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Are centrals my big problem
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ckingzzzs Offline

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Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #1
Are centrals my big problem
I have reviewed my numbers now for the past 30 days that show:

AI=6
AHI=7.4
Central=5.2

these numbers are pretty much representative of where I stand on using the machine for the past 120 days.

I have very little leaks. I use an airsense 10, with fx pillows. set on auto 7-16 and 10minute ramp.

I have been wondering why I can not get the AHI down. I have noticed however for the last 5 nights that I have high CA events that include: 24, 52, 32, 43, and 15 events.

Is it possible to lower the CA at all??? with continued CA events it appears I will never get the AHI down any further???
10-01-2015 05:55 PM
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kaiasgram Offline

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Posts: 241
Joined: Aug 2013

Machine: S9 VPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Aloha
Humidifier: H5i
CPAP Pressure: 8-10
CPAP Software: SleepyHead

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Sex: Female
Location: Northern California

Post: #2
RE: Are centrals my big problem
If your AHI is routinely over 5 and is predominantly centrals then it would be a clinical concern. You might be able to reduce centrals by lowering your pressure because sometimes pressure can cause centrals. The challenge there is not letting a bunch of obstructive apneas happen with the lower pressure, so you'd have to keep an eye on things.

Failing that, you might need a different machine. Did you have centrals in your sleep study? Some people develop Complex Sleep Apnea after starting CPAP and end up doing better with a bilevel machine. If those were my numbers I would lower the pressure a little and see if it helps.

EDIT: I just realized you have pressure of 10 in your profile but you're actually running a wide pressure range. I wonder if narrowing that range would be easier on your system along with lowering the max pressure. Pressure swings might be disturbing your sleep/breathing pattern.
(This post was last modified: 10-01-2015 06:37 PM by kaiasgram.)
10-01-2015 06:33 PM
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OpalRose Offline

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Posts: 3,166
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #3
RE: Are centrals my big problem
(10-01-2015 05:55 PM)ckingzzzs Wrote:  I have reviewed my numbers now for the past 30 days that show:
AI=6
AHI=7.4
Central=5.2
I have very little leaks. I use an airsense 10, with fx pillows. set on auto 7-16 and 10minute ramp.


ckingzzzs,
Can you tell us what your 90% and medium pressure numbers are? I am curious with your settings of 7-16 just how high your maximum setting reaches during any given night.

You may need to lower the max number to control clear airway events.
You should also be able to post a sleepyhead screenshot. Include events graph,
Pressure graph, leak rate, and the information to the left.

OpalRose
10-01-2015 06:49 PM
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ckingzzzs Offline

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Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #4
RE: Are centrals my big problem
(10-01-2015 06:33 PM)kaiasgram Wrote:  If your AHI is routinely over 5 and is predominantly centrals then it would be a clinical concern. You might be able to reduce centrals by lowering your pressure because sometimes pressure can cause centrals. The challenge there is not letting a bunch of obstructive apneas happen with the lower pressure, so you'd have to keep an eye on things.

Failing that, you might need a different machine. Did you have centrals in your sleep study? Some people develop Complex Sleep Apnea after starting CPAP and end up doing better with a bilevel machine. If those were my numbers I would lower the pressure a little and see if it helps.

EDIT: I just realized you have pressure of 10 in your profile but you're actually running a wide pressure range. I wonder if narrowing that range would be easier on your system along with lowering the max pressure. Pressure swings might be disturbing your sleep/breathing pattern.


no my pressures are a range of 6 to 16 but will try a new range this evening
10-01-2015 06:58 PM
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ckingzzzs Offline

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Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #5
RE: Are centrals my big problem
(10-01-2015 06:49 PM)OpalRose Wrote:  
(10-01-2015 05:55 PM)ckingzzzs Wrote:  I have reviewed my numbers now for the past 30 days that show:
AI=6
AHI=7.4
Central=5.2
I have very little leaks. I use an airsense 10, with fx pillows. set on auto 7-16 and 10minute ramp.


ckingzzzs,
Can you tell us what your 90% and medium pressure numbers are? I am curious with your settings of 7-16 just how high your maximum setting reaches during any given night.

You may need to lower the max number to control clear airway events.
You should also be able to post a sleepyhead screenshot. Include events graph,
Pressure graph, leak rate, and the information to the left.

thanks opalrose for the reply. The last five nights are as follows:

med 95% max
10.8 13.8 15
10.9 12.8 13.5
10.4 12.8 13.6
9.6 11.7 12.6
10.2 12.7 14.1

I sometimes go from a med of 8.5 to a 95% of 14 but its rare

what do you think??? is my range of 7 to 16 okay??
10-01-2015 07:01 PM
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ckingzzzs Offline

Preferred Members

Posts: 57
Joined: Aug 2015

Machine: resmed aircurve 10 VAUTO
Mask Type: Nasal pillows
Mask Make & Model: swift fx nasal pillows
Humidifier: resmed aircurve10 vauto
CPAP Pressure: min epap 7, max ipap 20, PS 4
CPAP Software: ResScan SleepyHead

Other Comments: CPAP user June-Dec 2015, VPAP starting Jan 2016 and struggling with proper adjustments

Sex: Male
Location: maine

Post: #6
further to are centrals my big problem
In furtherance to an earlier thread I posted, I wanted to mention that the central events for the last three months are:

an average of 27 in July, 23 in August, and 27 in September

My current range is set to 7-16, and my pressures for the last 5 nights have been:

med 95% max
10.8 13.79 15
10.9 12.8 13.5
10.4 12.8 13.5
9.8 11.75 13
10.1 12.7 14

