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AirSense 11 settings to tweak to reduce central apneas?
#11
RE: AirSense 11 settings to tweak to reduce central apneas?
You are not having enough centrals to worry about try to figure out why. Or to even try to reduce them

Should you associate them with an unusual symptom, maybe. Like you have no issue breathing in but every thing locks up when I exhale kind of unusual.

Why AM has increased CSs? I have a theory, can't prove it because there is no way for us to measure your CO2 and blood acidity levels in real time and in the home environment.

Fact; every CPAP no matter the type actually improves the efficiency of your breathing. This includes the flushing out more CO2 than you do without CPAP.

Fact: CO2 and the need to remove it provides our main drive to breathe.

Fact: when CO2 goes below ones apneic threshold a CA event occurs.

Theory: on some individuals not enough CO2 is "flushed" to result in a CA event. In some individuals the deficit is minor and only very slowly Approaches this anemic threshold

Theory: in some individuals by the end of the night your CO2 levels are very close to the apneic threshold and more CA events occur then because there is much less buffer before before you reach the apneic threshold.

This would result in a increased frequency of CA events late in the night.

Do note that this assumes the CA is predominately Treatment Emergent.
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#12
RE: AirSense 11 settings to tweak to reduce central apneas?
Thanks for all the feedback. My CA should be predominantly treatment emergent, since my in-lab sleep study recorded 74 obstructive apneas/hypopneas, and only 7 CA's.

My sleep specialist suggested something along the same lines in terms of not enough CO2 being flushed, which is why she prescribe acetazolamide, which is supposed to lower the threshold to trigger a breath. I think that was helping but it resulted in elevated creatinine levels in kidney labs, so I went off it. She also suggested adding an extra section to the mask that moved the vent further away, but I found it more difficult to breath with that configuration so didn't try it more than one night.
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#13
RE: AirSense 11 settings to tweak to reduce central apneas?
Adding length to the tube is a little aggressive, and there might be less aggressive means. 

Meanwhile, your current issue is you touch off too many CA so this means that the lungs have too little co2 to signal a sleep breath to get oxygen mix inhaled.  That problem is more accurately described as blowing off too much co2.

I hang a very thin hanky like a drape over my full face mask to slow the blow off just a little. 

Treatment emerging CA generally wears off.  It took about a month for mine to gradually reduce to minimal. But,  9 years later,  a still have a few left over. 

QAL.
Dedicated to QALity sleep.
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#14
RE: AirSense 11 settings to tweak to reduce central apneas?
EERS, we have a wiki on that.

http://www.apneaboard.com/wiki/index.php...ace_(EERS)

Didn't know you were trying that.
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#15
RE: AirSense 11 settings to tweak to reduce central apneas?
Thanks for the EERS pointer. I'll give it another try after I have a few more days of data from my recent change of lowering the max pressure (per Gideon's initial recommendation). Would you recommend any tweak to pressure settings when I add my six-inch hose extension in?

Also, if lowering the max appears to durably lower the CAs without increasing the OAs, is there any reason to tweak settings further? E.g. increase max by just a little to see if CAs stay low?
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#16
RE: AirSense 11 settings to tweak to reduce central apneas?
my hanky trick is a way of increasing the amount of co2 held back in the full face mask but only by a little bit. and of course it is not sanctioned
other things i've done to hack my mask (and not doing anymore, and not sanctioned, and not advised.) was block a portion of the designed-in vent holes (like 1/3 to 1/2 of the 24 tiny holes) using tape.

it calms to some extent the repeated hypopnea strings and, yea, I don't do it consistently for long. so, I cannot really show it works from data.
Dedicated to QALity sleep.
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#17
RE: AirSense 11 settings to tweak to reduce central apneas?
oh, yeah. What you asked was could you maybe tweak the settings to take advantage of the EERS fixture.

What you could do initially is to add back some of the EPR - so an EPR = 1 as this will add help for the exhale of breath which would make it a little more comfortable.

QAL
Dedicated to QALity sleep.
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#18
RE: AirSense 11 settings to tweak to reduce central apneas?
Your comment about not enough CO2 being flushed makes no sense to me.

For TECA the PAP machine flushed CO2 and increased EPR flushes even more.
EERS increases CO2 levels to either reduce CA events or to allow increased EPR which better treats hypopneas, Flow Limits, and RERAS.
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#19
RE: AirSense 11 settings to tweak to reduce central apneas?
Just had several good nights in a row (AHI<1) followed by another bad one (AHI>6), which also seems to correlate with more nightmares and difficulty in the morning. Below are graphs from last night, where all settings where the same as the previous several good nights. Any ideas for what I might do to track down why it varies so much, whether there is anything I can do to avoid the bad nights? I haven't yet tried the EERS configuration again, so maybe I'll do that next.
   
   
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#20
RE: AirSense 11 settings to tweak to reduce central apneas?
It's worth keeping in mind that CA indexes are notoriously variable -- up one night and down the next, with no obvious explanation in sight.

Another thing to keep in mind is that the zoomed-in views show a lot of arousal breathing -- which tends to be deeper and more irregular than asleep breathing -- followed by a CA. The arousal breathing washes out just enough CO2 to induce a pause between breaths of 10 seconds or more.

Finally, you're seeing some periods of unstable breathing, where a CA is followed by recovery breathing, which is deep enough to wash out some CO2 and produce another CA.

If you're feeling rested during the day, then none of this is worth worrying about. But if you feel unrested, I'd say the culprit isn't the CAs themselves but instead is the frequency of arousals.

If you feel unrested, then one experiment you could try is to set your min equal to your max at 8. Your pressures don't vary a lot, but some people are sensitive to even small changes in pressure. Your pressures go up and down mostly in response to your flow limitations, and the rises probably don't do much for the FLs. One other thought: with a min that's a little higher, you might see fewer OAs, not that yours are bad. At any rate, eliminating one possible cause for arousals might be worth a shot.
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