Still trying to tame centrals

jillianwi wrote:Maybe it is the trazodone? I'm a newbie, but when I asked my MD about my centrals, he told me they were likely from the Ambien or alprazolam I was using to try to adjust to the CPAP... and using SleepyHead, it does seem to correlate. He said any sleeping med would make CAs increase.

As I recall there are a couple of studies showing that hypnotics can be beneficial for one "type" of CompSA. Sludge helped me get a handle on this awhile back, so maybe he (it?) will chime in here with a little study wizardry.

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jillianwi wrote:Maybe it is the trazodone? I'm a newbie, but when I asked my MD about my centrals, he told me they were likely from the Ambien or alprazolam I was using to try to adjust to the CPAP... and using SleepyHead, it does seem to correlate. He said any sleeping med would make CAs increase.

The centrals cropped up well in March before I started taking Trazodone (May 24th). Doesn't look like it is making things worse. In recovery (almost 25 years) so I am very leery of benzos. With Meds its all about trade-offs. Would be interested in knowing what the research has to say on whether Trazodone is likely to be beneficial or has the potential to make things worse.

Kennerly wrote:I still see CAs on most nights, but generally its only a small number of isolated ones in the 10-12 second range, and not the clusters Iike I used to have.

Good to see there are some workable solutions..and you have managed to tame the centrals - gives me a cause for optimism.

Lots of food for thought as I engage my health care provider over the next week or two.

ResMed S9 Asv Solved / cured my central problems and other apnea events.

Did you ever figure out how to reduce or turn off your Flex setting?
If not, you have to go into the clinical setup menu to make the adjust so that the patient has access to the Flex settings.
The provider manual explains how or you can watch this video and I think it also explains how.
The PR S1 video is at the bottom
http://www.cpaplibrary.com/machines.html
You can request a copy of your clinical manual from here...instructions down at the bottom of the page
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

Your idea of a range of pressure from 6 to 9 would be a doable experiment. Though sometimes you have those centrals with no increase in that minimum pressure so I don't know for sure what would happen but wouldn't hurt to try it.
Pressure may not be the trigger and may be something else but hurts nothing to try to rule it out or confirm by reducing the pressure.
I also don't know if turning AFlex off or reducing it will make any difference. In theory it shouldn't but I see theories get bashed all the time and again it's a small change and worth a try.

Pugsy wrote:
"I also don't know if turning AFlex off or reducing it will make any difference. In theory it shouldn't but I see theories get bashed all the time and again it's a small change and worth a try"

Thanks Pugsy. The theory of reducing or switching off the CFLEX/AFLEX/EPR is that reducing any form of expiratory relief decreases the tendency for the hyperventilation phase of the periodic breathing/Cheyne Stokes breathing in Complex sleep apnea which Robysue has so eloquently referred to. I have just received the go ahead for a research study to be carried out in the UK to look into this effect but it will take a good while before we see any results. In the meantime I agree that it is worth a try.

The frequently recurring central events of periodic breathing which Startanew has demonstrated with the crescendo/decrescendo are, by definition, central events. When I had these on APAP (before changing to ASV) approximately 70% were reported as central and 30% obstructive. This was using a French Sefam machine which uses the same central detection method as Resmed. It is possible that the Philips Respironics method is superior but I am only guessing now.
Ian

igdoc wrote:Thanks Pugsy. The theory of reducing or switching off the CFLEX/AFLEX/EPR is that reducing any form of expiratory relief decreases the tendency for the hyperventilation phase of the periodic breathing/Cheyne Stokes breathing in Complex sleep apnea which Robysue has so eloquently referred to.

Well if that's the case then I suppose it goes along with what I have seen happen to a few people who use EPR in ResMed machines and have an increase in centrals and the centrals markedly decrease just by turning EPR off.
It's a very small subset of a smaller subset of people who see this happen though. Certainly not a common occurrence.
Respironics Flex relief isn't like EPR though and the reduction during exhale isn't necessarily all that huge since the flow rate (force of one's own breath) dictates the actual amount of reduction especially at a setting of 1. Even at a setting of 3 the most it can reduce the pressure is 2 cm and not 3 cm like people tend to believe.

It's a relatively benign experiment to try though unless the breathing rhythm changes and because the body likes AFlex a lot the body throws a fit when it gets turned off. I did that once just for grins after using AFlex at setting of 2 for probably over 2 years. Bad idea. Probably THE worst night I have ever had on xpap therapy in over 5 years.

Update

Do have an appointment with Sleep Doc scheduled now ... though the soonest I could get in is 3.5 weeks out. Sooner if there are cancellations.

In the meantime I will test turning Aflex off and going with smaller pillows - to see if I am in that small subset where those changes make a difference.

BTW I did try switching from Opus 360 to Airfit P10 earlier this week ... and while the P10 feels more comfortable --- also felt like I was getting much less air -- and was hyperventilating and was not settling down after an hour or so. Not a good thing given my tendency towards unstable breathing. Will prob need to boost the min (now at 5 CM) a little to make it work and do some work to gradually acclimate. In the spirit of only one change at a time -- I will hold off making another run at the P10 until after I test these other changes.

If the next size up in the P10 is comfortable you might try it if you still have problems the next time you try the P10.
Lack of air movement sensation can sometimes be helped with just using the next size up on the nasal pillows.
I had to go up a size when I got the P10 myself.