Oh...I think about them every time I see a newbie report with centrals and they are using any form of exhale relief. I just don't want to bring up the need to go down that road and make much of it until I have done some more thinking on it. I know people's minds...we start the EPR causes centrals crap and everyone will stop calling EPR training wheels on bicycles and the knee jerk reaction every time a central is seen woulb be "OMG..you are using exhale relief and it is a known cause of centrals so you can't use exhale relief"....they won't even remember the fact that 98% of the people using EPR/bilevel have zero issues with centrals.palerider wrote:that could very well be, I have seen pressure support (either through EPR, or bilevel) exacerbate centrals in some more sensitive people, and I s'pose I look for that more than I might ought to... it is very early days for our new friend here, and he's doing pretty well as it is.
Also remember the normal first line of therapy when centrals are too numerous before ASV is regular bilevel.
I think about all the possibilities but I put some of those thoughts on the back burner until I get more data to draw upon...and more history. So I try to keep things as simple as possible at first unless things are horribly not simple.
I want several nights where there's some decent hours of sleep.
I want a report on how that sleep was....good, woke often, slept soundly...all that.
Also remember that newbies often don't sleep so soundly those first few nights and with known awakenings there's automatically going to be more than usual number of chances to go back to sleep and have sleep onset centrals pop up....and that's normal and not caused by anything that can be altered.
Also remember that newbies have usually a higher number of arousals in general...so that increase the chances of post arousal centrals that are probably SWJ.
Finally the OAs can create the arousal and the arousal begets the central.
All this stuff runs through my mind when I look at a newbie report that has more of any thing than we would like to see.
I don't always voice it when it goes through my mind or at least at first.
I really need more data for trending and patterning to help me make my ideas solid instead jello floating around in my head.
My thoughts....fix the known easy to fix stuff first...then see what's left over to worry about because often when we fix the simple stuff like the OAs with a little more pressure the leftovers become much less numerous. The centrals aren't being ignored...just set back on the back burner until we have more data to help us out here....plus there's some through to the give it time thing...there can be some resolution without us changing anything.
When I started on bilevel I had to do a bit of tweaking to get it where it was "Okay" and okay meant 3 to 6 AHI. but I was sleeping great and feeling good. I left the settings alone for 3 months. At first had more 6 nights than 3s....then slower I started having more nights at 3.0...at about half way through the 6 nights were rare and most nights were 3 or lower with some between 1 and 2....by the end of the 3 months...my AHI was consistently down to 1.0 to 1.5 with a rare time below 1.0......and I never changed a setting at all during those 3 months.
I know we are all impatient and I am as guilty as the next person but we don't sleep the same each night and we really, really need multiple nights of good data from good sleep to be able to come up with clear and reasonable ideas.
