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Exhale relief is where there is a small drop in pressure during exhale to make the breathing out against the pressure easier to do.
http://www.sefam-medical.com/en/1141-2-2/
I couldn't tell from what I could find about the machine if that feature was even available on your machine as a setting you could change.
The CC+ feature might be built in and not adjustable. I couldn't really tell and no time to dig that deep into the specs.

Oh jeez, how did I miss all those centrals? Pugsy, do you think there'd be any value in the OP's using lower pressures for a night or two to see whether that brings the CAs down? And if that doesn't work, would you be inclined to recommend an ASV machine?

Miss Emerita wrote: ↑

Mon Apr 13, 2020 10:25 am

Oh jeez, how did I miss all those centrals? Pugsy, do you think there'd be any value in the OP's using lower pressures for a night or two to see whether that brings the CAs down? And if that doesn't work, would you be inclined to recommend an ASV machine?

Oh man, I just don't know in this situation what to offer. I thought about it a lot last night and there is so much I don't know that I would need to know before recommending anything beyond "see your doctor".
We don't know if the centrals were present during the diagnostic sleep study for one thing and it's a very important thing to know.
Did they show up only after starting cpap therapy....would the centrals still be present even at a low pressure setting...I have seen as many or more centrals pop up with people using 5 or 6 cm pressure. I know we tend to think higher pressures are the main trigger but actually the main trigger belongs to any pressure and the higher pressure trigger instances are in a minority.

Exhale relief can also be a trigger in some people which is obviously why I was trying to determine if there is any exhale relief that we could maybe lay some of the blame on. I can't tell with the report if exhale relief is even being used. If it is...it isn't much.

And the Obstructive Index is already too high...if we reduce the pressure to see if the centrals reduce it's pretty much a guarantee that the obstructives will increase. Even if the centrals reduce there is good chance the obstructives will increase and we are just trading one kind of apnea event for another.

The only other thing...how much of all this mess is SWJ and we don't have anyway to know.

This machine is a machine supplied in Europe or the UK...that area and he mentions British...so I am assuming maybe UK and those folks don't like people messing with things big time and they are extremely reluctant to even discuss ASV. If they finally acknowledge that central apneas are a problem they are quick to recommend the S/T machine which doesn't do such a good job with obstructive apneas.
Plus going the DIY route over there is extremely expensive and I sensed no income (or not much income) coming in from what was said as to why he was home.

Yes, ASV would fix things...it can deal with both the obstructive stuff and the central stuff but getting one isn't so easy and doing it yourself..while not impossible, it's not easy either even with deep pockets.

If the obstructive index were lower...we could try reducing the pressure but right now even at 18 cm his index is over 5.
All this is of course assuming those are all asleep flagged events and not SWJ and we have zero way to know for sure sleep status.
Plus this is a totally different machine that reportedly can flag central hyponeas and central apneas and we don't have a clue how the algorithm works.

So much we just don't know which makes it really hard to know what can be offered.

We could offer some ideas to try to see if anything helps or not....might get lucky but that would involve the patient changing the settings and I know know if the OP is comfortable doing that or what might happen to him if he did.
Based on what we see now though....he needs a different machine and the ASV would likely be the best choice IMHO. I don't hold much hope of some little tweaks making much of a difference but I have seen miracles happens.
It would be interesting to see if these ugly stuff now has been there all along or just started recently...but again..no way to check it out.

To the OP: you can see Pugsy's thinking and her concerns. Do you by any wild chance have a copy of your sleep study? If you do, it'd be very useful if you had some way to scan it (removing personal information) and upload it here. If you have it but can't scan it, could you look to see whether there's a breakdown of your events during the night of the study: a total AHI, an OI (obstructive events per hour), a CAI (central events per hour), an HI (hypopneas per hour)?

Yes, I do have the sleep study report - summary and 3 nights' worth of data.

Something I noted today - when my CPAP machine is at the same height or above my head when I sleep, it seems to perform better. So, I'm setting my pressure settings from 15 to 20 now (to vary between those) and having it on the window sill rather than the floor. My comfort pressure was previously set to 10 ages ago which could be worth updating. I'm going to see if the CPAP machine in this position will help my quality of sleep.

I may have overlooked it, but have you mentioned if you are making an effort to not back sleep in view of your report indicating your events increase with back sleeping? The other thing I noticed is in your history on the report it mentions your report your legs jerking. Are those jerks rare or regular? If you get your CPAP therapy optimized and you are still having daytime symptoms, you might want to make sure periodic limb movements aren't an issue.

kteague wrote: ↑

Tue Apr 21, 2020 5:23 am

I may have overlooked it, but have you mentioned if you are making an effort to not back sleep in view of your report indicating your events increase with back sleeping? The other thing I noticed is in your history on the report it mentions your report your legs jerking. Are those jerks rare or regular? If you get your CPAP therapy optimized and you are still having daytime symptoms, you might want to make sure periodic limb movements aren't an issue.

I now use an orthopaedic body pillow which I often cuddle so that I sleep on my side. This wasn't present in the sleep study (which took place nearly 4 years ago).

The most common problem I am having right now is, now that I'm living back with my parents (as my university halls were vacated due to the virus), that I am waking up a couple of hours before I actually want to, and not being able to get back to sleep despite still feeling really tired. For instance, I might go to bed at 1am (which is bad I know) but naturally awake at 9am, which, although is a good 8 hours, still leaves me feeling tired.

This has happened to me on occasions before, and can explain why I can't get proper "lie-ins", although it would be nice to be able to catch up on sleep properly on my days off by sleeping longer than I usually could...