any advice greatly appreciated

palerider wrote:

Wulfman... wrote:It's hard to tell if these "centrals" are the real thing or not.

as opposed to?

NOT the "real thing". If there were none in the sleep study, then that MIGHT make these suspicious/suspect.
And, without all the wires connected, it's not assured.


Den

.

sue60 wrote: Does anyone think I should I start adjusting the pressure settings or have another sleep study?

if it were me, I'd try setting the min pressure to 10, the max to 12, and epr to 1, or off, preferably.

you appear to be having great huge series of central apneas, perhaps caused by too high a pressure and over ventilation caused by the EPR, which causes you to blow off more co2 than if you don't use it, and this can depress your respiratory drive.... it's the same thing that happens if you breath really heavily and then hold your breath, for while, you're great, but then the co2 builds up and you just HAVE to breath more.... if you've blown off too much co2, due to the pressure and EPR combo, then you stop feeling the need to breath.... and you get cycles like what you showed.

other things can cause it, like congestive heart failure and brain abnormalities, but then that would probably have shown up on your first sleep test, which you said was clear of centrals.

go here and request a clinical manual: http://apneaboard.com/adjust-cpap-press ... tup-manual you need to go down to section 3, and do it by email.

sue60 wrote:I do know how to go in, are you suggesting it go from auto to cpap? Or could I set it auto 10->15, would that be comparable? The ramp is also on for auto.
Thanks again, I know I need to try something different-

My suggestion is to set it to what they found would work in the sleep study titration.......straight 15 cm.


Den

.

Wulfman... wrote:

palerider wrote:

Wulfman... wrote:It's hard to tell if these "centrals" are the real thing or not.

as opposed to?

NOT the "real thing". If there were none in the sleep study, then that MIGHT make these suspicious/suspect.
And, without all the wires connected, it's not assured.

well, she's having frank apneas, and there's no massive intakes of air before or afterwards, before would suggest a 'sigh', then a brief holding of breath, which wouldn't likely be a central. a recovery breath afterwards would suggest that the machine was misreading an obstructive as a central, (which is highly unlikely in absence of high leaks).

and i'm using "frank" in the correct, medical sense, "obvious".

Here's another link to download the manual:

https://sleep.tnet.com/home/files/resme ... -guide.pdf

And, if you can handle it, I would suggest turning off EPR. They wouldn't have used EPR in your sleep study titration.


Den

.

palerider wrote:

Wulfman... wrote:

palerider wrote:

Wulfman... wrote:It's hard to tell if these "centrals" are the real thing or not.

as opposed to?

NOT the "real thing". If there were none in the sleep study, then that MIGHT make these suspicious/suspect.
And, without all the wires connected, it's not assured.

well, she's having frank apneas, and there's no massive intakes of air before or afterwards, before would suggest a 'sigh', then a brief holding of breath, which wouldn't likely be a central. a recovery breath afterwards would suggest that the machine was misreading an obstructive as a central, (which is highly unlikely in absence of high leaks).

and i'm using "frank" in the correct, medical sense, "obvious".

HOLY CRAP!!! (Channeling Frank Barone) You used the term "frank apneas".
Somebody get me some smelling salts!!! Quick!!!

I'm merely suggesting she TRY the setting they claimed would work in the sleep study titration. If it doesn't, she's got some ammunition to take back to the doctor or sleep lab or wherever and pitch a fit.


Den

.

Wulfman... wrote:HOLY CRAP!!! (Channeling Frank Barone) You used the term "frank apneas".
Somebody get me some smelling salts!!! Quick!!!

I did that, just for you... using the correct meaning "obvious" not the incorrect meaning that'd been floating around the forum for while, where someone had misconstrued the term to mean "unexpected" or "sudden".

Hi Palerider, hope this is the correct screenshot you asked for. I do not have hypertension or anything. I have not been to a cardiologist in about 10 yrs. Back then my stress test was negative. I actually asked the sleep doc if I should go to a cardiologist or a neurologist and she said I was overreacting. My husband has told me when I sleep that I get really quiet for about 20 second then take a few deep breaths and that has been my pattern for as long as he can remember, and he has seen the same many nights even on the machine

http://imgur.com/4Ge6ubM

sue60 wrote:Hi Palerider, hope this is the correct screenshot you asked for. I do not have hypertension or anything. I have not been to a cardiologist in about 10 yrs. Back then my stress test was negative. I actually asked the sleep doc if I should go to a cardiologist or a neurologist and she said I was overreacting. My husband has told me when I sleep that I get really quiet for about 20 second then take a few deep breaths and that has been my pattern for as long as he can remember, and he has seen the same many nights even on the machine

http://imgur.com/4Ge6ubM

if you don't mind, would you zip up the *entire* contents of your sd card, and upload it to:

https://www.dropbox.com/request/0LalWvEsijRIgX8sdM7H

that way, I could look at more of your data.

there's no personal information on the card whatsoever... just breathing data.

the long strings of centrals that you're showing are consistent with your husbands description, .... but when you start breathing again, HOW are you doing it? (ask him) is it very peacefully, or like you startled/snorted...

