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DD Therapy (About to buy an ASV)
#1
DD Therapy (About to buy an ASV)
Hey Guys. 

First time posting on any message board. I am struggling and hoping to get some advice from some of you experts. I am 30 years old, 6'1" 190 lbs. I have had issues sleeping for years and finally had a sleep study done. I was diagnosed with moderate OSA with 20-25 events per hour. I have been using my machine for a couple weeks now and I am possibly feeling worse than before I started treatment. I am wondering if I was misdiagnosed with OSA because all of my Sleepyhead results are showing CSA. Please let me know what you think about my results that I have attached. I have struggled to sleep for more than 3-4 hours at a time with my machine. I originally started with a pressure range of 5-20 from my dr but I adjusted it myself due to the fact that I felt like I was not getting enough oxygen. My new pressure range is 9-15. I have messed around with EPR on and off but still get these clear airway events. Please let me know what I should do. I have been feeling awful. Thank you so much for any help. Let me know if you have questions or if i need to post different screenshots.
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#2
RE: DD Therapy (Centrals?)
sometimes new cpap users experience clear airway/central apnea (ca) as a result of the pressure required to resolve obstructives. in this case ca usually resolves within weeks to maybe 90 days. your pressure is not that high but maybe you are particularly sensitive to it. if, otoh, your ca is 'native' and not treatment emergent or pressure induced, apap will not adequately treat ca. do you know the breakdown of events during your sleep test? particularly # of obstructive apnea and # of central apnea? I was dxed obstructive despite a prior dx of central apnea and nearly equal numbers of oa and ca during my most recent sleep test. makes me wonder if it's common to dx obstructive unless or until clearly proven otherwise. for insurance purposes they make you fail with cpap or apap before moving to more appropriate therapy to be sure a different therapy is indicated. hopefully your ca will diminish. I would not call myself an expert though and will be curious what the more-experienced members suggest to help you fine tune your autoset for best possible results.
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#3
RE: DD Therapy (Centrals?)
Welcome to the forum.

Can you post a full copy of your sleep studies, including the charts?
It is not uncommon to see a diagnosis of OSA with significant centrals embedded in the details.

It is possible that the centrals will subside over 2-3 months as your body adapts. This likelyhood of this happening decreases if you have significant centrals in your diagnostic study.
Centrals cannot be treated with your machine, it is not designed to do so.  Treatment of centrals with your machine is a matter of avoidance. Higher pressures and higher pressure changes, either with the algorithm or EPR may cause an increase in central apnea.  Thus, as you have discovered reducing pressure and/or EPR may result in a reduction of centrals, at the potential cost of an increase in obstructive events.  Therapy is a matter of balance between central and obstructive events.
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#4
RE: DD Therapy (Centrals?)
I currently do not have access to my sleep study results. I’m sure I can ask my doctor to send them to me. In the meantime, what do you suggest I do? I’m assuming I need to continue with therapy’s and hope that it works itself out? Would it help to adjust pressure settings or anything? I am really struggling with this. Going to work ever you morning is tough. Thank you
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#5
RE: DD Therapy (Centrals?)
somebody might have a more efficient method to recommend but if I didn't want to wait for the doctor I'd start with a low fixed pressure of 6 or 7 (epr off) and work my way up incrementally. the idea being to try to determine if lower pressure reduces the ca. oa will likely increase. then as you slowly nudge pressure up 1cmw at a time, oa should drop and ca increase. doing this gives you a sense of where the tipping point is between oa and ca and therefore the best balance / trade off between the two. then you can experiment with fine tuning to see if you can tolerate an auto ranging min max setting and epr.
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#6
RE: DD Therapy (Centrals?)
I'll work in the opposite direction. Why because it is more likely the high pressures are causing the centrals.
Set EPR to zero.
Drop max pressure by 1 every night until you hit a sweet spot. Please note how you feel. As the pressure drops you should feel a little better, eventually it will get worse. Note that.
You can look at your overall AHI for a guide. CI should go down and OHI should go up. AHI we want to go down, the question is when will it start to rise.
Also be aware that your Central index could vary considerably from day to day as it is usually consistently inconsistent.
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#7
RE: DD Therapy (Centrals?)
probably a better method and it'll be less of a jolt to work downwards rather than starting with a big downward jump.
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#8
RE: DD Therapy (Centrals?)
Thank you guys for the ideas. I definitely think it is the high pressures that cause my centrals. I will report back tomorrow.
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#9
RE: DD Therapy (Centrals?)
So I made some pretty big adjustments last night. I felt great going to bed and slept with the mask on all night for the first time since starting my therapy. I woke up feeling pretty good for once and excited to check out my results expecting for sure to see single digit AHI. Of course, I was let down when I saw this. What do you guys honestly think is going on? I did feel like i was tossing and turning and my fiance said that I kept moving around all night. Do you think these are real centrals? Am I still just getting used to the mask? I am starting to get pretty disappointed. I was so excited to start treatment but this has not been easy. Do you think I would do better with a fixed low pressure? Do I need a different kind of machine? Please let me know what you think I should do. This is extremely frustrating. Thank you
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#10
RE: DD Therapy (Centrals?)
Set both your min and max to 7 (effectively a fixed pressure). Please note your breathing, many have difficulty inhaling with lower pressures. And ALWAYS post how you feel. This is all aimed at minimizing your centrals.

Want to see your Sleep Study results, the full study. The status of centrals there makes a difference in trying for a new (ASV) machine now, or wait for 2 to 3 months to see if these centrals are treatment-emergent or not. The journey to get an ASV can be a long and hard journey. Very few have done it quickly.
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