stuck

[onward60]

I seem to be stuck with an AHI of around 3.5 - 4 most nights. OSCAR says they are mostly centrals. How can I tell? I'm now at constant pressure of 10. Very tired. Here's a recent screen shot. Not sure what I should be zooming in on.

[vandownbytheriver]

I seem to be stuck with an AHI of around 3.5 - 4 most nights. OSCAR says they are mostly centrals. How can I tell? I'm now at constant pressure of 10. Very tired. Here's a recent screen shot. Not sure what I should be zooming in on.

I'd suggest turning down EPR from 3 to 2 or 1. This will result in an increase in the pressure you exhale against, so if you have a hard time tolerating this then lower the 10cm one for every EPR you take away... this will also increase the other events but will reduce the CA's.

[Pugsy]

this will also increase the other events but will reduce the CA's.

Only will work if EPR is the trigger/cause for the CAs/centrals.
EPR triggering centrals isn't all that common and doesn't always cause centrals.
You need to explain this little detail when you offer your (and Jason's) advice on using EPR or not.
Otherwise your advice is incomplete.

[vandownbytheriver]

this will also increase the other events but will reduce the CA's.

Only will work if EPR is the trigger/cause for the CAs/centrals.
EPR triggering centrals isn't all that common and doesn't always cause centrals.
You need to explain this little detail when you offer your (and Jason's) advice on using EPR or not.
Otherwise your advice is incomplete.

So maybe it won't work? Let's see if it does. I'll bet it does... how about 10$?

[onward60]

this will also increase the other events but will reduce the CA's.

Only will work if EPR is the trigger/cause for the CAs/centrals.
EPR triggering centrals isn't all that common and doesn't always cause centrals.
You need to explain this little detail when you offer your (and Jason's) advice on using EPR or not.
Otherwise your advice is incomplete.

Is there a way to tell if these are really centrals at all? I have not had good luck with reducing EPR.

[Pugsy]

Is there a way to tell if these are really centrals at all?

Oh...the question isn't whether or not they are "really centrals" but instead you have to learn to figure out if those flagged events are arousal/awake related or asleep related.
Hold your breath while awake for about 15 seconds....that's essentially a 15 second central apnea because no air is moving and there is no effort to move the air because you are not breathing but on purpose. It's a central apnea by definition but since you aren't asleep it doesn't really mean much.

Playing around with EPR doesn't help those "awake/arousal" centrals because EPR isn't the cause. The arousal is the cause.
Gotta try to figure out why you are having arousals/awakenings that lead up to the pause in breathing which gets flagged.

[Pugsy]

So maybe it won't work? Let's see if it does. I'll bet it does... h

Well I am betting it won't for several reasons.
1...past shared reports showed definite arousal related events

2...

I have not had good luck with reducing EPR.

3....Only 5 to 10 % of the people who have centrals pop up after starting cpap therapy will have those centrals be caused by using bilevel pressures which is what using EPR creates.

[vandownbytheriver]

Is there a way to tell if these are really centrals at all?

Oh...the question isn't whether or not they are "really centrals" but instead you have to learn to figure out if those flagged events are arousal/awake related or asleep related.
Hold your breath while awake for about 15 seconds....that's essentially a 15 second central apnea because no air is moving and there is no effort to move the air because you are not breathing but on purpose. It's a central apnea by definition but since you aren't asleep it doesn't really mean much.

In order to do this you have to avoid the 'glottal stop'... a CA as the machine defines it means that there is no obstruction, the machine pulses the air stream and tries to sense an obstruction... if it thinks there is not one it flags a CA. If it finds one (like if you're holding your breath normally) it flags an OA.

Playing around with EPR doesn't help those "awake/arousal" centrals because EPR isn't the cause. The arousal is the cause.

I have demonstrated to my own satisfaction that CA's can be generated by EPR, awake or asleep. Jason at AXG Sleep Diagnostics (who, I remind you, is well-thought-of around here) agrees. Why do you say that it is definitely *not* the cause? Seems kinda dog(pun)matic to me.

Gotta try to figure out why you are having arousals/awakenings that lead up to the pause in breathing which gets flagged.

The machine tells us it's a CA. Do you not believe the machine?

Dear OP, please get a SleepHQ account and post a Share so we can zoom in on on your events. From what I can tell the arousal comes after the CA... Oscar screenshots are inadequate here.

[Pugsy]

Why do you say that it is definitely *not* the cause?

