Noob to CPAP and Group. AHI in the 50's...

Well, the centrals don't seem to be caused from the EPR function. I really didn't think that EPR was the trigger but just wanted to rule it out....which this did.

That leaves pressure as a possible trigger to test out.
Did you ever have a report with lower pressures where the centrals weren't numerous?

Problem with lower pressures is that the OAs may become more numerous IF the pressure is the trigger which I really doubt that it is.

Here's the question in my mind...is the cpap machine making the centrals worse (I doubt) or would you be having all this ugliness even without treating the OAs and at least treating the OAs helps it be a little less ugly?
The original sleep study didn't mention centrals so we know they weren't present back then and the pain meds have come after that sleep study so that makes that old sleep study not a whole lot of help to us except to confirm OSA worse in REM sleep.

Sigh....your situation is complicated. But I imagine you already figured that out.

I don't see any way to possibly reduce the centrals as I think they are likely happening no matter if you use the machine or not. Is the machine making them worse....in all honesty I doubt it.
The breathing pattern doesn't look like CSR to me.

So do we treat the OA stuff as best we can and put the centrals on the side burner for right now knowing that you have already got a new sleep study and appointment with a new doctor in the works?

Did you notice any improvement at all in how you slept or felt with the addition of cpap therapy? Even a tiny bit?

I foresee that high dollar ASV machine being needed in your future. We have already discussed the hoops that you need to go through to get it. About all I am doing right now is going through some hoops in advance so those hoops will be already jumped through.

My big problem is that I just hate to see you have to wait so long for what I feel you are going to need but I don't have any way to speed up the process and I am extremely hesitant to tell you to go DIYing things in case I am wrong.

Maybe once you get that pulse oximeter so we can see what the oxygen levels are doing we can both feel better about the wait. You are having a lot of centrals but they aren't massively long....so maybe the desats (if any) aren't horrible.

While not able to speak with my Family Dr, I was able to send off a fax to him/ his office requesting that he amend my sleep study to a split study with ASV if Centrals are Present. Thanks again Pugsy for that idea to help the process. What is a split study? nm I guess i can always look it up

metsfan302 wrote:What is a split study?

For anyone who doesn't know what a split study is.
It's when a doctor writes an order/request that includes putting the mask on and beginning therapy in hopes of maybe finding a suitable pressure in that single night instead of coming back for another sleep study.
This of course has to be done in a sleep lab setting...home studies don't give that option because there's no way to know the results.

In a sleep lab setting there is a tech who monitors all sorts of data points..sleep, O2, sleep stages, air flow, etc. The labs can have different criteria but basically so many events within a certain period of time and that meets the diagnosis criteria for sleep apnea and beginning treatment. The techs can't do anything without a doctors order and by having the order include split study with appropriate therapy then they can go ahead and at least try the titration (finding the optimal pressure) if time permits.

Mine was ordered as a split study but I didn't meet criteria soon enough to allow the tech adequate time to find an optimal pressure....so even if there is an order in place it doesn't always mean it can be done.
In my case sleep was hard to get even with a sleeping pill so by the time I finally got some sleep and in REM where my OSA is worse we ran out of time to do much of a titration.

Any sleep study can be ordered as a "split study" doesn't always mean it gets done but the option is there if criteria gets met and sometimes this means a person doesn't have to come back and get another study with the machine. Now the ASV part of things complicates things a bit because there may not be enough time to do a good ASV titration (more complicated settings) but having the order in place at least gives the tech the option of trying it if he has the time. Without the order the tech can't add cpap/apap/whatever pap and the patient has to come back for another night in the lab.

They don't start a person on a machine without certain criteria (whatever they may have set up) being met.
Having the order in place at least allows for that option and maybe speeds the "getting the machine and therapy" process up a littlle.

Also I have multi masks - Nasal n full faces prob a half dozen of each in diff brands etc. Would using xyz mask vs abc make any diff in anything or whatever seals best n works best etc

Mask type really isn't going to make any difference.
Use the one that that is the most comfortable and lets you sleep the best and you have minimal leak with.

