Increasing centrals

[summer]

Need help again!! (not very clear headed), I have taken on board the good advice of making one change at a time. So last night I upped the max pressure from 10 to 12. The reason being is that part of the time I was hitting the ceiling of 10. So my new current range is 7.5 - 12 (old 7.5 - 10), well last night my AHI went up to 10.9, the night before it was 8.2AHI.
I know Pugsy mentioned to start increasing the min pressure to 8, but I wanted to see if what the pressure would go to. The pressure increased a few times during the night and peaked at 10.48, so that's a positive I guess (it didn't run away!)

Whats concerning me is that the centrals they have increased (I'm also concerned by the general increase AHI), are my central considered high?

Last nights figures per hour

CSA 2.3
OSA 0.3
MXD 0.6
HYP 7.6
Airway constrictions 4.9
AHI 10.9
Leaks 0

Previous nights figures per hour

CSA 1.9
OSA 0.3
MXD 0.3
HYP 5.8
Airway constrictions 5.6
AHI 8.2
Leaks 4

Below are last nights graphs split into two halves




I have learned from this great forum I need several days at one setting for everything to settle. Should I just continue at the setting 7.5 - 12 and just give it time? or does the max need bring back down to 10?

[Mary Z]

You are likely to increase centrals when you keep raising the max pressure. In any case you don't have enough to be worried about. BY the way, they are called clear airway events and may/may not be centrals.
Pugsy gives good advice why did you ignore hers?
I don't feel like you should go up further on your max pressure and perhaps go down to 11. A 1cm change at a time for at least a week should be ok.

[summer]

MaryZ

Thanks for your reply, Pugsy initially mentioned to increase the max, as in my previous post I was hitting the max a few times. But I think you are right I will put down to 11.00, take it slowly for a week. I just feel awful today, its very hard not to just keep tweaking!!.

I will then look to take Pugsy advice and increase upwards, but slowly over a few weeks.

This a fine art, there are so many avariables!!

[Pugsy]

Central Index of 1.9 one night and next night 2.3 is only 0.4 per hour change and is an insignificant number variation. I would not worry about Central Index unless it was over 5 all the time. Then I would say talk with doctor about them to see if he was concerned.

I had no problem with you increasing the maximum. You could increase it to 20 cm and the machine will only go as high as it thinks it needs to go. If pressure variations don't bother your sleep. It doesn't matter where the max is set. Only time it might be a problem if your machine tried to fix any leaks with pressure increases and might got

I did not expect any difference in the obstructive components to your AHI with an increase in max pressure.

As Mary says..those "centrals" may or may not be real centrals. There is more to defining a true central than the one dimension of flow which is all the machine can sense. It really takes seeing the EEG pattern to know for sure you were asleep because it is normal to have some "centrals" be scored if we hold our breath when turning over in bed or it is even normal to have some occur during sleep onset or sleep stage transition. So we don't know for sure about the "centrals". Even if they are real centrals they aren't occurring in the number that we would be alarmed about. So I would suggest that you sort of ignore the Central component of the AHI and concentrate only on the Obstructive component which is the Hyponeas and the Obstructive apneas.
OSA 0.3 obstructive
Hyp 7.6 Hyponeas
Total 7.9 which is obviously a little above the less than 5 AHI we try to get.

It isn't a horrible AHI...It is quite close to being acceptable. I still think the minimum pressure is the key to reducing the Hyponeas.

How are you feeling? Better? Worse? Same? We really don't expect to see huge improvement so soon after starting on the machine but some people are lucky and see it right away.

So leave the max or increase the max..I doubt very much it will impact those centrals at all. And it won't go anywhere that it doesn't think it doesn't have a reason for going. I do not see the number of centrals that would lead me to think that you are having centrals from pressure. We read about it and talk about but actually only 10 to 15% of cpap users experience it. It is not nearly as common as one might think.

Your minimum pressure is the most critical pressure and its adjustment is the one to watch closely.
The maximum pressure.....I don't think you need to reduce it at all. But you can do it if you wish. I just don't get the sense that those centrals (even if they are the real deal) are caused by the pressure. There just isn't enough of them to be thinking along pressure induced centrals. I think the minor variation between the 2 nights was just a normal variation.
The machine won't respond to centrals at all. One way or the other it just sits there. Any increases in pressure are from obstructive event sensing.

[summer]

Pugsy,

Thanks for your reply, I think since the max pressure the machine took me to was 10.48 I will probably bring down to 11.00. I probably paranoid about any movement upwards of centrals, I have been reading to many posts on the subject.

After last night I do feel worse in some respects on the machine than off it, although I am less fatigued, mentally I feel shattered. I just need a positive trend to occur, that I am at least going in the right direction.

Ok, actions, will;

1) Reduce to 11.00
2) Will increase min pressure by 0.5, and review after 7 days, and possibly increase after that. I will keep you posted.

Oh by the way I have asked for a resmed s9 autoset with climate control etc, and they will swap!!, as everyone really rates them on this forum.

Thanks again for your advice.

[Pugsy]

Oh by the way I have asked for a resmed s9 autoset with climate control etc, and they will swap!!, as everyone really rates them on this forum.

Please don't get disheartened because you aren't feeling like you hoped and aren't seeing the data you hoped. It takes time even if everything was perfect.

You will really like the S9.

You know the ResMed S8 version seemed to score Hyponeas very aggressively and the S9 machines have a different algorithm. In the back of my mind when looking at your reports they sure looked like S8 reports in regards to the Hyponeas.

It will be interesting to see if the S9 scores differently than your current machine. All brands have different algorithms.

When do you expect to get the S9?
You can use SleepyHead (links in my signature) or
ResScan..link found in Uncle Bob's signature memberlist.php?mode=viewprofile&u=38643

And the tutorial here http://montfordhouse.com/cpap/resscan_tutorial/

[summer]

Pugsy,

I'm hoping the s9 will arrive tomorrow, and I will see if I feel better with it. It will easier to find out advice about it as so many people have one.

Great what relief thanks for the links, I will check them out, would have been a mare otherwise!

I will keep you posted thank you for help

[Pugsy]

You are already way far ahead of where I was when I was just a week into therapy. Be patient.
Try not to get stressed out over the numbers. Remember even a bad night on the machine is still hugely better than without the machine.

I recently changed machines (just because I wanted to) I settled on some settings and left it alone. I couldn't see any huge changes in numbers night to night (bounced around quite a bit at first) but after 6 weeks I look back at all those numbers and there was a very gradual improvement from the first set of data to the most recent and I didn't change a thing.
I have a thread started about the new machine experiment. I need to up date it with a report on last night because I had 9 centrals and 1 Hyponea and that is all...I happen to know I was awake or partially awake a lot of the night and I doubt those centrals were anything more than toss and turn central because I did that a lot. Couple nights ago zero centrals... go figure.

If you are bored you might want to read the thread. It also has some examples of SleepyHead reports.
viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179 I haven't updated for last night yet but I will shortly.