making adjustments

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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onward60
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making adjustments

Post by onward60 » Tue Apr 02, 2024 2:19 pm

So, I've been using my machine for a few weeks and I tend to end up with a pressure of 10. My prescription is 4-14. Should I start to narrow those number, such as raise my low number to 5 then 6 then 7, etc.? Also, I am using auto ramp. Should I raise the start pressure for that, too?

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ChicagoGranny
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Re: making adjustments

Post by ChicagoGranny » Tue Apr 02, 2024 4:07 pm

What's your AHI? How well do you think you are sleeping?

Are you using OSCAR or SleepHQ?

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Sheriff Buford
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Re: making adjustments

Post by Sheriff Buford » Wed Apr 03, 2024 6:34 am

I wouldn't. There are times you may need a pressure higher than a 10.... so it's there is you need it. Are you comfortable with the 4?

Sheriff

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onward60
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Re: making adjustments

Post by onward60 » Wed Apr 03, 2024 2:36 pm

ChicagoGranny wrote:
Tue Apr 02, 2024 4:07 pm
What's your AHI? How well do you think you are sleeping?

Are you using OSCAR or SleepHQ?
I have OSCAR, but I don't really understand it.

The machine says my AHI is 4, but they are mostly centrals.

I talked to someone at Apria today and now am totally confused about what centrals are.

I'm sleeping OK, not great. I still wake up 2 or 3 times a night thinking I have to go to the bathroom but usually I don't.

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onward60
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Re: making adjustments

Post by onward60 » Wed Apr 03, 2024 2:38 pm

Sheriff Buford wrote:
Wed Apr 03, 2024 6:34 am
I wouldn't. There are times you may need a pressure higher than a 10.... so it's there is you need it. Are you comfortable with the 4?

Sheriff
The 4 feels like nothing.

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Pugsy
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Re: making adjustments

Post by Pugsy » Wed Apr 03, 2024 2:59 pm

Hold your breath for 15 seconds. That's essentially what a central apnea of 15 second duration is.
The airway is open but no air is moving because there is no effort to breathe. That's a central apnea.
We pause our breathing all the time while awake and don't realize it. The machine can and will flag those awake pauses as some sort of central apnea but if we aren't asleep it doesn't count for anything other than letting us know we weren't sound asleep.

OAs and hyponeas....those are when the airway is blocked (fully or partially) by saggy airway tissues.

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onward60
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Re: making adjustments

Post by onward60 » Wed Apr 03, 2024 5:56 pm

Pugsy wrote:
Wed Apr 03, 2024 2:59 pm
Hold your breath for 15 seconds. That's essentially what a central apnea of 15 second duration is.
The airway is open but no air is moving because there is no effort to breathe. That's a central apnea.
We pause our breathing all the time while awake and don't realize it. The machine can and will flag those awake pauses as some sort of central apnea but if we aren't asleep it doesn't count for anything other than letting us know we weren't sound asleep.

OAs and hyponeas....those are when the airway is blocked (fully or partially) by saggy airway tissues.
I think the woman at Apria had to idea what she was talking about. :roll:

Does anybody really know why a person would have no centrals in a sleep study and then have primarily centrals while on CPAP?

If I figure out how to post my current OSCAR charts (son not available to help with technology much right now ) will it give me a clue as to whether I am awake or asleep during the centrals? Or should I just not worry about centrals right now since I'm only a few weeks into using CPAP most of the night? And I'm still tweaking the rainout.

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vandownbytheriver
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Re: making adjustments

Post by vandownbytheriver » Wed Apr 03, 2024 6:31 pm

Pugsy wrote:
Wed Apr 03, 2024 2:59 pm
Hold your breath for 15 seconds. That's essentially what a central apnea of 15 second duration is.
The airway is open but no air is moving because there is no effort to breathe. That's a central apnea.
We pause our breathing all the time while awake and don't realize it. The machine can and will flag those awake pauses as some sort of central apnea but if we aren't asleep it doesn't count for anything other than letting us know we weren't sound asleep.

OAs and hyponeas....those are when the airway is blocked (fully or partially) by saggy airway tissues.
We're gonna have to agree to disagree Pugsy... you need to be asleep to have OA's or H's... being awake your muscle tone keeps your tongue in check. You can generate CA's while relaxed and awake. All you have to do is set your therapy pressure and relax for 10min... then engage EPR 3 or PS 4... then note the cycle of CA's generated. I found myself actually noticing when I'd stop breathing... I'm awake... the machine is popping CA's. For the entire relax period before, no CA's.

