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Centrals - help needed
#11
RE: Centrals - help needed
On a basic level an ASV machine deals with obstructive events in the same way a BiLevel without backup does, by using pressure and pressure support.  This is done without regard for Centrals.  When a Central event is detected Pressure Support is rapidly increased to a high level which provides a high degree of assistance to the inhalation in a sense forcing a breath.  As a result it is uncommon for these machines to record a Central Apnea.  

Most machines do not record Central Hypopnea, and I have no info on ASV treating Central Hypopnea.

Possibly another way, though there are very few clinics doing this.  
Enhanced Expiratory Rebreathing Space (EERS)
Enhanced Expiratory Rebreathing Space (EERS) may be a solution for individuals that experience therapy onset central apnea with CPAP or bilevel therapy. The rebreathing space prevents all of the exhaled air from being vented through the CPAP mask. This increases the amount of carbon dioxide that the user breathes in in the next breath. CPAP and Bilevel therapy flush most of the user's expired air out of the mask. For some sensitive individuals this decreases the amount of carbon dioxide which leads to the appearance of central apnea. Many of these individuals find that CPAP/BPAP therapy is uncomfortable due to the central apnea and hypopnea that they experience. EERS can ensure a volume of expired air is available for rebreathing, and this can prevent these therapy onset central apnea.

Obviously no guarantees on this.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#12
RE: Centrals - help needed
       
.pdf   2019_04_15_Signal_view.pdf (Size: 81.85 KB / Downloads: 5) Greetings Fred,
 
Two weeks ago, I decided, for the first time, to try SoftPAP 3 mode in the PRISMA 20A.  BINGO! My average AHI dropped from 7 to 2.7. Silly me. I have the machine for about 6 months and never tried it. I’m no more concerned about the type of events and all this stuff (for the time being…). Notable, almost all of me events were Hypopneas of all kinds an very few Apneas.
 
The manual defines SoftPAP 3 as: “breathing relief with inhalation assistance”. I added two images to the message so you can see what it practically does. The first one shows what the machine is doing with regard to pressure (CPAP mode with principal pressure of 4 cm H2O) and the second one is taken from a research which describes how the different vendors are handling breathing relief. At the end of the reply, there is a link to the research.

In addition to the low AHI, my sleep now is much deeper including the interesting fact that I have to urinate only once at night instead of 3 times in the past. A doctor told me once that “First we wake up (because of disturbed sleep) and then we go to the bathroom and not that we first have to urinate and therefore we wake up”.  At that time I thought he is talking nonsense but now I think maybe he is right.
 
https://www.researchgate.net/publication...ench_Model
 
Many thanks for your help,
Arik
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#13
RE: Centrals - help needed
Arik, thanks for posting the image comparing pressure relief by Respironics, Resmed and Prisma over a single breath. It is interesting to see the side-by-side comparison. For those trying to read this graphic, the V (L/min) is the respiratory volume, and Pm (Cm H2O) is the way each machine delivers pressure during a breath. A is the normal breath and B is an apnea. It appears that with CPAP pressure set to 10, the Prisma in SoftPAP 3 mode, actually is the only machine to deliver pressure support of +2 reaching 12 cm, before providing 3-cm of pressure relief during expiration to 7-cm. If I'm reading this correctly, the SoftPAP 3 mode can provide a total pressure support of up to 5 cm (12/7 IPAP/EPAP).

By comparison, the Resmed briefly peaks at 10 and reduced pressure throughout expiration to a minimum of 7-cm, providing up to 3 cm of pressure support, similar to Prisma SoftPAP3. Finally the Remstar in CFlex mode briefly drops pressure to near 8 cm before returning to 10 cm before expiration is complete, and the CFlex+ mode provides a bit more pressure relief to 7.5 cm and maintains pressure at 8.0 before rising to 10 during inspiration.

The flow volume (breathing form) on the Prisma during apnea (B) seems optimistic is showing the apnea is fully treated (no apnea). That may or may not actually be the case, but I assume this comes from a Weinmann literature source?

[Image: attachment.php?aid=11389]
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#14
RE: Centrals - help needed
Hi,

This is supposed to be an independent research that can be found in the link below. Note that it was performed with respiration simulator and not with true patients. Nevertheless, it contains a lot of educational material (which I only partially understood). In my particular case, there is a huge deference between SoftPAP 2 (only breathing relief) and SoftPAP 3 (breathing relief with inhalation assistance). Watching the screen, I realized that the assistance pressure went up to about 7 while the basic pressure was set to 4. One significant disadvantage, though, is the annoying noise of the machine while cycling between the different pressure values as a CPAP/APAP machine has only one source of pressure.
Arik,   

https://www.researchgate.net/publication...ench_Model
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