No one's saying to change from auto to cpap mode... no point in doing that now, but we want to know if you're having real centrals all night vs a couple at either end of the night because if they're all nighters, you may need a different type of machine to address them as a 'regular' c- or autopap won't do it.

Regarding ca, I would investigate whether you have a pinched nerve somewhere in your body especially in your neck. Could be that the Brain stem responsible of regulating the breathing is preoccupied with that nerve and not sending signal to breath or the muscles around the nerve INCLUDING isoghagus are going into spasms and triggering CA. see if this is the case: try to take IBprophen at night see if you have less CA events.
This is from personal experience, hope you get some relief

Julie, my events seem to be scattered, the higher the ahi, the more they are all night long, on better nights after 3am and the best nights with lower ahi mostly in the hour or 2 before I wake.

And thanks Born2bwild, I do have a pinched nerve in my neck and will take your advice on the ibuprofen or alleve at bedtime.

Thanks Wulfman, am trying pressure changes- last night range 8 to 15- I only slept 3 hours on my back on the recliner and woke to an ahi of .03, then I laid on my left side for 3 more hours and woke to ahi of 7. I wonder if that is significant or coincidence. Do many folks sleep elevated on their backs with better success? I would invest in an adjustable bed if I knew that to be true. I am by nature a side sleep otherwise. Tonight I will try 10-14 setting in bed on my sides and see what happens.

Thanks Palerider, I did upload my data and am extremely grateful you would look at it. My husband says I am very peaceful- I just get very quiet and when he has looked closely thinks my breathing becomes extremely shallow for count of 20 (he actually counts) rather than stop altogether and then 2 or 3 really deep breaths. He can hear the same pattern thru my mask at night as well I fall asleep on the couch every night for 10 to 120 minutes even sitting up straight- just depends- that is what sent me on this journey to start- its uncontrollable no matter what I do- he likens it to passing out rather than falling asleep. I think its falling asleep tho. So if this happens when not on the machine as well, can the machine really be causing it or just enhancing it?

I am working on getting my sleep reports scanned to upload for further advice. To all gratitude, as my doc has not been helpful yet-

Sue

sue60 wrote:Thanks Wulfman, am trying pressure changes- last night range 8 to 15- I only slept 3 hours on my back on the recliner and woke to an ahi of .03, then I laid on my left side for 3 more hours and woke to ahi of 7. I wonder if that is significant or coincidence. Do many folks sleep elevated on their backs with better success? I would invest in an adjustable bed if I knew that to be true. I am by nature a side sleep otherwise. Tonight I will try 10-14 setting in bed on my sides and see what happens.

Well last night was soo much better, AHI down from 48 to 7. When I said sleeping in a chair would not help, it's because sleeping setting up or head raised usually helps OAs and your having CAs. However with said, there is always the exception.

sue60 wrote:Thanks Palerider, I did upload my data and am extremely grateful you would look at it. My husband says I am very peaceful- I just get very quiet and when he has looked closely thinks my breathing becomes extremely shallow for count of 20 (he actually counts) rather than stop altogether and then 2 or 3 really deep breaths. He can hear the same pattern thru my mask at night as well I fall asleep on the couch every night for 10 to 120 minutes even sitting up straight- just depends- that is what sent me on this journey to start- its uncontrollable no matter what I do- he likens it to passing out rather than falling asleep. I think its falling asleep tho. So if this happens when not on the machine as well, can the machine really be causing it or just enhancing it?

Yes it does seem like there is more going on than what the machine is causing...but who knows, if you get the settings right it MIGHT all just go away. Your CAs might be caused by pressure changes, the less change the less CAs.. that's why Wulfman suggested a CPAP setting. However you don't have to put the machine in CPAP mode to sue a CPAP setting, you can set the min and max to the same pressure and this is better as you get more data than when in CPAP mode. I am not suggesting just explaining....but it is something to think about if narrowing the pressure range does not work.

Hang in there it will get figured out I find it hard to believe a doctor would leave you this way....this is so not good.

Just to let you know I had CAs of 17 AHI before I got my pressure right. I do use a range of pressure but have trouble with PS. Like I said Wulfman and palerider are both very knowledgeable

Julie wrote:No one's saying to change from auto to cpap mode... no point in doing that now, but we want to know if you're having real centrals all night vs a couple at either end of the night because if they're all nighters, you may need a different type of machine to address them as a 'regular' c- or autopap won't do it.

wulfman is... it's his schtick.

well, after looking at more data... it *is* a mystery. some nights she has almost zero CA, when she does have clusters of them,it's frequently as pressure is ramping down from a peak. 20-60 minutes later.

I feel my first thought, 10-12, lowest EPR you can handle, preferably none, and see how that does.