I urge (healthy) interested folks to try the experiment so you notice what a real CA is like. Wear an O2Ring etc... you may see it go off, depending on how long and deep you let the cycle go. Obviously if you're already on EPR2 this probably won't work, or the effect will be lessened. I'm on a bi-level machine set for APAP pressures and I turn PS0 to PS4... the effect hit within three minutes. Wide-awake, real CA's due to CO2 stripping.

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Pugsy
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Re: making adjustments

Post by Pugsy » Wed Apr 03, 2024 6:39 pm

onward60 wrote:
Wed Apr 03, 2024 5:56 pm
Does anybody really know why a person would have no centrals in a sleep study and then have primarily centrals while on CPAP?
For some people cpap therapy actually can trigger the unstable breathing that ends up with someone having more than a few centrals (it is normal to have an occasional central apnea) than is acceptable.

Most people though don't have cpap emergent centrals though....what they are seeing, when they first start cpap therapy, are SWJ (sleep/wake/junk) centrals or pauses in breathing while awake or half awake because when we first start cpap therapy we just don't sleep that great what with all the new stuff we have to deal with.
This greatly increases our chance of the machine flagging awake/arousal breathing irregularities as some sort of apnea event (commonly central flags but I have see both OAs and hyponeas flagged while I was awake.

I would bet my last dollar that the central flags you are seeing are awake/arousal related and not real asleep centrals and the only ones that worry us are real asleep centrals numerous enough to be a problem.
An occasional real asleep central is actually normal and expected. Centrals are only a problem when they are really numerous (think over 5 per hour, every hour, all night long) or if they cause desats.

You are still having a lot of wake ups fiddling with stuff????????

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Re: making adjustments

Post by Pugsy » Wed Apr 03, 2024 6:48 pm

vandownbytheriver wrote:
Wed Apr 03, 2024 6:31 pm
We're gonna have to agree to disagree Pugsy... you need to be asleep to have OA's or H's.
We are going to do more than just disagree. Do you have documentation proving what you are asserting?

Hmmmm....then I wonder why I have OAs and hyponeas when I am obviously not asleep.
Circled in red is the asleep breathing. I have other examples where I am clearly not asleep and yet the machine flags OAs and hyponeas....not many I grant you but I see them all the time. My sleep quality is in the toilet most nights so I have lots of experience looking at arousal/awake breathing and flagging. Plus I asked 2 different sleep techs about these sorts of flags.....and they both agreed with my evaluation. You CAN most definitely get a false positive flagged OA and hyponea but I will admit not nearly as common as false positive centrals.

Image

Image

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onward60
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Re: making adjustments

Post by onward60 » Wed Apr 03, 2024 7:55 pm

Pugsy wrote:
Wed Apr 03, 2024 6:39 pm
onward60 wrote:
Wed Apr 03, 2024 5:56 pm
Does anybody really know why a person would have no centrals in a sleep study and then have primarily centrals while on CPAP?
You are still having a lot of wake ups fiddling with stuff????????
I go to bed listening to an audiobook to make my brain happy (or it gets mad about the stuff on my face). I think I actually hear only about 5 minutes of reading. I wake up 1 to 2 hours later. Sometimes I have to make rainout adjustments. Sometimes I just do my habit of going to the bathroom whether I need to or not. Then I sometimes have trouble getting the mask to sit back in place properly. It makes a woosh-woosh-woosh noise until I get it in the right place. Fiddling with it can take a few minutes or sometimes more. I go back to sleep pretty quickly once the mask is settled. Then I wake up 1-2 hours later and repeat. If I wake up again, it's so close to dawn I just get up. Before the CPAP I was waking 2-4 times every night, going to the bathroom half asleep, and falling back asleep again. I did this for over 10 years not knowing why until I got a sleep study. I think maybe my brain is just stuck in a rut of getting up in the night.

BTW, I bought a box of Bleeps with my own money (have yet to find a Medicaid supplier who carries them) but went through them very fast because I was practicing multiple times a day and trying to get to the required 4 hours, which I wasn't able to do. The local Apria lady who actually uses a CPAP herself, suggested I try the N30. I was surprised she was right that it put less pressure on my face than the P10. So, I am trying the N30 now, and have been able to wear it more than 4 hours every night for several weeks. I have the hose suspended over the bed and pulled back toward the wall with a kind of crane-like thing and a CozyHose Boss. It looks crazy, but it works so far. There is nothing resting on my face except the cushion. Just having a bit of trouble with the fit. The small was too tight, made my nose sore, and the medium seems like it is just barely not too big. Hence the middle of the night fiddling.

