very stressful, obstructive apneas, hypopneas, and flow limitations *are*....

Those are all pretty low in this graph.

The centrals aren't at a level that I would be concerned about.

So, you're in a 'fine tuning' stage, and you need to remember that when you're fine tuning, you work on *averages* since sleep varies from night to night... don't make changes based on one or two nights.

We all have bad nights and good nights *without making any changes at all* to our cpap therapy.... there are just so many other variables.

[tyrone747]

My CA's just keep getting worse. It's starting to be concerning to me. They are also clustered in groups of 3 to 5 now which never used to happen. I used to get an one off CA here or there now they are happening frequently. I'm thinking perhaps EPR3 is making my breathing too unstable. I tried various EPR settings at the start of the night just to see if they are comfortable and I found even EPR off to be fine. The problem is I know turning it off is going to lead to higher flow limitations and required pressure and with that comes the aerophagia. What do you think?