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Having Centrals but not Diagnosed with Centrals, also having CSR's
#41
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
this was last night, side, pillow under chin thing to start off with, woke up on my back again,

[attachment=25102]

The one thing I've noticed, since swiping to EPR 3, my O2 saturation average has dropped, and my heart rate average has increased. that's not a bad thing, just something to notice.

Previous O2 Saturation (9-14 EPR 1)
 
[attachment=25103]

This is also an interesting event, I think its a RERA, but I could be wrong

[attachment=25106]

Subjectively, except for the fact that since switching to EPR 3 I haven't woken up bloated and farting like a trouper, I would say my sleep hasn't been as good, for example yesterday I slept an additional 6 hours on the couch, and this morning, I got up, had my shower, and then fell asleep again on the couch 15 minutes later..






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#42
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
There are two thing going on. You have positional apnea, and are going to have to deal with it or those clusters of obstructive events ranging from flow limit, hypopnea and OA are going to continue, and your pressure will quickly move up to near your maximum pressure setting. Second, there is enough CA that your input about EPR is something we need to consider in modifying your settings.

Let's set Pressure at minimum 9.0, maximum 11.0 and EPR 2. This will keep pressure from increasing to levels that don't really benefit you, and the lower EPR should be more comfortable while still relieving aerophagia. In fact, I don't have any problem with taking EPR back to 1 where you were before, but you must deal with the positional problem, or the lower maximum pressure may allow those hypopnea to become OA.
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.
#43
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Thank you @Sleeprider

I had to look up the word “aerophagia” - you learn something new every day.

Amusingly, I actually set the machine to 8-14 EPR 2 last night to see what that did; I changed my mind last minute & put it back - two nights for comparison is better than one, and the AHI's were good (comparatively) even if subjectivity, I still feel very tired, have a headache and went back to sleep within 30 minutes of getting up both days.

I have read the collar wiki and am trying to figure out a solution (that I can handle using every night) to try and better address the positional aspect - my partner I always knew my position in bed makes a big difference as she would kick me on my side or stomach when I was snoring and my snoring would reduce (I mean kick, she’s a black belt). I haven't found a way of sleeping on my belly since starting CPAP.

What’s frustrating, is even on my side, my partner said I stopped breathing for long enough to scare her at around 3:30 & 5:20, she thumped me on the back - which started me breathing again, but I would stop again a few seconds later and that happened a few times. It scared her - but after about the third one I sort of woke up and they stopped -  they were flagged as CA event clusters with minor O2 desaturation.

[attachment=25107]

Anyway

Its this graph that always gets me though.

[attachment=25108]

Thank you for your help; i’ll try the suggested setting and post the results.
#44
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
So I think EPR 3 is best for comfort, No EPR, i get woken up with stomach cramps and wind at like 5am or 6am

Original test 9 to 11 EPR 1 - AHI 8+ - 9.2Hrs  (High aerophagia, manage to make it through the night, but woke up in very significant pain and wind, got up and went back to bed taking off my  02 Ring)

[attachment=25156]

The day before yesterday, I forgot to change the upper pressure, so 9 to 14 EPR 2 - AHI 1.69 - 6hrs (Mild aerophagia, enough to know it was there and think - I rather EPR 3 / also trouble getting to sleep)

[attachment=25157]

Last night test 9 to 11 EPR 2 - AHI 2.99 - 7hrs (Moderate aerophagia, woke up to farting and pain such that I got a heat pack to calm the pain) - I was on my side as far as I can tell all night as I woke up there and went to sleep there.

[attachment=25158]

My favourite for comfort was 7/29/2020 with 9-15 EPR 3 - 7.25hrs (AHI 2.96 / 2.83 centrals) but its not as good as the tests - except I didn't have (very noticeable) aerophagia






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#45
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
In reality on 7/29 your pressure range was only 9-11 with EPR 3. I think on 7/24 the 9-11 EPR 1, you experienced some positional obstruction that really increased flow limitation, hypopnea and OA. The 7/30 9-14 EPR 2 results look good. I think your aerophagia issues kick in over 12 cm and that might be your top pressure. The central apnea are going to be consistently inconsistent and don't appear sensitive to EPR.
Sleeprider
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____________________________________________
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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.
#46
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
(08-01-2020, 07:49 AM)Sleeprider Wrote: In reality on 7/29 your pressure range was only 9-11 with EPR 3.  I think on 7/24 the 9-11 EPR 1, you experienced some positional obstruction that really increased flow limitation, hypopnea and OA.  The 7/30 9-14 EPR 2 results look good.  I think your aerophagia issues kick in over 12 cm and that might be your top pressure.  The central apnea are going to be consistently inconsistent and don't appear sensitive to EPR.

@Sleeprider - Thank you for your help & feedback

I think I have learnt a little more about my condition. I recognise that my main issue is positional Obstructive Apnea's - with secondary Central Apneas without explanation.  I also have memory issues (example forgetting to change the pressure the other day) so I accept I might have put the wrong dates in my last post.

(Ignoring CA's) I recognise position is key, so I am investigating pillows to try different options (I tried a travel pillow around my neck, I took it off and couldn't handle it); my biggest issues is that without a mask, I sleep on my stomach and historically have had less noticed apneas or snoring when I am on my belly, so I am struggling just dealing with having to be on my back or side, so I think trying to find a pillow that helps my positions is my best hope (& a maybe a nose only mask with a chin strap) - I haven't found a pillow yet.

Question on Centrals :

I get the idea that my CA's don't seem to be EPR related and that they are increased by higher pressures, but I don't understand why I get centrals even at low pressures. Maybe its incorrectly flagged? or ... I don't get it... last night I set the pressure in the dark half asleep so I actually didn't know what it was; but anyway - it ended up that on average my pressure was 9 and EPAP 6 (EPR 3) - and I was on my side (woke up there) - I still had centrals flagged that were associated with a drop in oxygen & pulse rate changes, I didn't think that was usually the case with centrals - so is it possible that was a incorrectly flag apnea?

I guess I am just trying to get my head around what's causing them OR wrap my head around the idea that they are incorrectly flagged.

Example :
[attachment=25184]
[attachment=25185]
#47
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
CA events are more related to CO2 than oxygen or other factors, and you seem to be more susceptible to being near an apneic threshold than most. In both clusters show above, a brief breathing disturbance and a large breath(s) are present that starts a cluster of CA and trailing variable breathing where volume oscillates after the events end. This is the effect of CO2 dropping which increases breathing rate and volume, and increasing, which tends to suppress breathing rate and volume. You can see the oscillation in SpO2 and your CO2 can be assumed to be doing the inverse of that chart. A possible solution is to stabilize CO2 by using an Enhanced Expiratory Rebreathing Space (EERS) to conserve some CO2 on each breath. http://www.apneaboard.com/wiki/index.php...ace_(EERS)
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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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#48
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Thank you for your help @SleepRider. I have a lot to think about... even with all this, I feel worse. I must be looking in the wrong place for whatever’s causing “this”.
#49
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
No CPAP machine, 

Head held in position, on my side with my chin raised by multiple pillows and the couch’s back. 

(Yes I felt so sick I couldn’t sleep so I didn’t get much sleep but - fascinating how I can stop the Apneas by position alone.

No oxygen drops at all all night but 10 additional bpm over average machine nights.

Don’t get me wrong, it was a sh*t night but a proof of concept
#50
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I traveled a few years ago on vacation, and forgot the power supply for my CPAP. I did the same thing to correct positional apnea, and got through the night, but drove 450 miles back home to get relief. Sleeping without the machine is simply not an option.
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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