Pressure settings

If I want to lower my settings to reduce centrals. Should I lower epap ipap or both. How much.

IMO, you should lower the IPAP b/c it is the higher one.

The highest my ipap has went to in the last few days is 21. It is set at 22. Should I lower it down to say 20 and leave the epap alone?

As long as the obstructive side of things doesn't increase...you can lower both.
That way you can keep your pressure support the same which will help with comfort.
We are assuming that your centrals are pressure related and not something else...and they may or may not be related to pressure because you had the one report where centrals weren't an issue and finally had a good report with leaks well controlled.

This was your past entry of data. Why are you using such hi pressures, i.e. if your pressures were lower would the data show more obstructive events, if yes, then by how much (assuming that you reduce the 95% leak to below 24 L/Min)?

I suspect using higher pressures because that is what the doctor ordered. As to why? I guess he had his reasons.
The prior data that Avi posted...inconclusive data because of massive leaks. It can't be trusted to offer a clear picture of what is going on. Well documented in other threads.
Just recently got leaks under control so that we can trust the data that gets reported.

Benny, I don't remember seeing this report that Avi has posted ...did you send it to him or did I just miss it?
You are going to have to evaluate your therapy based on the recent nights with the new mask and when leaks are well managed so that we can trust the data. The old data with big leaks is pretty much useless in terms of helping you decide what to do now.

Pugsy wrote:I suspect using higher pressures because that is what the doctor ordered. As to why? I guess he had his reasons.
The prior data that Avi posted...inconclusive data because of massive leaks. It can't be trusted to offer a clear picture of what is going on. Well documented in other threads.
Just recently got leaks under control so that we can trust the data that gets reported.

Benny, I don't remember seeing this report that Avi has posted ...did you send it to him or did I just miss it?
You are going to have to evaluate your therapy based on the recent nights with the new mask and when leaks are well managed so that we can trust the data. The old data with big leaks is pretty much useless in terms of helping you decide what to do now.

Comment,
The above is incorrect when talking about Resmed S9 machines b/c they would flag those questionable events as UNKNOWN due to the higher leaks. In the above data these unknowns were at 0.9 per hour which comes out to 20% of the AHI of 4.5. So the remaining 80% of events should be acceptable.

Bennnyp wrote:If I want to lower my settings to reduce centrals. Should I lower epap ipap or both. How much.

Do you have a copy of your sleep study? If not, you need to get it.......and if you do, look it over and see if Centrals were noted and at what pressure(s). In other words, you need to find out if the Centrals are only coming from your reports or if they were there at the sleep study.
So, with the sleep study and your XPAP reports, do the "Centrals" coincide with the pressures reported in the sleep study?

You could then use that data to determine which setting(s) you could lower.


Den

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I've been fighting to figure out how to reliably manipulate low frequency CAs (<2 per hour average) for months. The only thing I have learned for certain is that I do not know how to reliably manipulate low frequency CAs. Therefore, I will limit my comments to this:

At low frequencies like 1 or 2 per hour, it is very possible your CAs will not react increase/decrease consistently in reaction to small increases/decreases in pressure. At that low of a frequency, I find CAs more related to subtle factors like the number of times you roll over in your sleep, how recently or frequently you've made pressure changes, what Flex / EPR you are using, whether or not you've changed your Flex / EPR setting recently, taking an OTC or prescription medication, etc. I'm not suggesting your don't try it, or that a pressure reduction won't work, but it is also possible you will end up driving yourself crazy trying to determine if the 1/2 CA per hour effect you think you see is the result of the specific change you made, or just a side effect of change itself, or if you rolled over a couple more or fewer times that night and it has nothing to do with the change at all.

The above is incorrect when talking about Resmed S9 machines b/c they would flag those questionable events as UNKNOWN due to the higher leaks. In the above data these unknowns were at 0.9 per hour which comes out to 20% of the AHI of 4.5. So the remaining 80% of events should be acceptable.

No, it is not incorrect.
The entire problem with leaks this big is that the absence of events getting flagged (doesn't matter the name it gets called) could possibly mean that the machine simply couldn't sense anything during the time of such excessive leaks so any AHI that might appear to be low...could be falsely low because the machine simply couldn't sense anything at all.

Yes, if the machine sensed something and couldn't figure out what it was..it would be a green unknown flag but there comes a point in the big leaks where the machine can't even sense anything at all and thus even the green flag doesn't happen.
Now maybe nothing happened during that big leak but there's always the chance that something could have happened and the machine had no idea it was even happening.

That's my point about excessive leaks and AHI that looks good on paper. We don't know if it is acceptably low because nothing happened or the machine was clueless.