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Are centrals my big problem
#1
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???

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#2
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.
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#3
(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.
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#4
(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
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#5
(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??
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#6
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????
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#7
(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.


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#8
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.)
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#9
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!
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#10
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.
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