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The way you can tell if he has centrals, clear airway events, obstructives, whatever, is with Sleepyhead. Yes, he may feel better one day and not the next, and his chart may or may not show diddly, but without some consistency over time (days, weeks) and without correlating the charts with events, both apneic and personal (how he feels physically) over time, no conclusions can be made intelligently. He may feel good one day for who knows what reasons, but you can't base everything or anything much just on that.

Do you think 100 scientific papers have been written re centrals and a lot of other data just based on how someone feels on a given day?

Let's see what the reports show when your husband perhaps can help isolate awake times vs asleep times by turning the machine off and on to help maybe pin point awake events.
We already know that from 3 AM on that his sleep was troubled and there was a lot of awake time where it's possible that the centrals are just awake breathing irregularities getting flagged and making for a difficult evaluation of what is going on.

If these centrals/clear airway are indeed awake flagged events then they are not part of the sleep apnea problem but instead are just a symptom of the primary problem which is poor sleep due to the pain in the hip and back. They should then resolve once the pain issues are addressed by whatever means it needs to be addressed....and which should be addressed anyway.

If this were my husband...the absence of centrals for a considerable time while on cpap and the fact that they suddenly appeared at around the same time that the pain issues manifested themselves...I would try my darndest to figure out if what we are seeing is awake events because it is very possible that what we are seeing is related to asleep vs awake times.
I doubt that these centrals are pressure related...and I bet if you look back on the nights where his AHI was nice and low that the pressures varied pretty much like they are varying now.

The pain issues need to be addressed....even without the centrals muddying up things...he's not sleeping well because of the pain.
Fix or attempt to fix the known for sure problems first and then deal with whatever might be left over.
The back and hip issues are a known significant problem...get them dealt with so that he can actually get some decent sleep and then worry about centrals should they be present once sleep is back to normal.

So have him try to help us evaluate the software reports with the break in therapy trick...AND get something done about the pain issues. They need to be addressed anyway.....might get lucky and have the other issues resolved simply by taking the pain out of the equation.

Thank you Pugsy. I spoke to him about the pain thing and the work stress issue. Now those problems are out of my hands. I am not sure what he's going to decide to do. Here's a GOOD recent night. he slept well.

This all started the beginning of December, before that all was well. http://imgur.com/a/E7zt2 This was just a few days ago.

I think these centrals might be real. If anything, I think I should try the other sleep doctor. The tech is clueless and the gp is clueless.

For Roman, let me ask him if mask setting is correct. He originally started out with this nasal mask thing which he LOATHED. He couldn't keep mouth closed. He then went to full mask. I think that has been fixed. I will ask him. I had him take machine to Apria and see if it was functioning correctly and they said it was. So I guess they checked that but I don't know. Good point though.

I recently met two women who told me they had sleep apnea and said, Oh I totally don't need that machine. Yes they totally do. This crap is nothing to play with and will cause cognitive decline. So I am grateful that this is being treated. Thanks for helping me Roman.

Who has or doesn't have ED is none our our damn business!
That being said, it is only one item in a continuum of misery caused by untreated apnea.
It can also be a contributing factor in depression, also an effect of OSA.
That too, need only be discussed where you are comfortable.
Using the machine is key, and the right mask is essential to that.

I think, but could be wrong, frog, that the mask is okay. The other mask didn't work for him. That was the nasal mask thing. One big problem I had when they handed out the machine and stuff was that they gave everyone the same exact thing. It was like being in a herd. They even instructed us in a herd and didn't explain anything. It's no wonder I know a lot of people don't comply. People get discouraged and give up because none of it makes sense, or they don't know what to do.

palerider wrote:cpap pressure is a dynamic, active thing, affected by many factors, whether there's a humidifier (set automatically) whether there's an AB filter, size and length of hose, type of mask. all of these things resist airflow and cause pressure drops.

if the machine were to simply say "well, I've got 15cm at my pressure sensor, I'm good!" then you'd be having substandard treatment, because when you went to inhale, you'd NOT get 15cm of pressure to hold your airway open.

as you can see in the following diagram, the pressure generated at the machine isn't what ends up being experienced at the mask.

where intended pressure delivery is what's desired that the patient experience, and actual pressure is what's generated in the blower unit.

it has nothing to do with net volume, it has to do with fluid dynamics, with FLOW, flow through your airway and controlling the pressure dynamically so that you get the appropriate pressure in your face.

of course, the only way you could see that would be with high rate graphing manometers connected at the machine outlet, (before the humidifer) and inside the mask. my dual port manometer doesn't record data, and doesn't update fast enough to be able to make a chart, but it's easy to see the pressure differential on the two ends of the patient circuit.

Sorry, I'll try to be clearer.

Yes, the pressure in the mask is different from the pressure in the blower unit.

Yes, the machine does try to compensate for this and control the mask pressure, not just the blower unit pressure.