Would you suggest I just ignore the centrals until my brain is more accepting of the CPAP and I get the rainout under control? Or are the centrals contributing to my brain being unsettled? Or is it a coin toss?

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Re: making adjustments

Post by Pugsy » Wed Apr 03, 2024 8:08 pm

onward60 wrote:
Wed Apr 03, 2024 7:55 pm
Would you suggest I just ignore the centrals until my brain is more accepting of the CPAP and I get the rainout under control? Or are the centrals contributing to my brain being unsettled? Or is it a coin toss?
onward60 wrote:
Wed Apr 03, 2024 2:36 pm
The machine says my AHI is 4, but they are mostly centrals.
Even if every single flagged event composing that AHI of 4 was a real asleep central (which I am fairly sure they aren't) it still isn't enough to get a doctor to worry about. They won't even bat an eyelash until the central index goes over 5 and consistently over 5.

Ignore them for now (or at least until I can see your data reports and maybe use SleepHQ) and I think that once you start sleeping more soundly those centrals will reduce because the problem is the sleep quality and not the airway.
The centrals right now....I am pretty sure they are nothing more than a symptom of crappy sleep quality.
Fix the sleep quality problem and the centrals will fix themselves.

Awake stuff doesn't count and all those centrals mean is your sleep quality isn't optimal.

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vandownbytheriver
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Re: making adjustments

Post by vandownbytheriver » Wed Apr 03, 2024 8:27 pm

Pugsy wrote:
Wed Apr 03, 2024 6:48 pm
vandownbytheriver wrote:
Wed Apr 03, 2024 6:31 pm
We're gonna have to agree to disagree Pugsy... you need to be asleep to have OA's or H's.
We are going to do more than just disagree. Do you have documentation proving what you are asserting?
(snip)
I did an experiment where I used CPAP to strip my CO2 and experienced CA's. I was awake. As you're aware, pressure does not help with CA's. Basically I proved to myself that I could generate CA's with EPR while awake. Do they count? They did to me! I'm not going to try PS or EPR any more at my current pressure level.

Don't we agree that you have to be asleep to have OA's? *Real* OA's? My point is that you don't have to be asleep to have real CA's.

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Pugsy
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Re: making adjustments

Post by Pugsy » Wed Apr 03, 2024 8:45 pm

vandownbytheriver wrote:
Wed Apr 03, 2024 8:27 pm
Don't we agree that you have to be asleep to have OA's? *Real* OA's? My point is that you don't have to be asleep to have real CA's.
If we aren't asleep then it's not sleep apnea. Gotta be asleep to have sleep apnea.
The machine doesn't measure sleep status....you know that.
The machine only measures air flow/breathing and just calls them like it sees them.
It's up to us to figure out what is important in terms or therapy....the machine just gives us data to use to help us figure it out.

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onward60
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Re: making adjustments

Post by onward60 » Wed Apr 03, 2024 10:04 pm

Pugsy wrote:
Wed Apr 03, 2024 8:08 pm

Even if every single flagged event composing that AHI of 4 was a real asleep central (which I am fairly sure they aren't) it still isn't enough to get a doctor to worry about. They won't even bat an eyelash until the central index goes over 5 and consistently over 5.

Ignore them for now (or at least until I can see your data reports and maybe use SleepHQ) and I think that once you start sleeping more soundly those centrals will reduce because the problem is the sleep quality and not the airway.
The centrals right now....I am pretty sure they are nothing more than a symptom of crappy sleep quality.
Fix the sleep quality problem and the centrals will fix themselves.

Awake stuff doesn't count and all those centrals mean is your sleep quality isn't optimal.
Yeah, nobody seems to think anything below 5 matters. Still seems like a lot to me, especially if the average is 5 but they are all clustered in REM.

So, I'll just ignore the centrals.

I've been creeping the lower number up and leaving the higher number as is so I have less of a swing between pressures. I hope that's the right thing to do.

I'll also try to figure out OSCAR, if my sleepy brain remembers I said that! :wink: I don't know what SleepHQ is.

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