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First Night with SleepyHead Data Please Help.
#11
RE: First Night with SleepyHead Data Please Help.
"I know nothink" -- Sgt Schultz (Hogan's Heroes)  That being said, I understand that CAs can come and go when triggered by flow when the pressure is too great and it often starts when someone is adjusting their inhale or exhale pressure to address OAs or hypopneas.

I'm sure one of the gurus will be along soon to give you some good information and advice.
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#12
RE: First Night with SleepyHead Data Please Help.
(06-14-2018, 08:41 PM)BlueMachine Wrote: Yes, I am just highly confused as to why I have central sleep apneas. When two at home sleep test basically showed zero.  Now with my machine it says I have 10 with basically no obstruction and low rema.  My sleepyhead  document is at the top of this post.


Your home sleep study probably used a chest strap that measures respiratory effort. In obstructive apnea, the chest expands, but there is no airflow and an OA is scored.  If there is not any chest expansion and no airflow while asleep a central is scored.  The home sleep study does not use the same sophisticated sensors and observations as clinical polysomnography. One of the big differences is the use of a actigraphy instead of EEG to measure a sleeping state.  This is like trying to substitute a fitness watch for brain wave sensors.  Needless to say, home sleep studies get the job done, but have some imprecision. 

Many patients also have a sleep study with CPAP where the pressure requirement is titrated.  This is often done in a 2-part study with diagnosis and titration in one night.  Somewhere between 5% and 15% of patients with only obstructive apnea and hypopnea, will incur central apnea when subjected to CPAP.  This is called complex sleep apnea or CPAP induced centrals.  It's not uncommon and you will need more than the fingers on your two hands to count the number of members on this forum that use ASV to resolve that.  The mechanisms of complex sleep apnea are not fully understood, but one of the notable causes is that the increased ventilation with CPAP, and especially bilevel where IPAP is higher than EPAP, can cause a reduction in serum CO2. This reduction of CO2 can affect the respiratory drive through various feedback mechanisms that control the urge to breath, leading to central apnea.  These apnea are usually short duration and have minimal SpO2 desaturation associated with them because they arise from increased respiration that actually keeps O2 levels a bit higher.  Many patients that initially experience CA when initially tried on CPAP will adapt, and the problem basically goes away on its own.  Others, may continue to experience CA above an acceptable threshold, and ultimately require bilevel therapy with backup.  The gold standard of that therapy is adaptive servo ventilation (ASV) which is a non-invasive positive pressure machine like CPAP that in addition to providing pressure to keep the airway open, also can provide pressure support to treat hypopnea and central apnea.

If it turns out you are one of those people that continues to have centrals, you will require another sleep study to clinically document the condition and to try bilevel and ASV to determine efficacy. You are a long way off from that at this point, but it's worth making your concerns known to your doctor so he and you can plan to revisit this issue at your followup. Meanwhile, central apnea responds best to CPAP at low pressure with no EPR. You need to find a minimum pressure at which you do not have significant OA and H events, with the understanding that higher pressure and EPR can trigger CA.
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#13
RE: First Night with SleepyHead Data Please Help.
Thank you for that information. For the home sleep test all I did was wear something on my head. No chest strap.
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#14
RE: First Night with SleepyHead Data Please Help.
Sleeprider, mind if i copy that last post? I know of a few places for the information you've spelled out in wiki works.
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#15
RE: First Night with SleepyHead Data Please Help.
    Night 2
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#16
RE: First Night with SleepyHead Data Please Help.
(06-15-2018, 07:23 AM)JesseLee Wrote: Sleeprider, mind if i copy that last post? I know of a few places for the information you've spelled out in wiki works.

I wrote it with hopes it could be harvested for a Wiki, so have at it.  Bluemachine's question was a perfect setup.

Bluemachine, look!  CAI is half of the night before.  You are on your way. Your home sleep study was pretty rudimentary and in most cases they end up under-estimating AHI by diluting events into time when you were not sleeping. In your case, we will never know whether apnea was central because there was nothing to measure it.
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#17
RE: First Night with SleepyHead Data Please Help.
It's half but has large leaks. Should I keep this setting or drop the max pressure to 9? I'll try the medium size nasal pillows.
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#18
RE: First Night with SleepyHead Data Please Help.
Everyone always uses larger nasal pillows than they think they need. You might be surprised even the large may work.

10 still looks good for pressure. I see some ragged looking breathing on the flow line where there is fairly low pressure under 40 mL/sec, then spikes over 80. Something is there, but not sure what yet.
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#19
RE: First Night with SleepyHead Data Please Help.
Sleeprider,
Do i need to upload something else so you can see the problem?  I originally used a large pillow, now I'm going to try a medium. If my Centrals do not go much lower, then I will buy the best used AVP machine.. I already talked to my dr and told him about the centrals and he said it was stress!  I feel as if I'm going to have to treat myself with your guys help.  Thanks for all the help so far Bigwink
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#20
RE: First Night with SleepyHead Data Please Help.
(06-15-2018, 10:20 AM)BlueMachine Wrote: Sleeprider,
Do i need to upload something else so you can see the problem?  I originally used a large pillow, now I'm going to try a medium. If my Centrals do not go much lower, then I will buy the best used AVP machine.. I already talked to my dr and told him about the centrals and he said it was stress!  I feel as if I'm going to have to treat myself with your guys help.  Thanks for all the help so far Bigwink

Let's take a look at what's going on at 01:45 or 02:25 and we can take a look at the central and flow limit at 03:52.  For pressure, if you want to try something a bit off the wall, just set your machine for 8.0 cm fixed pressure.  From what I'm seeing that might be your sweet spot, and fixed pressure is often helpful when centrals are happening.  Looking at your chart, you seem to have uneven breathing at low pressures, and the centrals kick in at higher pressure.

It's a bit premature to consider ASV, but we can help you locate, and obtain a good deal on either the Resmed Aircurve 10 ASV or older Resmed S9 VPAP Adapt.  I think your centrals will come down, try to be patient.
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