newbie questions

Pugsy, I was asking because here is what I was seeing in the posted charts:

min 7: CA index of 4.02

min 8: CA index of 13.55

min 9: CA 16.14.

So that's why I was wondering whether higher minima will just make the CAs even worse. Looks like we have reason to think that'll happen. Of course, might just try it and see, but I worry about someone getting up into that 13-16 index territory.

Miss Emerita wrote: ↑

Sat Mar 14, 2020 10:42 am

A question for the experts: it appears that xskier is going to get a boatload of centrals with a minimum pressure higher than 7.

Look at the pressure curves, and when the centrals happen again. your statement is not borne out by the graph.

Miss Emerita wrote: ↑

Sat Mar 14, 2020 10:42 am

Meanwhile although the hypopneas do improve a little with increased pressure, they don't seem like as big a problem as the CAs -- the HI stays at less than 3 even at lower minima.

A HI of 3 isn't good.

Miss Emerita wrote: ↑

Sat Mar 14, 2020 10:42 am

So wouldn't a good strategy be to avoid higher pressures and stay at 7 for a while, with EPR off? That would allow for a period of time to see whether the CAs will abate. (They weren't prominent in the sleep study.)

If there were a clear correlation, perhaps.

Miss Emerita wrote: ↑

Sat Mar 14, 2020 7:02 pm

Pugsy, I was asking because here is what I was seeing in the posted charts:

min 7: CA index of 4.02

min 8: CA index of 13.55

min 9: CA 16.14.

So that's why I was wondering whether higher minima will just make the CAs even worse. Looks like we have reason to think that'll happen. Of course, might just try it and see, but I worry about someone getting up into that 13-16 index territory.

It's possible that the higher pressures are causing more centrals but I am seeing some central clusters happen even at the lower pressures.
Sun March 8....look at the pressure at around 05:00 and the central cluster and no CSA flagging. Makes me wonder how much is real and how much is SWJ from the previous central cluster and a hyponea or 2 flagging and the CSR flagged breathing.
I would really like to evaluate all that flow rate close up along with the pressures to get a better handle on it but at this point I don't have the time.

The woman I talked about the miracle happening....everything cleared up when she went to 15 cm fixed pressure. Go figure that one.
Auto mode probably isn't the best mode for some people which is why I suggest trying fixed mode (or extremely tight auto mode)....a few years back auto mode was a total no no for people with centrals.
The woman I was talking about....25 to 35 centrals an hour. Some really ugly reports for sure. Like I said...everything fiber in my body was screaming ASV and the 15 cm was a last ditch effort because that was what the lab titration study said to use. I thought they were crazy coming up with that but we figured might as well try it since nothing else was working. Low and behold it worked.

Now do I really think that is going to work here...no I don't.....but it wouldn't be totally impossible. Unlikely yes but impossible..not totally.

I wouldn't spend a lot of time trying higher pressures. Sure wouldn't do my usual "try it for a week" thing. It w.ould be a one night only thing and I would do fixed pressures and not auto

All these ideas...just something to try if a person wants to try something because they feel helpless. Something to do while "giving it time" which is what the doctor is doing. Sort of a home titration study.

Or just go backwards with the minimum pressure...limit the maximum severely...and see how much the centrals reduce without causing a lot more obstructive stuff.

The more I think about it...maybe one more higher pressure experiment but make it 10 cm and fixed without letting the machine to go trying to kill off the FLs and see what happens. If the centrals climb even higher with 10 cm...I would back way off.

An in lab titration needs to be done for sure.
I am unclear as to whether the diagnostic study was a home study or not...or whether a titration study was ever done or not or did they just get handed an apap to sort out the pressures.

To the OP...question for you.

Are you taking any medications that might suppress your respiration particularly pain medications????

What is the altitude where you live at?

Any respiratory/lung problems going on that you are aware of?

Was your original diagnostic sleep study a home study or an in lab study (I couldn't really read the fuzzy image) and have you had a lab sleep study where they used cpap on you?

Many thanks, Pugsy and palerider, for the further insights into your thinking.

Just got back to check in. I tried 9 & 10 minimum pressure and couldn’t see any changes. Last night I tried 11 and was miserable. I evidently swallowed a bunch of air and was up for an hour trying to burp it up. I turned it back down to 9 minimum and did ok the rest of the night. I hadn’t seen these recommendations to shut off auto but I don’t think it ever went above 13 or 14.