You are the one talking in absolutes....certainly not me. I don't see where I ever said "definitely". Please don't go putting words in my mouth that I didn't say.

The only "absolute" when it comes to cpap or sleep apnea is that there are no absolutes. There are always exceptions.

The only time I might ever use the word "definitely" would be in reference to you and here's a news flash....it wouldn't be a compliment.

Have a nice day.

Stop the pissing contest of arguing with me. It's hijacking the thread and not helpful.
State your point of view and move on.
Others can comment on your point of view...and then move on.
I am moving on....I suggest you do the same or risk seeing your posts go bye bye.

[robysue1]

I seem to be stuck with an AHI of around 3.5 - 4 most nights. OSCAR says they are mostly centrals. How can I tell? I'm now at constant pressure of 10. Very tired. Here's a recent screen shot. Not sure what I should be zooming in on.

If you are wondering whether the CAs have a high likely hood of being "false" because they are a normal post-arousal return to sleep pattern, you can zoom in on the period where the CAs are scored. Look at what happens just before the CA is scored: If there is a big inhalation just before the CA is scored, it's likely the CA is not real, but rather a normal post-arousal return to sleep breathing pattern. I'll try to post a couple of screen shots in a bit to show you what I mean.

If the breathing pattern right before the CA is scored looks like normal sleep breathing, there's a good chance that the CA is real--i.e. it occurred while you were asleep.

Now if the vast majority of your CAs seem to be real, then the question about whether EPR and/or the pressure is causing them may be worth investigating. But then first set of questions that need to be asked include:

How long have you been using xPAP? Have you ever felt better using xPAP? If you have been using xPAP for more than 4 or 5 months, has this pattern been present right from the start? Or have the number of CAs started to increase or decrease over time?

And the most important one: How are you feeling?

[robysue1]

Here's an image from my own data of a flagged CA that is most likely a normal post arousal central that would not be scored as a "real CA" on an in-lab sleep test:

Note the large inhalation just before the CA: That's the sign that I probably had a spontaneous arousal for some unknown reason, but I immediately went back to sleep. During the transition back to sleep, I had a normal pause in breathing as control of the breathing was reset to the autonomous nervous system.



Here's an image from my own data of a flagged CA that may very well be a real CA that could be scored on an in-lab sleep test:

Note the regular sleep breathing pattern continues right up to where the CA starts. There is no large inhalation to indicate a probable arousal in this CA. Since CAs like this are rare in my data, I don't worry about them.

[onward60]

OK, thanks. I read all the advice. I haven't looked at OSCAR in awhile. I'm trying to remember what all this means.

I started therapy in March. My OA dropped pretty quickly, but the Centrals persisted. I slowly started feeling a bit better and got some better numbers, but they were intermittent. Eventually I ended up using a set level of 10. I wasn't actually looking at my numbers much any more. I figured I just needed some time to get used to the CPAP. And I thought I was. But lately I have been feeling more tired, dozing off during the day, feeling dread and anxiety. I check my numbers and saw that I was stuck around 2.5 to 4 range of AHI with mostly/all centrals.

Then, this morning, out of the blue, I felt better when I woke up and not anxious. Had a decent (for me) day. I just checked the machine. Last night I was 1.5 AHI. And that that rarely happens.

It's been awhile since I've looked at OSCAR, so I'm trying to remember how to do this stuff. Is this a good place to zoom? I confess, I find the lines nearly impossible to interpret.

[onward60]

Here's another.

[Pugsy]

arousal related since the flag comes after some very brief not asleep breathing and you probably have no memory of it since it is relatively brief

so post arousal

Here's a thought....maybe your recent not feeling so great symptoms were from not so great sleep quality because of some sort of arousal (probably spontaneous since we don't know what might have caused the arousal but it doesn't seem airway related) ...so you weren't as rested as your body needs because your sleep quality wasn't optimal from the arousals.
And maybe those post arousal centrals are simply a symptom of poor sleep and not the cause of the poor sleep.
I see this all the time in my reports because I have a lot of arousals.

The nights with a little lower (less centrals) simply means you slept better and that equates to feeling better.
I see this all the time myself except for years ago I had a day where I was superwoman and I just knew the prior night's AHI just had to be 0.0 but to my surprise when I downloaded the data it showed AHI being 9.4.....go figure.
Back then we didn't have software that let us zoom in on the breaths and I don't think the machine even recorded flow rate anyway....back in the dark ages.

[onward60]

....back in the dark ages.

Or before Noah's flood! My kids seem to think that was my era.