Well here is todays screenshots. I only slept for about 4 hrs, (more sleep to follow today before my night shift)

Not sure who else is following this, but ill keep it updated regardless even if its for my amusement and record's.

Well last night I lowered the pressures way way down, turns out the number of Central events went down (well to like a 100 or so vs 200) and the length of time they lasted lowered? BUT the Obstructives went way up I guess from the lower pressure? I think I am understanding the reports correctly

A Summery -



The Events -



Till later, happy papin

I expected the OAs to increase with the reduction in pressure because the airway isn't being held open well enough to prevent the collapses with the lower pressure.
I don't know what to make of the slight reduction in centrals...fluke night or something else going on with the pressure maybe making centrals worse. Scratching my head for sure. I still think that ASV is what you need because it can treat both the centrals and the obstructives.

When you do your imgur link....can you choose the bottom link in that little box of addresses...the bottom link will give us a link with the ability to click on it and go see the image full sized so that we can read the numbers (if we want to).
So the procedure is....click on large thumbnail first...then copy the last/bottom address in that little box and paste that link in the body of your post here.
Don't really need to see the events list at this time. That was a one time request. You are just doing more work than is really needed.

Ok thanks, what do u think would be a decent pressure till that sleep study?

Once I do the sleep study, the DR sees me and reviews the results etc and they say I need that diff machine. Will the centrals just go away/lower as well as the AHI get down to a somewhat normal number?

metsfan302 wrote:what do u think would be a decent pressure till that sleep study?

Geez....I don't know.
If the pressure is indeed maybe adding to the centrals but reducing the pressure just swaps centrals for obstrucive apneas then it's a toss up.

What I would like to do is get pulse oximeter reports for both higher and lower pressures.

At this point you have a choice between ugly and ugly with no clear cut winner so in that case I would go with whatever I feel I sleep the best with and feel the best during the day with.

Once the pulse oximeter arrives then see if oxygen levels are impacted one way or the other and re evaluate at that time which might be the best.

metsfan302 wrote:they say I need that diff machine. Will the centrals just go away/lower as well as the AHI get down to a somewhat normal number?

Well..yes and no....the centrals will trigger the machine to breathe for you.
If the centrals are from CO2O washout then breaking the hypoventilation cycle may prevent some centrals and the ones that aren't prevented the machine will deal with by giving you a big rapid burst of pressure to essentially breathe for you.

I think that if the centrals are just hypoventilation (shallow breathing) because of suppress respiration due to the pain meds then the machine will likely just breathe for you.

The end result is that with optimal EPAP the obstructive stuff is taken care of and with the centrals are either prevented or dealt with IPAP burst of pressure and your AHI will come down to around 5 or below and you should feel better and sleep better.

Ok I am going to order one shortly so should be here early nxt week I'd imagine. Will keep you posted for sure. Now my only fear is the insurance will say I don't quility or something.... But if that should happen or I feel it's taking too long, I'll just get one on that website that has gently used devices etc. But I just don't see them saying I don't need it. Wonder if I should print any Sleepyhead reports etc for either the new sleep Dr / Sleep center

Hot damn! My dr'a office got the fax I sent them yesterday. They agree and are going to modify that sleep study order to be a split study with asv like you said I should do - Pugsy!

Thanks I would of never known it was even an option or that I could ask my dr something like that and they actually do it!!

I can't imagine the insurance saying you don't need a different machine.
I can't imagine a doctor saying you don't need a different machine.

The new doctor may not be aware of SleepyHead and my instead be familiar with ResScan so let's get you ResScan so you can use those reports. ResScan is the official ResMed software and most docs are familiar with it. While some docs are familiar with SleepyHead....not all are.

Plus you will by then hopefully have the new sleep study which most likely will show the centrals and obstructives.

If you get to the point that you feel you just have to buy your own machine...please check with me first because I sometimes know of gently used machines.
But I really can't see your insurance denying you....it's so blatantly obvious that there's a complicated problem that needs to be addressed.

Good news...that split study request also eliminates them trying to make you do a home study instead of an in lab study. You definitely need an in lab study.

Now to cross our fingers and get that sleep study on the books sometime sooner than later.