It's a little clearer if you ignore exhale relief for the moment.

The "mask resistance" refers to the resistance to flow between the air space in the mask and the patient's airway, not to the resistance to flow between the blower unit and the air space in the mask.

The average flow rate in the hose is equal to the leak rate of the mask.

The average flow rate in the patient's airway is zero. Air volume in must match air volume out. (Ignoring mouth leaks.)

The average pressure in the mask is not a function of the mask resistance or the tidal volume of the patient.

The machines try to maintain a controlled mask pressure, estimating the airflow resistance of the water tank and hose, and the flow rate in the hose.

Let's assume for the moment that the machine does a good job of controlling the mask pressure.

Assuming the pressure in the mask is at the "right" pressure, let's consider the effect of mask resistance.

During an apnea event, with no airflow, the pressure drop between the mask and the patient's airway is zero. By "Airway," I mean the inside of the patient's nose. Let's assume it's a nasal mask.

The pressure drop will also be zero at the end of the inhale or exhale cycle when flow drops to zero.

During these times, the patient will experience the pressure the blower unit is trying to provide. In particular, during an apnea event, the pressure will be "correct."

When the patient's airway is open and the patient is inhaling, there will be a difference between airway pressure and mask pressure. Note that this effect is low when the flow rate is low or restricted.

The airway pressure will be low during inhale and high during exhale. The average pressure will be the same.

There may be some slightly different effects when exhale relief is used, but they should be small. The effect of mask resistance will still drop to zero when airflow is zero. There may also be some small transient effects going from inhale to exhale.

Mask resistance probably affects the calculations the machines use to differentiate centrals from obstructive.

It's also possible that machines try to compensate for the mask resistance and keep the airway pressure constant during the middle of the inhale and exhale cycle. The pressure will still be "correct" when the airflow is low or zero.

Most importantly, the mask resistance is different from the other resistance because the vent rate of the mask doesn't figure in.

If you were using manometers to study the effect of "mask resistance," you'd need to put the manometer into the patient's nose, not the mask. Mask resistance affects the pressure drop between the mask and the patient's airway, not the pressure inside the mask.

archangle wrote:Sorry, I'll try to be clearer. [lots of obfuscation deleted]
If you were using manometers to study the effect of "mask resistance," you'd need to put the manometer into the patient's nose, not the mask. .

depends on the mask. for a ffm or nasal mask, measuring in the mask near the nose would be just as effective, for a pillow mask, yes, you'd need to have a sensor in the airway.

the whole point of these calculations and compensations that the machine does are to maintain desired pressure DURING inhalation and exhalation. not in the brief pauses between respirations that you seem to be fixated on.

The Remzzz mask liners really helped my husband. He was getting this horrible sore on his nose from the mask. The Remzzz really cut down on the leaks too. I think they are about one dollar a day, because you have to use a new one every time because it gets all stretched out. They come in different sizes and it's very important to get the right size.

Use the Remzzz as a pattern and make mask liners out of an old tee shirt. These will be reusable. I put mine in a small knit bag and throw them in with the laundry.

A detailed download using sleepyhead or some form of Rescan/Airview through your Resmed CPAP is the best place to start Stardust. Do you know what kind of CPAP machine he is using? If you are using an S9 model it should likely be a silver color and to the left there is a on/off button. To the upper left of this button it will tell you what kind of machine he is using. Hopefully it is a machine that provides detailed information to review. Please let us know.
From the sounds of your AHI being slightly elevated it is likely that a slight pressure change is needed. Whether it is increasing the pressure slightly or decreasing cannot be known unless the machine is download and data reviewed. If your spouse is having a lot of obstructive sleep apnea then slight more air may be needed which is the factor majority of the time. If he is using 10cmH20 then he does not have to increase drastically. You could increase to 11cmH20 then to 12cmH20 if the AHI does not fall. But a download through sleephead or Rescan/Airview would be the best place to start. It sounds like you are working through Sleepy Head right now!
Also, if he has a low mask leak percentage and he is using the therapy compliantly, that is great! That takes away one major factor and that is comfort. What you have is a clinical problem and a slight pressure change would likely help. Although I will say that sometimes the pressure must be changed drastically to help as well.

thecpapguy! wrote:A detailed download using sleepyhead or some form of Rescan/Airview through your Resmed CPAP is the best place to start Stardust.

have you ever considered reading the thread before jumping in with redundant, and possibly confusing "advice"?

Wow that's a great Idea about the Remzzzz. I never thought of that. I could make that Remzzzz thing out of CLOTH! Save me some money and recycle old tee shirts.

Thanks CPAP guy. I did lower the pressure a notch and it seems he's better. I also been having him take advil at night because his hip hurts. Here's last night. Thanks little devil man, for looking out for me.

http://imgur.com/a/M5lDh