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Centrals - help needed
#1
Centrals - help needed
Hi Guys,

After lot of tries, my main problem is a lot of Central Hypopneas. All other issues can wait until this one is solved.
 
In a typical night, I’m having an average of 15 central hypopneas per the most "disturbed" hour, concentrated at the two first hours of sleep. Only few of them will appear at the rest of the night.
 
I’m attaching  few views of different scales and dates to demonstrate the problem. As there are almost no obstructive events in a typical night, the CPAP will keep the pressure at the minimum.
 
Current pressure settings – min 4-max 8 cm H20. Pressure support is Set to mode two, however, it is almost not active because the CPAP will stay at 4 most of the time.

Additional fact that should be considered, I have 9% average of flow limitation over a period of two months.
 
Please let me know what can I do in order to reduce the number of these hypopneas.
 
Thanks,
Arik


Attached Files
.pdf   24 March B.pdf (Size: 78.44 KB / Downloads: 48)
.pdf   24 March 2019.pdf (Size: 91.38 KB / Downloads: 33)
.pdf   15 March 2019.pdf (Size: 90.3 KB / Downloads: 28)
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#2
RE: Centrals - help needed
With your machine you want to find a balance.
Goal 1: reduce centrals by reducing both pressure and pressure variance and at the same time increase hypopneas and flow limitations with setting a fixed pressure at the lowest value you can tolerate.
Goal2: reduce hypopneas by increasing pressure variance with pressure support and increase in max pressure with likely small increases in epap which will increase centrals.

The only way to do both is with an ASV.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Centrals - help needed
Hi Fred,

Thanks a lot for your fast response.

Few notes/questions:

1. For many days, I have only Central and Obstructive Hypopneas. Apneas are very rare.
2. I went over all reports since I started therapy. It looks like the more leakage I have, the less centrals will appear. Also, the less leakage, the more centrals will appear. Does this make sense to you? See attached image. you can immediately tell when I switched to the low leakage FFM mask  Wink

3. With the above being said, what settings would you recommend me to try?

Arik
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#4
RE: Centrals - help needed
Hi Fred,

I forgot to add the image, here it is

Arik


Attached Files
.pdf   Report A.pdf (Size: 347.42 KB / Downloads: 35)
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#5
RE: Centrals - help needed
A lot of people are not comfortable at a pressure of 4, I am assuming that you are fine at 4 and do not feel that you are starving for air.
Set your Max and min to 4 and turn off your Flex/EPR/Pressure Support. The idea is to get a low a pressure as you are comfortable with and eliminate pressure changes.
With your machine, any CPAP not intended to treat Centrals, this should minimize the number of Centrals that occur.
Really need to hear in every post how you feel?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: Centrals - help needed
Will do, what about my idea regarding possible link between leakage and centrals (see 2 above)?
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#7
RE: Centrals - help needed
High leaks have a tendency to mask events so that is possible.  Between mask types, I don't see as that much difference is possible.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: Centrals - help needed
Hi Fred,

I much appreciate your devotion and enthusiasm helping the forum members while the health system is leaving us behind (same problem everywhere).

Few notes/observations:

1. I did not change the settings yet. However, last night I slept very well.

2. Average AHI per the last whole nigh is 3 (only hypos), however, I started evaluating my situation according to the "peak hour" results (a good tip from a forum member!) and it is 16 (only Central Hypos). Typically, my event are "grouped" or clustered. Cannot understand why I get AHI =16 for part of the nigh and AHI=0 for another part. Does not make sense to my that our body acts so randomly. I'm starting to lose my faith in the PRISMA 20A readings.

3. With regard to the possible link between mask leakage and Centrals, I speculated that maybe with high linkage, the residual CO2 left in the mask "cavity" is flushed more quickly, causing less Centrals. What do you think?

Thanks,
Arik   
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#9
RE: Centrals - help needed
Centrals are often consistently inconsistent in many users with the problem.  We do not see why they occur and while the medical field has identified some causes for centrals occurring there are many more cases where no cause is found.

If the mask vents were to clog from getting wet (condensation/rainout with a fine mesh vent) I would expect it to continue for a much longer period.  In the design of a mask CO2 wash-out is a definite and important factor.  While that is possible with a manufacturing defect or a design flaw I would think that is very unlikely.

You may be much more sensitive that the average patient to the CO2 levels and a mask leak would cause more washout so the non-leaking mask could show more CA/CH because of that sensitivity.  I would use the mask that gives you the best results.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: Centrals - help needed
Hi Fred,

After 7 days of sleeping with the proposed setup (CPAP mode, fix 5 cm H2O, turning off Flex/EPR/Pressure Support) results are worse: average AIH went from 5 to 8 and more clustered Central Hypopneas. Still no Apneas of any type at all.


How would you suggest to proceed? I’m out of ideas (except for trying my old Nasal Pillow mask for few nights). How does ASV machine overcome these Hypopneas?
Thanks,
Arik
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