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AHI is getting worse. Having more centrals
#1
Gross 
Hello. I don't really know where to begin. I've been on cpap for about a month now. Started with the Quattro Air face mask then switched to the P10. About a week ago I talked to my sleep dr. about my CA's and waking up feeling out of breath. The dr. turned on the EPR and set it to 3. The next morning my AHI was 1.03. I had 6 RERA's and only 5 CA's but felt like crap. MY AHI (4.56, 5.66, 5.31, 11.11, 18.8) has gone up since then with more CA events every night. Last night my AHI was 18.8 and I had 158 CA's. I feel like crap. The attached screenshot is from last night. Is there something I can do to lower the CA's or is it just going to take more time to get use to the machine?

[attachment=3177]
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#2
Hi Amdx64. Welcome to the Apnea Board from a fellow Vermont resident.  Since I am originally from NJ I can't call myself a "real Vermonter".  To get to your question, your Centrals are most likely caused by your machine.  If you look at your Sleepyhead charts you will notice the high leak rates surrounding the groupings of CAs.  What is happening is that the leaks are washing out too much CO2 making your body believe that you have done enough breathing.  Work on your mask fit.  You may not be able to use the nasal pillows because you are probably bumping them out of place.  I tried the nasal pillows but I couldn't control the leaks.  I use a nasal mask for this reason.  You will be hearing from more of us shortly.  Good luck with your treatment and stay in touch.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#3
I would suggest taking the EPR back out (set to 0). For some people having a different inhale and exhale pressure can wash out CO2 excessively, and result in these central apnea. It is important to reduce this event rate, and the only thing that makse sense right now is to take the EPR out of the equation. It's interesting your doctor increase EPR when you were having CA events. If they are not reduced significantly by going back to zero EPR, you may have complex apnea and need a different therapeutic approach.

What were the results of your sleep study? Were central events present? Did you have a titration study?
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#4
I did not have a titration study just a overnight PSG. The report says my AHI was 11.5 and RDI was 11.5. Frequent OH events and occasional OA,CA,MA and PLM's. 
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#5
The thing that jumps out at me is the steep pressure increase (caused by OAs) just before the centrals. I wonder if increasing the IPAP to 9 or (eventually) 10 wouldn't reduce the (pressure change induced) centrals. As for eliminating the Pressure Relief, I may be an anomaly, but reducing or turning off EPR makes my AHI go way up.

Both possibilities need to be checked, but only one at a time. With my sensitivity to EPR, I would raise the pressure first.
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#6
Last night was much better. Banana I turned off the EPR and increased my minimum pressure to 7.  AHI was down to 5.8

   
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#7
Is the clump of CA's around 6:20am considered sleep wake junk?
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#8
Big improvement and very encouraging. That cluster obviously affected AHI a lot, but most of your night looks pretty good. I would hold pat on these settings for a while. It's probably not possible to determine the cause of that cluster, and would require a greatly zoomed in screenshot to see the waveform. Since there is just the one episode, I'd worry a lot less about it than if that was going on like the night before. Note, your high pressure was only 8.67, so the machine is reacting to an indication of obstruction or flow reduction in raising pressure. Mostly it seems pretty stable just over 7.5.
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#9
Sleeprider is this close enough?

[Image: 0yUQs62l.png]
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#10
[Image: VvQrAfel.png]
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