Having trouble on high pressure, still tired, please help!!

[Pugsy]

We really don't have any way of knowing if your fatigue or breathing problem is related to the sleep apnea or possibly something else. We can try to help you determine if there is anything in the reports that might explain it but we can't possibly know every little thing about you from a short history.

If you will post one of your reports we can look at it and see if anything sticks out that might need improvement on and maybe help you feel better.
Don't know how to post a report? Here is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[cflame1]

I'm recommending that you see a sleep doc... somebody that has experience with dealing with complex sleep apnea. You may need a different machine in order to deal with your centrals.

[Pugsy]

I'm recommending that you see a sleep doc... somebody that has experience with dealing with complex sleep apnea. You may need a different machine in order to deal with your centrals.

I will second this recommendation.
The suggestion to look at your data was really so we could see what might be going on and then tell you to take the report and shove it under the doctor's nose...I was not going to try to fix any centrals with dial a wingin.. I was really trying to find something concrete to tell you that a doctor is the best judge...not internet advice.
If your doctor won't listen to you....get another doctor. People with a lot of centrals need much more specialized advice.

[ozij]

Excellent advice by both Cflame1 and pugsy.

[rested gal]

sickwithapnea17, I went back to some of your earlier posts, hoping you had posted a PSG sleep study report from your bilevel titration night at the sleep lab. I wanted to see if you really do have a problem with cpap or bilevel therapy causing you to have centrals -- as identified by PSG equipment, not our home therapy treatment machines. I couldn't find where you had posted a full PSG sleep study report. So, I think the jury is still out regarding what you're seeing on your home data reports as possible centrals.

Looking back at what you said about your Encore software results at home:
viewtopic.php?p=633607#p633607

OK I got the encore data from 4/21-9/6 and the most severe problem is clear airway apnea which is as high as 9
---
so I don't know what to do about the CA?

It may be that you don't need to do anything at all about the CA's showing up on your Encore reports. Even if they all are "central apneas", some of them could be perfectly normal, harmless centrals -- like "sleep onset centrals. Some could also be post arousal centrals...the normal pause following deep recovery breaths after an obstructive apnea has hit. A PSG sleep study would show that. Our home therapy machines cannot differentiate between a "normal" central and one that has been caused for other reasons, be they neurological or therapy induced.

I think it is too much of a leap to start suspecting "complex sleep apnea" without seeing if centrals showed up in significant numbers during your PSG bilevel titration.

oh and the higher pressures on the report reduce the CA to under 2 but at about 15/12 average not 18/14

Well, I think this is a key point. If higher pressures are reducing your CA index, instead of increasing the CA index, that's all the more reason in my mind (but I'm not a doctor!) to stop suspecting "complex sleep apnea."

It sounds more as if too-low starting pressure at home in auto-bilevel mode is allowing OBSTRUCTIVE events to happen, and the increased number of "clear airway apneas" (possible centrals) are probably just post-arousal centrals (if they are centrals at all) -- normal pauses in breathing after you took some deep breaths to end an obstructive apnea. The solution to post arousal "centrals" is to deal with the obstructive apnea that leads to deep breathing arousals... getting the EPAP pressure up high enough to prevent most obstructive apneas right from the get-go. Then you won't have the obstructive apnea that leads to take recovery breaths followed by a normal pause in breathing (which the machine would note as a "clear airway apnea" if the pause lasted so many seconds.)

so the cas are probably centrals?

Maybe. But again...even if they are centrals that does NOT mean they are problem centrals or that an ASV machine would be necessary. The first two things I'd want to do before even considering "ASV" would be to see what the full PSG report from your bilevel titration at the sleep lab looked like. If the bilevel titration in the sleep lab was not causing centrals in significant numbers, I'd work on getting the current bilevel therapy you're on at home optimized to deal with your obstructive apneas. To do that, I'd want to get some baseline data at home while using the bilevel machine in plain bilevel mode for awhile. Not in autotitrating bilevel mode. I'd talk to the doctor about that.

maybe I need an ASV since I am sometimes having up to 9 cas on the graph

I wouldn't even be thinking "ASV" at this point....for all the reasons I've mentioned in this post. You really, really, reallllllly need to get your sleep study bilevel titration PSG full report first. It may be that all that's needed is to get your current bilevel therapy going better for you.

the O2 machine really helps set to 5.0 liters

Is 5L of O2 what a doctor prescribed for you? Or have you been making adjustments to your supplemental O2 on your own?

the other bad problems I have are memory loss and trouble concentrating even a little....somedays I take one class and I don't even have energy to do anything else that day

That has to be rough. Sure hope you're able to get some relief and improvement soon!

Can you ask for a copy of the titration sleep study when they were using bilevel on you? If that sleep study titration did not make centrals show up in big numbers, it's VERY UNLIKELY you have "complex sleep apnea" and VERY UNLIKELY you would need an ASV type of machine.

I'd talk to the sleep doctor about using plain bilevel mode for awhile, instead of autotitrating bilevel mode.... and at an IPAP/EPAP that lets you sleep comfortably and get used to it, even if the IPAP/EPAP are not up quite as high as the sleep study recommendation.

I like JDS74's suggestion:

Your reaction to the higher pressures may suggest that a slower approach to them is needed. Talk to your doc to see if you can set your machine to lower numbers for a while and then gradually move them back to the 18/14 as you get used to the higher pressures. Changing from a straight 10 cm to 18/14 BiPap is a big jump and it sometimes takes a while to get used to the higher pressures.

[sickwithapnea17]

thanks so much! I started to have bad fatigue 2 years ago and couldn't pull all nighters anymore. I'll work on posting the graphs or other data?
by the way this face mask is pretty comfortable though it has leaks sometimes and the O2 machine is great from invacare (though I still can't get restorative sleep it seems)

[BCZF]

Howdy.. I have a 16/22, so I can understnd very bad numbers.. But I am a lot better.. Using the Oracle mask has been a revelation.

[sickwithapnea17]

wow so you are doing well on 22/16? I noticed on my reports the clear airway apneas go up to about 9 when I switch to bilevel 10/4, but then on 18/14 I wake up a lot
is it good if I go with like 16/12 instead? Does the other mask help you sleep?
so if my clear airway apneas aren't centrals then what could they be, just random leaks? it seems that the fact that they decrease when I am using higher pressure closer to 18/14 means that they seem to be central apneas
maybe I should try this acetazolamide, I have high blood sugar though