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Miss Emerita wrote: ↑

Sun Aug 23, 2020 3:42 pm

I was going up very slowly from 3, .2 cm at a time, and when I got to 5, the centrals and the aerophagia just wouldn't settle down. So I backed off to 4.8, where both are OK. Shorter answer: trial and error!

Do PS-induced centrals usually settle down then? Say if one goes too high with PS and gets centrals, is it a good idea to give it a few days to see if centrals go away?

Lightweaver wrote: ↑

Sun Aug 23, 2020 4:25 pm

Do PS-induced centrals usually settle down then? Say if one goes too high with PS and gets centrals, is it a good idea to give it a few days to see if centrals go away?

I wouldn't continue using a too high PS while getting a truckload of centrals because there is zero guarantee they will just magically go away.

Now you might find a line where you could use some PS and be okay and just above it...not okay but I had a friend use PS of 4 for nearly a year (dumb ass doctor thought he was being helpful) and she had at least 15 centrals an hour for over year and felt absolutely horrible...big surprise there. I thought for sure she needed ASV until on a whim we decided to try PS of 3...just a little 1 cm difference and the centrals all but went away. She needed the PS because to treat her OS she needed around 16 cm minimum pressure...let me tell you that isn't much fun without some exhale relief. She had been doing great on a regular apap machine using EPR of 3 which is of course equal to PS of 3. So the doc wanted to help out and told her "lets get you a bilevel machine and give you more exhale relief" and oops..PS of 4 caused a truckload of centrals and the doc didn't do a damn thing for a year except tell her "give it time".
Well...no amount of time was going to fix that problem. I got involved when she came here after a year of feeling like crap and a central index running 15 to 20 every night.

The light bulb went off in my head when I had her show me a report from her old apap machine....EPR 3...no centrals...duh.
The centrals all started with the bilevel machine...and PS of 4. We fixed that problem real fast once we had enough information to figure out what was happening. All we had to do was change the PS to 3 and she was a happy camper real fast. There was zero excuse for the full year of misery she experience plus all the worry about heart issues and all that.

So don't assume that PS triggered centrals will just go away...they might not and they can still mess with your sleep, your O2 levels and how you feel during the day when you have a truckload of them. I wouldn't want them happening to me.
I like PS myself...makes my breathing so much more natural feeling but if for one minute I even remotely thought that it was causing central apneas...I would reduce or even eliminate it. I would never ever continue to use something that appeared to cause a problem while crossing my fingers that there would be a miracle happen and all of the sudden it no longer caused a problem.

Pugsy wrote: ↑

Sun Aug 23, 2020 4:47 pm

Lightweaver wrote: ↑

Sun Aug 23, 2020 4:25 pm

Do PS-induced centrals usually settle down then? Say if one goes too high with PS and gets centrals, is it a good idea to give it a few days to see if centrals go away?

I wouldn't continue using a too high PS while getting a truckload of centrals because there is zero guarantee they will just magically go away.

Now you might find a line where you could use some PS and be okay and just above it...not okay but I had a friend use PS of 4 for nearly a year (dumb ass doctor thought he was being helpful) and she had at least 15 centrals an hour for over year and felt absolutely horrible...big surprise there. I thought for sure she needed ASV until on a whim we decided to try PS of 3...just a little 1 cm difference and the centrals all but went away. She needed the PS because to treat her OS she needed around 16 cm minimum pressure...let me tell you that isn't much fun without some exhale relief. She had been doing great on a regular apap machine using EPR of 3 which is of course equal to PS of 3. So the doc wanted to help out and told her "lets get you a bilevel machine and give you more exhale relief" and oops..PS of 4 caused a truckload of centrals and the doc didn't do a damn thing for a year except tell her "give it time".
Well...no amount of time was going to fix that problem. I got involved when she came here after a year of feeling like crap and a central index running 15 to 20 every night.

The light bulb went off in my head when I had her show me a report from her old apap machine....EPR 3...no centrals...duh.
The centrals all started with the bilevel machine...and PS of 4. We fixed that problem real fast once we had enough information to figure out what was happening. All we had to do was change the PS to 3 and she was a happy camper real fast. There was zero excuse for the full year of misery she experience plus all the worry about heart issues and all that.

