standard or soft response

Maybe my OSCAR needs updating. I will ask one of my millennials about that, whichever I see first! Or maybe I should wait for the one with the Mac.

This is a bit of a tangent, but I wonder about this. For some reason I overslept, right through my dawn clock and woke feeling very anxious, like the bad old days before CPAP when I woke with extreme, debilitating anxiety every morning. I looked at my chart. It shows erratic breathing, a central, and more erratic breathing, and then I woke up. The machine did not boost pressure in response. So, if the machine thinks it's a central, does it ignore the event? I'm sure that event was what woke me this morning or I'd still be asleep. I am so tired.

A side note, I decided to at least report to my sleep NP that I am having centrals and got a call back from her "certified medical assistant." Oh, God, what a waste of time.

onward60 wrote: ↑

Thu May 09, 2024 4:28 pm

So, if the machine thinks it's a central, does it ignore the event?

These machines can't treat or deal with central apneas unless you have one of the special machines like the ASV.
Your machine can't do anything with central apneas so it won't even try.
More pressure won't/can't force you to breathe if you aren't breathing due to a central apnea.
Even during OAs and hyponeas the machine won't do anything until the event has passed. It won't do anything during the obstructive event.

So yeah...the machine will just ignore the centrals other than record them.

Pugsy wrote: ↑

Thu May 09, 2024 4:36 pm

onward60 wrote: ↑

Thu May 09, 2024 4:28 pm

So, if the machine thinks it's a central, does it ignore the event?

These machines can't treat or deal with central apneas unless you have one of the special machines like the ASV.
Your machine can't do anything with central apneas so it won't even try.
More pressure won't/can't force you to breathe if you aren't breathing due to a central apnea.
Even during OAs and hyponeas the machine won't do anything until the event has passed. It won't do anything during the obstructive event.

So yeah...the machine will just ignore the centrals other than record them.

Since my centrals started with CPAP use, I hope I don't actually need an ASV. Just need to get my settings right, right?

I tried to message my NP about my settings. My message first got intercepted by a CMA then sent to a different NP that I saw in the past, can't stand, and never want to hear from again. (The one who asked me why I deserved a second chance at CPAP when I failed the first time.) She told me to set my pressure at constant 10 and get back to her in 3 weeks. I asked her what happened to my regular NP and said I preferred to stick to one provider to avoid confusion (which seemed a better thing to say than, "I can't stand you").

I really don't feel like making a giant settings change. My brain is starting to reject the mask again and wants me to settle down and stop making changes, I think. A big, abrupt changed based on who-knows-what does not seem like a good plan.

Here's some stuff from SleepHQ

Trend data:

https://sleephq.com/public/6a8d9ee7-315 ... 234d7be213

Last several days:

https://sleephq.com/public/4d1b5b83-9f8 ... fd7f1fbd46
https://sleephq.com/public/4fe70036-409 ... 07b7c4fa5e
https://sleephq.com/public/3debe527-c7f ... 4ac6b80782
https://sleephq.com/public/559ba6e0-771 ... f991c05354
https://sleephq.com/public/1c869dd6-925 ... 49bae33ff0

I don't have time to look at all those SleepHQ reports but I did scroll through the May 4 report.
Probably at least 85% of the flagged events you weren't asleep when they got flagged. You may not remember the arousal but it happened and your breathing reflects it. Lots of arousal/awake breathing showing up just prior to most of the central flags and even a couple of hyponea flags.

You slept like crap but it wasn't from the apnea events. Those apnea events flagged are a symptom of the poor sleep quality and not so much the cause of the poor sleep quality.
You weren't sound asleep when the majority of those events got flagged.

IMO wean yourself off EPR, I believe it's causing your CA's at 10cm. Good luck.

I would go back to when you weren't screwing around with the settings. Back to what seemed to be working well for you and you were feeling good.

I do NOT believe your centrals are EPR related (the bulk or over 80% of them are arousal/awake breathing related) but you can certainly try discontinuing it if you wish but I am afraid that the increase in pressure that reducing or totally stopping EPR is very likely going to cause your brain to be unhappy with "more changes" and your sleep quality will likely suffer.

I had time to scroll through all - but my post got stuck.
Pugsy's right - all those change were not doing you much good:

You're pushing your minimum pressure far too high.
You're making dramatic changes in pressure
And you're not letting your body get used to whatever pressure you're trying.

April 10 is where you clearly got a handle on your leaks.

Stick to what you had on May 8th. Take a week to just concentrate on sleeping. You're spending at least half the night with no flow limitations - no matter what your pressure. Your breathing, when the pressure is close to 8 looks great.
Your flow limitation are not waking you up - which is Lanky Lefty's point about when they should be ignored. And according to the May 8th chart, even your machine doesn't think you need pressures above 10.2. As a matter of fact on this night you were at pressures of 9.76 or less than that for 95% of the time. This in spite of the machine being given permission to go much higher should the need arise.

On ResMed machines, after you've run them for a while on a low minimum for titration purposes, it's enough to set the minimum at the median they show you. The median is the pressure at which you spend at least half the night - but its only informative when you start out with a low minimum. If you minimum is too high - as it was for some of the nights, the rest is meaningless.

