(08-11-2013, 11:23 PM)mraley82 Wrote: Reviewing my data I see sometimes where i have very minimal events or none at all for 30 minutes to an hour then for maybe an hour I have events constantly. Majority are central/open airway and very very few are ever obstructed. I will have 3-4 breathes in/out then nothing for usually 10-15 seconds, and this repeats sometimes for an hour or so then stops then reoccurs sporadically through the night.
Hi mraley82, welcome to the forum!
If the central apneas aren't lasting longer than about 20 seconds, I think it probably is not cause for great concern.
So I wouldn't let myself get too anxious about it, but obviously you should work to reduce or eliminate the many central events.
Sounds like you may be describing Cheyne-Stokes Respiration. You can google it or read about it here (but, again, don't let yourself get overly worried about this):
I suggest you use ResScan to print out full reports, showing the whole night in the upper set of detailed graphs, and, in the lower set of detailed graphs, zooming into a 10 or 30 minute period when the central events are occurring back-to-back. I would print reports for about 5 of the worst nights to give to the doctor for his records, or email the reports to him in pdf format. Be sure to include the Flow plot and the High Rate Pressure plot. Heck, you can include plots of everything in the reports.
Discuss these reports with your doctor and ask to be given a titration with an ASV machine, and after the ASV titration ask to receive an ASV machine such as the S9 VPAP Adapt (Model# 36037 not older model 36007) or the Philips Respironics System One DS960TS BIPAP autoSV Advanced. (Try to not accept a standard bi-level machine, because if you have CSR I think you should qualify for an ASV class bilevel machine.)
Your present machine (S9 AutoSet) is increasing the pressure up to 12 when it needs to, to avoid obstructive events, and it is doing that very well. The S9 AutoSet can detect CA events but will do nothing to treat them.
ASV machines will immediately (breath-by-breath) boost the pressure during inhale to keep you well ventilated even when you stop trying to breath. If you don't start inhalation on your own, it will start it for you, and it will keep you ventilated by alternately increasing the pressure (to cause inhale) and decreasing the pressure (to cause exhale) until you are breathing on your own again.
You may hear that ASV machines can be hard to get used to, which is somewhat true. Basically, you may need your exhale pressure (EPAP) to be as high as 12 to prevent obstructive events, for example, and when you stop trying to breathe you may need the inhale pressure (IPAP) to automatically raise itself about 10 higher than that, which would be 22, for example. These high pressures make controlling leaks the main challenge. But if we need it, we need it, and we can deal with it and get used to it.
An alternate thing to try before getting an ASV machine would be to wear a snug teeshirt to bed with a tennis ball or two in pocket sewn right between the shoulder blades, to keep you off your back. This may lower how much pressure your machine needs to use to prevent obstructive events, and sometimes central events occur mostly only while the pressure is high. So making sure you stay off your back may keep the pressure lower and reduce the frequency of central events.
Another thing you can try with your present S9 AutoSet would be to turn EPR down or off, because it is pretty common that folks who have central events often will have fewer if EPR is reduced or turned off.
Good luck and take care,