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Higher pressure causing centrals?
#11
RE: Higher pressure causing centrals?
I made a huge mistake of not reading my Flow Rate chart at two minute segments. There was a lot more to reading charts then I thought ! I thought I had alot more CA then I really had. Post the chart within 2 minutes, and see then. Post the chart and let the mod's and monitors have a look see.

Like Dave said..2 minute segments. And flex... I also have the same machine you do. I played with flex, and for me it has to be 3 for comfort for now... my sleep study coming up will show what changes, possibly ASV, I don't know yet.
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#12
RE: Higher pressure causing centrals?
(05-22-2020, 01:36 PM)milboltnut Wrote: I made a huge mistake of not reading my Flow Rate chart at two minute segments. There was a lot more to reading charts then I thought ! I thought I had alot more CA then I really had. Post the chart within 2 minutes, and see then. Post the chart and let the mod's and monitors have a look see.

Like Dave said..2 minute segments. And flex... I also have the same machine you do. I played with flex, and for me it has to be 3 for comfort for now... my sleep study coming up will show what changes, possibly ASV, I don't know yet.
Thank you! 

I've attached some examples of the CAs and hypopneas I was having: 
   
   
   
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#13
RE: Higher pressure causing centrals?
A couple more examples - any advice would be greatly appreciated :Smile

   
   
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#14
RE: Higher pressure causing centrals?
hang tight....
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#15
RE: Higher pressure causing centrals?
Most events are preceded by flow limited breathing.  I'll post a example below.  What we see in this sequence are three severely flow limited breaths where the inspiratory flow is restricted and instead of reaching a normal peak, becomes a downward sloping flow rate with a much smaller flow peak. At 04:58:10 there is an arousal and large sigh followed by 3 breaths of larger than normal flw and then diminishing flow rate with 3 normal breaths then three flow-limited failed breaths leading to the CA.  The apnea starting at 04:58:50 looks like a mixed apnea that began obstructively, then becomes clear airway at the pressure pulse at 04:58:55. Recovery breathing leading to more flow limitation and the OA.

I'm going to be a contrarian and say most of the CA is obstructive sleep apnea or at least arises from airway restriction/ obstruction.  For example in the second figure beginning at 04:36 all of the breaths are classic flow limitation, with another big sigh, then a CA followed by more flow limitation during a period of dropping CPAP pressure, then a OA event.  The apnea may have been clear airway, but the source is obstruction or airway resistance.  Based on a tendency for these events to cluster, I think you should read the Soft Cervical Collar wiki in my signature and also read the Positional Apnea secton of Optimizing your Therapy.  You would be far better treated by a machine that delivers bilevel pressure like the Airsense 10 with EPR or a regular bilevel that helps to counter these flow limits that are the root cause of early all the CA and H events you experience.  The source of the flow limits is most likely positional where your head and neck are enough out of alignment to allow chin-tucking or a restriction of your airway.   Feel free to ask any questions or challenge these interpretations, but you need higher minimum pressure, and probably an aid to stabilize your cervical airway.


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#16
RE: Higher pressure causing centrals?
(05-23-2020, 08:11 AM)Sleeprider Wrote: Most events are preceded by flow limited breathing.  I'll post a example below.  What we see in this sequence are three severely flow limited breaths where the inspiratory flow is restricted and instead of reaching a normal peak, becomes a downward sloping flow rate with a much smaller flow peak. At 04:58:10 there is an arousal and large sigh followed by 3 breaths of larger than normal flw and then diminishing flow rate with 3 normal breaths then three flow-limited failed breaths leading to the CA.  The apnea starting at 04:58:50 looks like a mixed apnea that began obstructively, then becomes clear airway at the pressure pulse at 04:58:55. Recovery breathing leading to more flow limitation and the OA.

