New CPAP User, Long time sufferer...

palerider wrote: ↑

Fri Dec 14, 2018 4:29 pm

Well, I'd say there's a caveat, enough ps will do that, since that's how nice machines work... Forcing in air to make you breathe through centrals.

Yeah, I think I mentioned that a while back somewhere in that only the machines with a back up rate available (either fixed with someting like the ST or auto with ASV) and ability to push lots of air quickly if someone doesn't try to breath.
Regular bilevel...can't do it and even if it could PS would need to be a lot higher to move enough air to do the job needed when a central happens.
That horse kicking us in the chest we were talking about the other when back up rate machine modes force us to breath with a high PS.
I asked Jason how much PS is needed to deal with a central when I sent my ST machine to someone who did have centrals that were a problem and I wanted to set it up optimally. He said at least 8 cm PS but preferably 10 or even more to best deal with centrals.

I like PS but I sure don't want to do 10 cm PS all night long....man that would be rough.
I was plenty uncomfortable when I tried 6 cm PS on my VPAP Auto.

Pugsy wrote: ↑

Fri Dec 14, 2018 5:21 pm

I asked Jason how much PS is needed to deal with a central when I sent my ST machine to someone who did have centrals that were a problem and I wanted to set it up optimally. He said at least 8 cm PS but preferably 10 or even more to best deal with centrals.

*points* and right there, that's what I REALLY dislike about ST machines... with what we know about the respiration loop.... if you've got a problem with central apnea, you're probably more sensitive to the whole co2 issue, so they want to put you on a machine that is just *going to make the situation worse*! Like that guy I was helping (who's doing fine...) that pretty much needed a negative PS, if anything... he's so much better now that he's off that ST his doctor (who's now disappeared) had him on.

I'm thinking about setting my PS to 3 and my EPAP min to 12 tonight. Wonder if that's too much adjustment... I don't think the pressure increase will bother me. The lower PS would probably be the issue but I've never tried it that low before...

Would you guys recommend against adjusting it so soon? Maybe keep the 10 EPAP and reduce the PS? Seems like they both need an adjustment *shrug*

I don't like making multiple adjustments at one time unless there is an urgent need to.

You only used the new 10 minimum EPAP one night....
If you do anything...just reduce minimum PS to 3 or 4 assuming you are comfortable with that and if you aren't...whatever you were using, try just 1 cm lower..make the minimum and maximum the same...don't let it go higher...and then see what happens.

That's me....PR is a lot more aggressive with any changes than I am. I tend to be ultra cautious unless there is a significant urgent need for big changes. I don't see an urgent need here...you had one night with a rather significant change in minimum EPAP.
We can't base much on one night's data.

Remember at this point we don't even know for sure if your centrals are related to PS anyway....it's a maybe.
Some of your centrals were SWJ and those aren't real and don't count.

By "minimum and maximum the same" are you saying to make the epap 10 and the ipap 13 if I set the PS to 3? And of course assuming that the epap was 10 to start with (as it was last night)?

Yes, when I said minimum and maximum to be the same thing I was referring to PS.
Take away the ability for PS to go higher.
It did go to 7 last night. Not for very long but it did go there.

I'll add this re shallow breathing. Make sure you get your thyroid levels checked. Low thyroid levels depress the brain's response to those chemical signals to breathe.

My thyroid levels periodically go low (likely stress induced because it comes and goes) and I have to start taking a low dose of T4 supplemental thyroid for a while (when pulse rate goes into the high 80s-low 90s and doesn't drop I know I need to drop the supplemental T4). When it's low, I eventually notice that my respiration rate slows, my breaths get shallow, and I will get suddenly overheated and spontaneously start deep breathing at a faster rate for a few minutes -- this is really annoying as I think I should recognize this (not responding as I should to the need to breath). I'm getting thyroid levels checked as I've had several episodes of this lately. I do not see any number changes re APAP readings, so no tipoff via that avenue.

Muse-Inc wrote: ↑

Sat Dec 15, 2018 12:08 am

I'll add this re shallow breathing. Make sure you get your thyroid levels checked. Low thyroid levels depress the brain's response to those chemical signals to breathe.

Hi Muse-Inc, I've heard this from others lately too. I plan to see my doc soon and have a full blood workup done just to rule out any weird deficiencies. Thanks for the heads up though

Here's a new chart from last night. I was weak and decided to raise the EPAP min. to 11 as you will see. The PS was set to a hard 3.

Last night I tossed and turned a lot, it definitely wasn't a 'good' night. The pressure and PS didn't bother me that I can tell. I never woke up and felt like I couldn't breathe or had the urge to remove the mask. I can remember a couple of times that I felt the pressure was overcoming my ability to keep my mount closed. So that woke me up a few times. It might just take me a bit to get used to the higher pressures. In other words, I think I can pretty easily get used to these settings. I'll keep them here for a few days and see how it looks. I looked at most of the events individually. It seems like there was some erratic breathing leading up to almost all of them. Perhaps most were SWJ?

12/14/2018

With remembered not so great sleep quality there's always a good chance that a good number of the flagged events are SWJ especially if you see the erratic breathing just prior to the flag.

And yes...with any change in anything there sometimes needs to be a time for the body to adjust to the new settings.

You've made substantial changes since the 7 cm minimum ..and in only 2 days. Doesn't surprise me one bit that you didn't sleep so great last night.

Right now my intention is to keep these settings and see how it goes. I'll be interested to see if I can maintain a consistently lower AHI. I'll keep updating with new charts as I go.

Update: Last night was not great either. A lot of tossing and turning. Actually picked up a new pillow. The pillow was great. 18 mo. old daughter coughed all night long and I know that woke me up quite a few times. Head and neck comfort with the new pillow was great though, it didn't mess with my mask at all, which was refreshing. The pillow I picked up was the Beauty Rest TruTemp Gel Infinity Pillow. If anyone would like any info about it, please feel free to hit me up.

As for analyzing the Clear Airway events, almost all of them displayed some type of breathing disturbance before the event. I would wager to say that only one or two weren't SWJ. Even the OAs seem to have some erratic breathing beforehand.

12/15/2018
Examples of erratic breathing before events:

Really, until your centrals are crowding 10 per hour, just ignore them.

The bulk of your events appear to be SWJ....and to me that screams crappy sleep.
Now why the crappy sleep....million dollar question and probably involves a billion dollar answer/solution. Not always easy.

I'm guessing the sleep quality will get better this week. With the current settings I hope to see some good charts once I do have a good night. It's hard to sleep on my back, for some reason it makes the tops of my thighs go numb... it's pretty weird lol. Oh, I forgot to mention in my original post that I'm 6'0" and weight 214 lbs. Figured that might be relavent at some point.