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Having Centrals but not Diagnosed with Centrals, also having CSR's
#1
Having Centrals but not Diagnosed with Centrals, also having CSR's
Hi,

I am going back in for a new test next week because I have been having a lot of centrals, I have tried both a Resmed (current) and a DreamStation (used for 266 days) (setups below)

Honestly I don't want to go into the clinic for nothing, (hospital phobic, did my last test at home) so I'm trying to understand if the centrals are a actual problem or if they are treatment induced and I can just no go to the test.

.....or am I letting my fear of hospitals get in the way of getting the treatment I need to not feel like death warmed up? 

Current Resmed Setup 
------------------------------
Mode :APAP
Pressure Min: 11.00 cmH2O
Pressure Max: 19.00 cmH2O
Antibacterial Filter: No
Climate Control: Manual
EPR: Full Time
EPR Level :1 cmH2O
Humidifier Status: On
Humidity Level: 3
Mask: Full Face
Ramp: Off
Temperature: 28 ºC


[attachment=24776]

[attachment=24775]


Previous Philips Setup
------------------------------
Mode: AutoCPAP
Pressure Min: 10.00 cmH2O
Pressure Max: 20.00 cmH2O
Flex Level : 3
Flex Lock : Off
Flex Mode : A-Flex
Hose Diameter :15mm
Humid. Lvl.: 5
Humid. Mode : Heated Tube
Humidifier Status : Connected
Mask Res. Lock: Off
Mask Resist: Off
Ramp Time: 0.00 Minutes
Ramp Type : Linear
Tube Lock: Off
Tube Temp: 5 

[attachment=24777]
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#2
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I believe you may be headed for an ASV. Definitely keep your appointment with the sleep clinic. You need to get this sorted.

In the meantime, turn the EPR to off. Have you tried to use a lower pressure? This may help stabilize a little and give more comfort. I would stay in Auto Mode and set the Cpap to 10min and 10 max.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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: Having Centrals but not Diagnosed with Centrals, also having CSR's
On the PR machine you were tucking your chin. Slight signs of it on the second ResMed Chart in which you had flow limitations drive your pressure really high .

For now set your Flex/EPR =0 or off, set your max pressure to 11 to prevent pressure excursions. EPR and Flex increase the efficiency of your breathing which can and apparently did result in low CO2 levels which causes Central Apneas.
If this doesn't really knock down the centrals you need to consider an ASV.


You described Treatment Emergent Central Apnea BUT you have exceeded the 2-3 months that that typically clears up. Still I would like to see the results your sleep test, a full copy.
The difference between the ResMed and the PR with Flex =3 also indicates Treatment Emergent Central Apnea.Flex=3 should cause more centrals if that is the case

The sleeptest is likely a diagnostic one to see if you have centrals without8 a machine. Lab based Sleep Test is better at picking up Central apnea.
That's ok. But the lab test must end with you on an ASV.

To evaluate better download the latest OSCAR and take a screenshot with F12 as that will hide the right sidebar, the calendar and the piechart thus allowing the important stats to show.
Also, also in the flow rate chart right click on the title then dotted line and set the zero line. That splits the inhales from the exhales. Also set a y axis range as 80, both plus and minus.
Take and post a 2minutre view zoomed image of 2 different areas of centrals and a 15 minutes view to look for patterns. Always include a full night view as it provides context.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#4
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
At your appointment be sure to specifically request a titration sleep study with bilevel and ASV. That is the path forward to ASV through the normal medical and insurance channels, however you can always just self-finance a new or used unit and get more immediate results.

Generally we see the lowest CA event rate with steady constant pressure and no EPR or Flex. You can try a fixed pressure of 8.0 and no EPR and see if that gets you to a better place. Either use CPAP mode or set minimum and maximum pressure in Autoset mode to 8.0.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#5
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Thank you

I’m turning EPR off tonight & I’ll follow the instructions in the comments to include the information requested in a reply in the morning (1am here)

Night & Thank you for you feedback / advice
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#6
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I missed that you are in Australia. Obtaining ASV therapy is not as big of a hurtle there, and it may be possible to hire a machine on a trial basis. The machine you want is either a Resmed Aircurve 10 ASV or Aircurve 10 CS Pacewave. Both are ASV therapy machines that are very easy to setup and use, and will resolve central apnea. These machines are quite expensive in AU, so your best bet is to obtain a lightly used ASV from Supplier #2 who sells these for $1350 USD plus some shipping costs.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#7
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Hi Primalyogi, just want to offer encouragement. I'm one of those people who started experiencing centrals and--thanks to the good counsel and support of the knowledgeable folks here (many of whom are are your case here) I was able to push my way through the potentially burdensome required here in the USA, and I got my ASV.

I hope your journey even is easier with regard to getting a machine approved (or self-funding).

You are in the right place and in good hands here. I'm grateful for the help I've received here. Best wishes.

Bill
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#8
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Last night wasn't a good test, I didn't get to bed until after 2am and was up at 7am; but even with all that, I did have a lower number of Centrals last night than average, as it wasn't a good test I will try again tonight and see what happens & post the difference.

as a FYI : I made a few adjustments (from the suggestions in the comments, very appreciated advice - balanced against the voice in my head that says "but the doctor said" blah blah - anyway) so I made a few adjustments like turning off EPR and modifying the pressure range by dropping the top end down from 20 to 15 (11-15), I had extra Obstructives but less centrals, but we will try again tonight and I will post the results (following commenters instructions)
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#9
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Try again tonight. Getting enough sleep is important.
Keep the EPR off, but you may do better with a straight pressure Setting as was suggested.
Post a screenshot so that we can see what happened with the changes you made.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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: Having Centrals but not Diagnosed with Centrals, also having CSR's
Ok managed to get one test night in that is decent

[attachment=24920]
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