I'm going to be a contrarian and say most of the CA is obstructive sleep apnea or at least arises from airway restriction/ obstruction.  For example in the second figure beginning at 04:36 all of the breaths are classic flow limitation, with another big sigh, then a CA followed by more flow limitation during a period of dropping CPAP pressure, then a OA event.  The apnea may have been clear airway, but the source is obstruction or airway resistance.  Based on a tendency for these events to cluster, I think you should read the Soft Cervical Collar wiki in my signature and also read the Positional Apnea secton of Optimizing your Therapy.  You would be far better treated by a machine that delivers bilevel pressure like the Airsense 10 with EPR or a regular bilevel that helps to counter these flow limits that are the root cause of early all the CA and H events you experience.  The source of the flow limits is most likely positional where your head and neck are enough out of alignment to allow chin-tucking or a restriction of your airway.   Feel free to ask any questions or challenge these interpretations, but you need higher minimum pressure, and probably an aid to stabilize your cervical airway.


[Image: attachment.php?aid=23151]

[Image: attachment.php?aid=23150]

Thank you ever so much for the detailed response! I actually received my Eliminator collar and tried it yesterday. Frustratingly, I didn't get any sleep last night (started to drift into a semi conscious state a few times) that I am aware of before eventually taking the APAP off and giving up.

I woke up again on an inhale a couple of times - it almost seems I can feel some sort of mini snort (but it's not audible) in my right nostril, which seems to disturb/arouse me.
I also made the mistake of not using mouth tape, and my mouth came open at one occasion causing an air leak which woke me back up, after which it seemed almost impossible to fall asleep. 
The Neck Pillow does seem to hold my neck up though so I do believe long-term it will be good at stopping chin tucks. 

I'm not sure if there's much to be gleaned from it particular as I think I was awakre, but I've got some snips from yesterday which showed a couple of RERAs and flow limitations if there is any info to be gained from them? 

   
   
   

Do you generally think I should titrate up the pressure? And a silly question, but how is it that the EPR on the Resmed is better able to deal with these than the Phillips Dreamstation with its Flex?
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#17
RE: Higher pressure causing centrals?
Further two snips for reference:
   
   
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#18
RE: Higher pressure causing centrals?
On the ResMed EPR vs. the Respironics Flex: we don't know much about Flex beyond that it has 3 settings. It's handled as more or less smoke and mirror magic; AKA Philips doesn't say much about the workings of Flex. However, it sounds like feedback indicates it's a hit or miss with users. I don't recall what Flex's 3 settings equate, it's possible they are just reference strength indicators.

On the other side, we have ResMed and EPR. EPR is also 3 settings worth of adjustment. This comes across as a Bi-level/BPAP limited to 3 cmH2O drop in pressure. EPR's range of 1-3 are actual cmH2O values akin to EPAP pressure setting numbers in what they do. It is very much a BPAP but working backwards as I see it, in that a BPAP adds PS onto the set pressure, while EPR subtracts/reduces its setting from your pressure.

Both are supposed to be comfort features, yet EPR can actually become therapy oriented in becoming a limited range BPAP.
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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#19
RE: Higher pressure causing centrals?
(05-23-2020, 11:48 AM)SarcasticDave94 Wrote: On the ResMed EPR vs. the Respironics Flex: we don't know much about Flex beyond that it has 3 settings. It's handled as more or less smoke and mirror magic; AKA Philips doesn't say much about the workings of Flex. However, it sounds like feedback indicates it's a hit or miss with users. I don't recall what Flex's 3 settings equate, it's possible they are just reference strength indicators.

On the other side, we have ResMed and EPR. EPR is also 3 settings worth of adjustment. This comes across as a Bi-level/BPAP limited to 3 cmH2O drop in pressure. EPR's range of 1-3 are actual cmH2O values akin to EPAP pressure setting numbers in what they do. It is very much a BPAP but working backwards as I see it, in that a BPAP adds PS onto the set pressure, while EPR subtracts/reduces its setting from your pressure.

Both are supposed to be comfort features, yet EPR can actually become therapy oriented in becoming a limited range BPAP.

Thank you!
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#20
RE: Higher pressure causing centrals?
EPR and Flex are both considered to be 'Comfort' Settings,

PS/Pressure Support on a BiLevel is considered therapeutic (and EPR, not Flex, mimics this behavior for settings of 1, 2, and 3)
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