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Pugsy wrote:

TedVPAP wrote:I guess what is puzzling me is that the OP's charts show all signs of OSA, and nothing that supports Central. That is why I thought is would be useful to review the sleep study. I don't think it Is reasonable to conclude that the OP's treatment is misidentifying all events, or that the treatment is working perfectly for Central, but working poorly for OSA. Maybe I am wrong. Trying to learn.

You don't see obvious signs of centrals because the machine is preventing them by breathing for the person and that's why the patient triggered breaths aren't 100%. If the machine wasn't breathing for him his PTB would be 100% instead of something else.
Example...of PTB is 70% then that means for 30% of the time the machine is doing the breathing.
It doesn't flag a central when it breathes for a person. It would only flag a central if it was prohibited from breathing for the person ...say with too restrictive of a setting that ties it's little hands.

So the PTB numbers being low tells me the machine is doing some breathing for the person and that fact tells me that centrals are being dealt with.
So a back door way of knowing centrals are a factor without ever seeing the actual flags which we don't want to see anyway.

Complex Sleep Apnea..that's when a person has both problems...central and obstructive sleep apnea.
So we have to do 2 things...treat the obstructive stuff in the traditional way and then let the machine treat the centrals assuming we haven't tied it's little hands.
That's why I gave the link to the ASV titration document
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
So it could be read since it explains the need for EPAP minimum doing a good job holding the airway open in the first place (just like when using regular apap). We need to do both things....hold the airway open for the obstructive stuff and treat the centrals at the same time. This is why these ASV machines do both but we have to set the machine so that it can do both and sometimes minimum EPAP of 4 or 5 or 6 or even 7 simply doesn't do a good job just like with APAP machines and minimum of 4 or 5 or 6 or even 7 doesn't do such a good job.
I know one guy using minimum EPAP of 12 with his ASV to deal with the obstructive side of things and may even need a bit more.

I am not so sure that those hyponeas are central in nature...but they could be...and if it were me I would at least try killing them with more EPAP or IPAP but the OP didn't want to do that because he was afraid it would cause centrals...which to me wouldn't matter because he is already on a machine to deal with centrals because we assume he already has a problem with them. But I can't come up with an urgent proven argument to tell him to do that because I can't say with 100% certainty those hyponeas are obstructive in nature since I know that sometimes the machine can make mistakes.
OP seems to prefer to investigate the back up rate thing as maybe being a factor instead of the usual thought "more EPAP minimum"...it's a reasonable thought. Worth seeing if something as simple as putting the machine back to fixed back up rate will prevent ugly hyponea clustering.

So I am not saying that the machine is wrong...just that it could be wrong...and if it were me I would go about things differently but I am not the OP and he wants to go about things a little differently...so I will try to help him in that regard. Maybe later if no joy with other ideas he will want to maybe try more EPAP or maybe just adding a little PS minimum (which would be what I would probably try first....I would try just a little PS minimum to see if those hyponea clusters would get smaller).

n3kf wrote:I am going to take Pugsy's advice and add a bit of min PS and see how it goes. Have a nice Christmas.

Sent from my Nexus 7 using Tapatalk

Pugsy wrote:Let me know if anything changes with adding a small minimum PS baseline.

Merry Christmas