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Higher pressure causing centrals?
#1
Higher pressure causing centrals?
Hi, 
Hope you are all well!Sorry to keep coming back with queries, but I was hoping someone might be able to take a look at some my Oscar data to help determine if my pressure settings might be inducing central events/need tweaking at all? 

Essentially, I started with the default APAP settings on my Phillps Dreamstation (30 minute ramp with 4-20 pressure range) and had some success with it at first. 
As you can see from the stats, I had some issues with compliance and getting used to this all has been a bit of a battle for me, but more recently, I decided to up my pressure in the last month to deal with the issue I was having with vibratory snores (I was getting woken up by my own snoring and essentially used the 5 minute awake snore test to determine a good pressure). 
I was then having issues with flow limitation and RERAs and was kindly advised by members of this forum to up the starting pressure a bit to overcome this. 

As a result, I'm now on a starting pressure of 8.0 with no ramp function. 

My RERAs and flow limitations seem to have dropped off over the month, and my OAs are very few and far between, but my central apneas do seem to have gone up slightly. I also have a lot of hypopneas, but I don't know whether there's any way of knowing whether these are obstructive or central in nature?

Last night was a particularly bad night, though I did feel a little woozy last night (not congested, but some possible heat stroke type symptoms) which might have exacerbated it) and whilst it's still considered in a health range, I wonder whether it's possible a higher pressure is driving more centrals and whether this is a cause for concern? 

I've attached my monthly statistics where you can see the changes (April was a very poor month compliance wise). I've also attached last night's overview and a close up of a series of a CA, OA, and a series of hypopneas as an example to see if this is of any concern:

   
   
   

As always, any advice would be hugely appreciated!

Kind regards, 
Stuart
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#2
RE: Higher pressure causing centrals?
I'd consider a redo on the event areas in question to 2 minutes to see these better.

Several things from this not good chart reader: I suppose Flex or something else is dropping pressure. The green pressure line is dropping to near 4 for a good bit, it's just riding along and not responding to quite a few events. If you're dealing with Central apnea or hypopnea, pressure swings need to be minimized. I'm not saying you are but an if here, so if it applies the action to correct needs enacted.
Dave

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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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#3
RE: Higher pressure causing centrals?
It is really hard to recommend settings when we do not know what your are.
I will suggest that you reduce your Flex to see if that reduces your central events.

Yes, some of your hypopneas look as though they may be central.

Always provide a full chart when you provide details as that does provide context for the details.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#4
RE: Higher pressure causing centrals?
Thank you both for the responses and sorry for the poor chart data! I've attached some close-ups of a cluster of hyponeas, a CA/OA  cluster, and a CA/Hypopnea cluster.
I've also got the details of the night as a whole on the side, but let me know if there's anything missing!

   
   
   

My flex setting is currently 2 - would it be advisable to drop this by 1 and see if this helps?
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#5
RE: Higher pressure causing centrals?
Give us a chart with no zoom also. Then let's see what is going on overall also.
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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#6
RE: Higher pressure causing centrals?
Definitely drop the Flex. Depending on what is seen we may recommend turning it off.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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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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#7
RE: Higher pressure causing centrals?
I'm seeing flow limitation to the point of obstruction and in my opinion the CA events are improperly flagged. In my opinion the clusters of hypopnea and even the CA events are coming from positional apnea (chin tucking) which restricts your airflow. You contiunue to breathe, but at a greatly reduced flow rate and higher respiratory effort. I think you would eliminate most of this if you used a soft cervical collar. Please read out wiki articles on positional apnea and the soft cervical collar.
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...cal_Collar
Sleeprider
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#8
RE: Higher pressure causing centrals?
Thank you so much for the responses - I've attached an overall view with the chart: 
   

I'll drop the Flex and see how it goes. So you think it's fine to keep with the pressure as it is for now and assess from there?

Thanks Sleeprider - I was wondering whether the cluster signified some sort of positional apnea but I didn't realise these could be improperly flagged as CAs? 
And just to say I really do appreciate all your previous advice on the subject re: cervical collar: I've tried a Caldeara one (we're limited here in the UK with what we can get), but it was making my neck quite uncomfortable. I've actually just ordered an 'Eliminator' neck pillow from the US so hopefully that will remedy some of these issues.
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#9
RE: Higher pressure causing centrals?
If you find a collar that works for you, I think that 05:00-06:00 segment clears up at quite a bit. It may impact other areas of this chart as well. Best to your successful finding a workable collar.
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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#10
RE: Higher pressure causing centrals?
(05-22-2020, 12:28 PM)SarcasticDave94 Wrote: If you find a collar that works for you, I think that 05:00-06:00 segment clears up at quite a bit. It may impact other areas of this chart as well. Best to your successful finding a workable collar.

Thank you! Here's hoping the Eliminator does the trick ?
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