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CSR - What causes & any concerns?
You have made great progress with CPAP to deal with a complex apnea problem. Limiting maximum pressure and keeping things simple with EPR off is usually what gets the best results in these cases.   Your patience and diligence in trying alternatives and avoiding too many changes seems to have worked in your favor.  I sometimes wonder if it is better to optimize on CPAP or just let it fail and go for the ASV.   Dont-know
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I think issues 7 and 8 can not be overemphasized.
Mask leaks, particularly large leaks, in addition to throwing off the machine's ability to tell what's going on, can also lead to excessive CO2 flushing which could promote CA/CSR events.
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(06-26-2017, 08:09 PM)Sleeprider Wrote: I sometimes wonder if it is better to optimize on CPAP or just let it fail and go for the ASV.

My new sleep doc. will not even suggest ASV unless the conditions are really severe.  There appears to be concerns now that ASV treatment can make heart conditions worse so I felt concerns from the doctor in going forward with any ASV treatment unless it was an extremely bad apnea problem.

I believe moderate complex apnea can be treated with APAP but the patient must be willing to self-adjust the pressures and I don't believe most DMEs or apnea professionals are willing to spend the time required to fine tune the individual settings required.  Mine would have been happy to leave the settings as they were originally from the DME even if I was not sleeping well as long as my results were under AHI 20! 

This is probably the only forum we can turn to & achieve any beneficial results.  I am so very lucky to have done some research to have found all of the wonderful people here.  I will continue to "check-in" from time to time and hopefully be able to let others know that long term help is only a thread and post away.
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(05-29-2017, 12:06 PM)richb Wrote: Even though we can call your CAs machine induced, it is your body's response to the machine that characterizes your particular results.  You have a sensitive "setting" in your CO2 feedback mechanism that triggers the CAs more quickly for you than most other people.  In my own case my setting is so sensitive that just being asleep puts me into Central Hypopnea and periodic breathing.  You can continue searching for that "sweet spot" in your settings but if you can't consistently get your AHI under 5.0 you probably need an ASV machine.  Your sleep doc would characterize your condition as mixed apnea that is not successfully treated by fine tuning your traditional CPAP machine.  You would most likely need a titration on an ASV machine to show that it solves the problem.  Good luck with your search for the best settings.  Keep in mind that if you can't find the sweet spot you just might need that ASV machine.  


Right on Rich - saw my new sleep doc. today and he said about the same thing (except that CA & OA must be at least over a total of 20 events per hour before looking at any changes).  I have managed to get my pressures right and averaging about 3.25 AHI with CAs about 25% of the AHI.  Very happy there and hope to be able to keep my numbers (and feeling more rested more importantly) in the good range.  So far the new settings have eliminated the CSRs as well!  Thanks for all the help and encouragement.
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Success (at least for 1 night) in my search for beating complex apnea with APAP treatment!  Night before last I had a horrible night with almost 25 minutes of PB/CSR so I tried new settings (squeeze the max./min. pressures) and at least for a night it worked!  0.84 AHI with 8+ hours sleep in 4 sections (up many times due to prostate and reflux problems) - 7 total events for the entire night equally spread between CA, OA, & H.  I'm hoping that this may encourage others with similar problems to keep working on it and not give up their hopes of better sleep.  New settings are 9.2 - 11.2 with no EPR (was 9.0 - 11.4 no EPR).
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(06-26-2017, 08:25 PM)CB91710 Wrote: I think issues 7 and 8 can not be overemphasized.
Mask leaks, particularly large leaks, in addition to throwing off the machine's ability to tell what's going on, can also lead to excessive CO2 flushing which could promote CA/CSR events.

Would you be kind enough to elaborate on the process by which you came to the conclusion that excessive large leaks can lead to excessive CO2 flushing. I can not see the logic path.

Best Regards,


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After several weeks of really good results I had a really bad one last night - 8.09% of the night in CSR/Periodic Breathing - felt like no sleep at all and dizzy all day and still tonight.  No idea why but thinking maybe taking another Melatonin (10 mg.) may have contributed to the problem (?) - taking 1 10 mg. now at bedtime.  Posting screenshots so you can see the mixture of OA, CA, and H being classified as CSR.  I know this is just a "one-off" but I would sure like to eliminate these!!!  Any comments greatly appreciated (can see progress and stuff tried earlier in this same post).  Really weird as I took a nap this afternoon for 1-1/2 hr. and had no events!

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