Pugsy wrote: ↑

Thu May 09, 2024 8:40 pm

I don't have time to look at all those SleepHQ reports but I did scroll through the May 4 report.
Probably at least 85% of the flagged events you weren't asleep when they got flagged. You may not remember the arousal but it happened and your breathing reflects it. Lots of arousal/awake breathing showing up just prior to most of the central flags and even a couple of hyponea flags.

You slept like crap but it wasn't from the apnea events. Those apnea events flagged are a symptom of the poor sleep quality and not so much the cause of the poor sleep quality.
You weren't sound asleep when the majority of those events got flagged.

Thanks, Pugsy. I didn't expect an instant answer. I just wanted to give you a variety of nights in case one was more helpful than another.

Can you tell me how you can tell I am not fully asleep? Where should I look to see that and what am I looking for? Thanks.

ozij wrote: ↑

Fri May 10, 2024 2:44 am

Stick to what you had on May 8th. Take a week to just concentrate on sleeping. You're spending at least half the night with no flow limitations - no matter what your pressure. Your breathing, when the pressure is close to 8 looks great.
Your flow limitation are not waking you up - which is Lanky Lefty's point about when they should be ignored. And according to the May 8th chart, even your machine doesn't think you need pressures above 10.2. As a matter of fact on this night you were at pressures of 9.76 or less than that for 95% of the time. This in spite of the machine being given permission to go much higher should the need arise.

On ResMed machines, after you've run them for a while on a low minimum for titration purposes, it's enough to set the minimum at the median they show you. The median is the pressure at which you spend at least half the night - but its only informative when you start out with a low minimum. If you minimum is too high - as it was for some of the nights, the rest is meaningless.

May 8th was a strange night. Probably shouldn't base therapy on it? I was ill for a few days and sleeping horribly and need to be somewhere the 9th, so I took a sleeping pill the 8th. And then I listened to an audiobook in bed for a long time, not really asleep. And then I overslept the next morning which I never do even when I take a sleeping pill. I have no idea how I got such low numbers. My numbers don't make any sense to me. They seem to have nothing to do with what I perceive my sleep to be or what my settings are.

Pugsy wrote: ↑

Thu May 09, 2024 8:54 pm

I would go back to when you weren't screwing around with the settings. Back to what seemed to be working well for you and you were feeling good.

I like this plan!

I have never been feeling good, but I feel better than I did without the CPAP, that's for sure. I'm not going to do what the sleep nurse told me (set single pressure of 10 for 3 weeks).

Side question: Is 3 weeks a good time to stay at a certain setting to see if it helps or did she pull that out of thin air?

Since last night was not horrible, I think I'll just stay with what I have now for awhile:
Pressure 7-14
EPR 3
Ramp on auto (start at 6 because it's comfortable)
Soft response

Pugsy wrote: ↑

Thu May 09, 2024 8:54 pm

I do NOT believe your centrals are EPR related (the bulk or over 80% of them are arousal/awake breathing related) but you can certainly try discontinuing it if you wish but I am afraid that the increase in pressure that reducing or totally stopping EPR is very likely going to cause your brain to be unhappy with "more changes" and your sleep quality will likely suffer.

I tried twice to reduce my EPR to 2 and both times could not sleep and got up and changed it back. I agree that my brain will not like it, and it is a measure of last resort.

Here's a theory. People like me who had no centrals during the study but develop centrals when they start CPAP are really just having poor sleep because they are not used to the CPAP. When the centrals resolve on their own, it is because the person's sleep improved as they got accustomed to the CPAP. What do you think?

I gotta a bunch of stuff on my plate today.
So no time to go into much detail at all.
Sorry.

Stuff related to my late mother's estate that got dumped on my plate to handle.

I have explained how to tell the difference multiple times in the past.
Here's a thread that I happen to have handy.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

Pugsy wrote: ↑

Fri May 10, 2024 8:39 am

I gotta a bunch of stuff on my plate today.
So no time to go into much detail at all.
Sorry.

Stuff related to my late mother's estate that got dumped on my plate to handle.

I have explained how to tell the difference multiple times in the past.
Here's a thread that I happen to have handy.
viewtopic.php?f=1&t=187767&p=1451526#p1451526

No worries. I never expect instant answers. I will check out that link.

I hope all goes well with sorting the estate stuff. I'm sorry for your loss.

onward60 wrote: ↑

Fri May 10, 2024 8:37 am

Since last night was not horrible, I think I'll just stay with what I have now for awhile:
Pressure 7-14
EPR 3
Ramp on auto (start at 6 because it's comfortable)
Soft response

You've got me thoroughly confused.
This is the night of May 8th.
https://sleephq.com/public/4d1b5b83-9f8 ... fd7f1fbd46

These are the settings for that night:
Mask Pillows
Mode APAP
Pressure min 7.0 cmH2O
Pressure max 14.0 cmH2O
EPR level 3 cmH2O
Humidity level 5
Ramp pressure 6 cmH2O
Ramp time

When I suggested you stick to these setting, you responded:

May 8th was a strange night. Probably shouldn't base therapy on it?

Were you referring to another night?

Just to be clear: those are the settings I think you should stick to, and stick to the for a week or two.