Any idea as to where I should consider setting my range given so many central events????
(This post was last modified: 10-01-2015 07:16 PM by ckingzzzs.)
10-01-2015 07:15 PM
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OpalRose Offline

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Posts: 3,166
Joined: Nov 2014

Machine: PR System One REMstar Auto 560 with A Flex
Mask Type: Nasal pillows
Mask Make & Model: AirFit P10 For Her
Humidifier: REMStar heated humidifier with heated hose
CPAP Pressure: Auto Cpap 10-13 AFLEX 1
CPAP Software: SleepyHead EncoreBasic

Other Comments: Started CPAP Therapy October 23, 2014

Sex: Female
Location: Northeast Ohio, USA

Post: #7
RE: Are centrals my big problem
(10-01-2015 07:01 PM)ckingzzzs Wrote:  
(10-01-2015 06:49 PM)OpalRose Wrote:  
(10-01-2015 05:55 PM)ckingzzzs Wrote:  I have reviewed my numbers now for the past 30 days that show:
AI=6
AHI=7.4
Central=5.2
I have very little leaks. I use an airsense 10, with fx pillows. set on auto 7-16 and 10minute ramp.


ckingzzzs,
Can you tell us what your 90% and medium pressure numbers are? I am curious with your settings of 7-16 just how high your maximum setting reaches during any given night.

You may need to lower the max number to control clear airway events.
You should also be able to post a sleepyhead screenshot. Include events graph,
Pressure graph, leak rate, and the information to the left.

thanks opalrose for the reply. The last five nights are as follows:

med 95% max
10.8 13.8 15
10.9 12.8 13.5
10.4 12.8 13.6
9.6 11.7 12.6
10.2 12.7 14.1

I sometimes go from a med of 8.5 to a 95% of 14 but its rare

what do you think??? is my range of 7 to 16 okay??

ckingzzzs
I really think 7 is too low to start because for 95% of the night and under you are at a pressure of 12 +.

I think ideally your setting should be in the vicinity of 9-14.
i would turn the ramp off unless you feel you need it. If you are going to use the ramp, start it at 7 for 15 or 20 minutes.

OpalRose
10-01-2015 07:28 PM
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kaiasgram Offline

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Posts: 241
Joined: Aug 2013

Machine: S9 VPAP Auto
Mask Type: Nasal pillows
Mask Make & Model: Aloha
Humidifier: H5i
CPAP Pressure: 8-10
CPAP Software: SleepyHead

Other Comments:

Sex: Female
Location: Northern California

Post: #8
RE: further to are centrals my big problem
cking, it's best to stay in one thread so folks can follow your progress more easily and won't be duplicating responses, suggestions, etc.

Could you clarify: The central numbers you're giving us -- 27, 23, 27 -- are those total for the night or the central index (per hour average) for the night? The total numbers can't be interpreted without knowing how many hours of sleep occurred on those nights.

Based on your pressure numbers you can definitely get by with a narrower pressure range and a lower Max pressure. Just make changes in a stepwise fashion and watch the data to see if the centrals are resolving. I might lower the Max pressure to 13 and leave it there for a while. Others might be more conservative about lowering the pressure. I'm just seeing that 95% of the night you are already at or below 13 (at least 4 of the 5 nights you reported show that). That's what the 95% number means -- for 95% of the time you were at or below that pressure.

If you do well at max pressure 13 and there are no upswings in obstructive apnea events, you could try lowering the max pressure a little further.

Opal Rose asked for some graphs because we can get more information from the graphs than we can with the numbers alone. For example, with your Min pressure at 7, are your obstructive events occurring while the pressure is still down around 7 or 8? Would a bump up in Min pressure help keep obstructives down while a drop in Max pressure help keep the centrals down? Graphs can really help us help you. (I'm not suggesting you do all these changes right now, just trying to help you get set up to get the most help here.)
10-01-2015 07:32 PM
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Dagmar Offline

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Posts: 97
Joined: Jul 2015

Machine: Resmed Airsense 10 Autoset
Mask Type: Nasal mask
Mask Make & Model: Wisp by Respironics
Humidifier: Resmed
CPAP Pressure: 10
CPAP Software: ResScan

Other Comments:

Sex: Male
Location: Michigan

Post: #9
RE: Are centrals my big problem
You've received excellent advice already, I'll just add that I'm one of the people that don't handle pressure changes well, my CA's kick in with pressure changes. It's easy to see the corolation with SleepyHead. Good luck!
10-01-2015 07:36 PM
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SleepyWabbit Offline

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Machine: DS560S (PRS1 REMStar Auto)
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Sex: Male
Location: descensus in cuniculi cavum

Post: #10
RE: further to are centrals my big problem
My understanding is that a regular cpap does not help with CAs, only OAs, RERAS and HAs. Central are where the brain does not send the "breath" signal. The other events are where your throat is partially or fully obstructed. CPAP (Continuous Passive Air Pressure (I think)) forces your through open so you can breath. It can't force your brain to send the breath signal.

Another thing to think about is is only guessing what kind of apnea event you are having. It can detect a partial or blocked airway by sending pressure pulses and measuring the resistance. If it sees your airway is not blocked but you are not breathing, than this may be a central apnea. Without an eeg, it can't know for sure.

The algorithm on each machine is different. I could be way off in left field here. If I am, hopefully someone corrects me.
10-01-2015 07:54 PM
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