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Having Centrals but not Diagnosed with Centrals, also having CSR's
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I guess this is what frustrates me, there is kind of 2 measurements that should be taken into account; the signs and symptoms.

The machine is saying I am having CSR's and >6 CAI on a regular night (signs), I am also having significant problems with sleeping during the day (signs). Also, while initially I felt there was improvement by using the CPAP - to a point - that point has come and gone and things haven't improved since the (symptoms).. last night I had the largest CSR I have had that started at about 6am and woke me up at 6:56 am (signs) I got up and had a shower and then fell asleep on the floor of the spare bedroom

[attachment=25840]

Even Fitbit (which is unusual as it only ever shows oxygen variations if they last a long time) detected some variability in my breating 

[attachment=25839]

Off that topic:

It was interesting @Sleeprider said something "About mid-December, you experienced an increase in CA that continued to presence" and I have been going back through my medical history (as I keep all my documentation, you can't get anything done without it); so the first thing I notice is that on the 10th of December I purchased a new machine - rather than continue using the rental I was assigned (the rental was a very old model with 3900hrs blower time on it (lets estimate that as 550 days) the rental model had c-flex only; where as the new model came with a-flex and that is what the clinician set me up to use.

(from Oscar) DreamStation Auto CPAP (500X150) - J257******AC8 - 10 Dec 2019

The only other things that happened around that time was diagnosed with Deviated Septum which got fixed in January, and I was diagnosed with GERD nearer to the end of December, but there was not medication or injuries or other changes at that time; no bed changes, or ... literally anything other than the fact that I had a new machine - a more sensitive machine and it picked up on centrals from when I started using it.

I have gone through all my folders and there are no other changes at that time - and since then, including last night my CAI is dominant and CSRs are growing (6% last night, usually 3% or 4%).

Anyway...

Will wait until my appointment in 2 weeks and see what  comes of that.
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
One thing that may help, and maybe you are already doing it, make notes of all sleep apnea and machine symptoms and tell it to Doc Dolittle. And keep telling doc the symptoms over and over till their ears start bleeding from the constant "noise". Literally tell them every time you're seen...these are my sleep related symptoms and state x y z. You tell them the aspects of CA until they realize you're not quitting on making them listen and maybe they finally see CA. If not maybe hit them with their pointy rubber mallet and see how their reflexes are...OK maybe not that. Smile
Dave

OSCAR
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
wow... wtf happened last night

[attachment=25858]

AHI = 17.8

CAI = 7.8
OSA = 2.8
HA= 7.8
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I'm sorry I have to tell you this friend, but if you wanted to see what nasty, ugly, and failing badly PAP therapy looks like, here it is.

I'm not even going to ask how you feel. You could not possibly feel better for the use after that train wreck. Tell the doc this is a poor joke at therapy and one that isn't funny at all. I almost want to say box the PAP up and take it back.

I sincerely wish you success in getting a proper therapy device ASAP.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
ummm....

[attachment=25896]

AHI= 35.18

CAI = 15.43
OSA = 5.54
HA = 14.22

Min 8.0 Max 16.0 (cmH2O) EPR 3

I have used that pressure range HEAPS - what's strange is that the pressure says a min of 6 - so something bizarre went on... but below is a comparison of the same pressures

[attachment=25897]

That explains how I felt, I thought the AHI of 17 was generous, apparently after rebuilding the machine (the oscar option to rebuild machine) the numbers changed (the index not the events, the event count stayed the same the AHI and index's changed)

[attachment=25898]

I just wish I could have a sleep test on a night like that 35 night, my at home sleep study (setup by the hospital, worn 18 hours then returned to the hospital) only had an AHI of 44. I've never had a Lab study - I have it in my head now that I need a lab study and I need someone willing to look at the history of my last 12 months using CPAP and my Central dominant experiances...

*that feeling where you feel like you might cry because you are so fragile from lack of sleep - that me*
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
The problem with central and complex apnea, as you have certainly heard, is that they are consistently inconsistent. I'd like to see a review of the pressures and EPR ranges you have tried, but based on the latest results, I think it is clear that higher pressures trigger more events. Your pressure range of 8-16 might even be improved at 8-12. To some degree, you got relief from the pattern of clustered obstructive apnea by removal of the tonsil stone, however they are still present under whatever condition occurred on August 21, but nothing at all on the 18th. I don't see higher pressure as being successful in breaking the clusters of OA, so maybe the counter-intuitive move of reducing max pressure may help. As I recall, we were having pretty good luck with the range of 9-13 EPR 2 at the beginning of the month before the tonsil change. Somehow, maximum pressure has since crept upward, and it certainly doesn't seem to help.
Sleeprider
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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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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Latest advice of the doctor was 8-16; that’s why it was raised, trying the prescription.

I got told off by my shrink & Sleep Doctor for self adjustment of the CPAP pressure and trying to control the medicines they keep trying to push on me (antidepressants that I refuse), I guess he got to me ... I caved and so I put in the settings to doctors prescription.

I don’t know why it got to me so badly...  I was made to feel like I’m the cause of the problems.

So I did what I was told and suffered
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I think it is safe to say the settings failed. Tell Doc Dolittle McDuck this. Quote me if you like.
The consistently inconsistent factor isn't helping your therapy either. You may have to figure out how to get the ASV without the quack. Sincerely, I wish you the best on this as this poor medical practice only hurts you.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
... after that stupid night I swapped it back to something we were working with;

8-14 EPR 2; had an AHI of 2.39 (CA=2.09 / OSA 0.3 / HA 0.0)

if I go below 8 or above 14 (EPR value doesn't seem to matter) the chaos comes back and I have those crazy central clusters, hypo-apneas & CSR's

Even last night (pressure : med=8.44, 95%=12.80) I woke up with a splitting headache after a cluster of centrals 15 minutes or I woke up before hand.

Anyway; going to speak to the doctor next week and then see what happens..
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RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
This may have been discussed already, but if you're trying to tame CA, it's a possibility the EPR should not be used. It introduces pressure swings that will likely increase CA.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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