So don't assume that PS triggered centrals will just go away...they might not and they can still mess with your sleep, your O2 levels and how you feel during the day when you have a truckload of them. I wouldn't want them happening to me.
I like PS myself...makes my breathing so much more natural feeling but if for one minute I even remotely thought that it was causing central apneas...I would reduce or even eliminate it. I would never ever continue to use something that appeared to cause a problem while crossing my fingers that there would be a miracle happen and all of the sudden it no longer caused a problem.

I'm slowly increasing my PS .2cm every few nights, no real centrals so far. What should my actions be if the next 0.2 increase brings the centrals on? Should I back down right away, or should I wait a few days to see if the centrals settle down?
I apologize for hijacking this thread!

Lightweaver wrote: ↑

Sun Aug 23, 2020 5:16 pm

I'm slowly increasing my PS .2cm every few nights, no real centrals so far. What should my actions be if the next 0.2 increase brings the centrals on? Should I back down right away, or should I wait a few days to see if the centrals settle down?
I apologize for hijacking this thread!

Would all depend on what you reported your sleep quality was. Did you have a bad night and do a lot of tossing and turning and didn't sleep well for some other reason. We all have bad nights. Not every bad night is because of a minor setting setting we might make.
Might just be a bad night because of any other number of reasons for having a bad night. Just how much of a change in centrals are we talking about ....1 per hour or 10 per hour. Big difference there.

The chances of you having PS triggered centrals...very slim. I have used as much as 6 PS....no change in the number of centrals but I didn't like it in terms of comfort. The number of people who actually have PS triggered centrals....very small. Remember we get the problems with cpap people here. The people who start cpap and feel good and merrily go on their way won't have a need for a forum like this. We get the outliers.

Miss Emerita has been monitoring her data and how she feels for quite some time now. I never ever make changes based on one night's data....never. She doesn't either. She has looked at lots of data and has lots of nights under her belt to help her make decisions that work best for her.

I also never ever go just by the AHI numbers alone. They lie through their teeth sometimes.
Have you ever read my story about my AHI of 10.6 night.....OMG I woke up and felt like superwoman...this was about 4 months into my cpap therapy some 11 years ago. Back then I never checked my software reports until the evening because I didn't want to cloud my perception of the day. Didn't want to create a self fulfilling prophecy kind of thing. So I always did the software looking before bedtime...it was just my habit.
Anyway I was superwoman all day...amazing day...slept great...felt great...got a lot done...happy camper. I thought for sure I must have had one of those miracle AHI 0.0 nights.....nope...AHI of 10.6. Go figure that one but let me tell you right now if I could feel that same way and had to get AHI of 10.6 to feel it....I would take it every day of the week right now and forever.

Back then we didn't have the level of details available in the software to review stuff. Heck, they didn't even flag centrals at all. Any centrals just got lumped in whatever basket they most closely resembled...which was hyponea I think back then. I suspect that my elevated AHI was nothing more than a lot of SWJ sleep/wake/junk false positives being reported either at the beginning or ending of the night. Once I fell asleep...I slept well and for a respectable amount of time but the AHI probably reflected some awake time. That was why I felt like superwoman I probably slept decently once asleep and for a decent amount of time.

Now my AHI is less than 1.0 most nights and I feel like dog crap because I don't sleep well or long enough.
It has nothing to do with OSA though or my therapy. It has to do with the fact that my body hates me and I can't find a position to sleep in that doesn't hurt like hell and medications to help end up making me feel like a walking zombie during the day and I refuse to do that.
I just tried a new one last month...it lasted 2 weeks. No thank you as the side effects were worse than the problem it was supposed to help out with and didn't even help out that much as it was.

CPAP fixes airway related problems...that's it. It doesn't fix any other problems that aren't related to the airway. It won't fix bad sleep if the bad sleep isn't from airway issues. No matter how much we want to put all our problems in the apnea basket....they aren't all related to the airway. I know my sleep quality sucks but I also know it isn't from airway related issues. 75% of any of my now flagged AHI events....all awake related flagging from tossing and turning and not sleeping well.

But I do yearn for an AHI of 10.6 where I once again felt like superwoman. I would take it every day of the week if I could feel that way again. Sigh...this getting old sucks but I guess still beats the alternative....been on cpap since May 2009. I am 68 now. We age and things just aren't ever like they were when we were younger. Nothing stays the same and rarely improves...