To answer the questions, no medication other than blood pressure and generic Crestor. Sw Missouri. Elevation 1000 ft above sea level. Yes some history of respiratory problems. I had pneumonia 9 times in 7 years. 2 years ago diagnosed with chronic organizing pneumonia but luckily got that cleared up much quicker than expected and just in January had a CT scan showing no return of COP.
I’ll try to post Oscar graphs tomorrow. Early morning meetings tomorrow and it’s bed time. Thanks for the help.

well the saga continues...... I think the card reader on my computer choked so I can't post any Oscar data. I got the chance to buy a Resmed Aircurve 10 ASV with only 174 hours for less than the price of 2 doctor office visits so I bought it.
It arrived yesterday so I tried it last night. I had no idea how to set it so here's what I tried.
ASV auto mode. Min EPAP 4.0 Max EPAP 12.0 Min PS 3 Max PS 15 Start EPAP 4.0 Ramp 20 min

Can't read the SD card although I plan to take it to my office at work and see if I can read it on a different computer. Anyway the numbers on the machine's Essentials plus this morning are as follows: 8 hours run time 1.6 events / hour pressure 14.8 Exp pressure 7.7 AHI 1.6

If the AHI number off the machine is real that is far lower than anything I ever got on the normal APAP machine.

My questions. How should I readjust my settings? The one thing I noticed was i woke up several times from what I believe was a big blast of air that really inflated my full face mask. I suppose that's how the ASV machine deals with a central apnea to get you breathing??? If that's correct does it automatically decide how much pressure that takes or do I need to tweak some of my setting numbers? I know without the Oscar graphs this is all kinda shooting in the dark. If i get some downloaded I'll try to post later today. TIA

Those settings you use are the factory default settings and actually a decent place to start.
I suspect that you might need a little bit more minimum EPAP but really need to see what kind of events composed that AHI of 1.6 to know for sure.

And yes....you probably did get a rather big burst of air a few times during the night and it can cause people to wake up until the brain learns that the burst of air is a good thing. It's one of the features of this type of machine that can take some adjusting to.
Again need to see the details but most likely PS was kicking in and giving you a big inhale pressure which is how it deals with central apneas. Gives you a bigger PS burst to try to get you to jump start your own breathing and if you don't it does it for you for a few breaths.
When things are going along nice and calmly with nothing abnormal happening you will be using that minimum PS of 3 but when you have a central apnea the machine might increase the PS to 10 or more depending on what it thinks you need.

It will auto adjust your EPAP as it senses a need for the obstructive stuff and then add more PS to that EPAP when a central apnea happens.

I think there is another screen available on that sleep report that will show you the AHI breakdown if you can't get your SD card drive up and running. It should give you a UA and hyponea breakdown.

Bear in mind the ASV won't separate OAs and central (CAs) any more.....it only does UA and hyponea classifications.
The assumption being is if the machine has the settings so that the machine can deal with the centrals (and yours is) then any apnea events that happen are going to be obstructive and the fix for obstructive stuff is more EPAP first when EPAP is on the low side.
I think a trial of 5 minimum EPAP is in order. No other changes. It's a minor tweak that may be all that is needed to clean up the AHI a little further.

Xskier, it's great to hear you've taken matters into your own hands and had such good early results. How did you feel this morning? Any change? Might be much too early to look for that, but I'm curious. Looking forward to hearing more from you.

xskier wrote: ↑

Thu Mar 19, 2020 8:06 am

well the saga continues...... I think the card reader on my computer choked so I can't post any Oscar data.

USB card readers are *cheap*

I'll try to post Oscar graphs from last night

As I expected...mainly hyponeas.

Try increasing minimum EPAP by 1 cm and see what happens. No other changes.
So minimum EPAP from 4 cm to 5 cm.
This does 2 things....a little more baseline EPAP to help hold the airway open better in general and also pushes IPAP up by default which adds an additional baseline for IPAP that is a bit higher....both of which helps prevent the airway from collapse.

So we still need the Obstructive apnea stuff to be dealt with but at the same time we want to only use higher pressures when absolutely necessary since it seems like pressures are a trigger factor in your central apneas.

Thanks I’ll give it a whirl tonight

I got a card reader off ebay. So I'm going to try to post last nights results. Questions: Is this as good as it gets? What should I try tweaking next? If these centrals I got on the APAP are now fixed on this ASV machine what does that mean long term? If they were treatment induced (didn't show up in sleep study) does that mean they will go away after several weeks or months on the ASV? During my several bouts of pneumonia through the years various doctors encouraged me to learn to breathe more deeply. One thing I've noticed on this ASV machine is it seems to give you a "blast" of air when you either don't breathe or breathe very shallow breaths. I assume that's how it works and why it fixes the centrals. So does it retrain your body to breathe more regularly as the weeks go by? I'm thankful some of this is seeming to start working. Thanks for the advice and encouragement. and i'm still open to suggestions.