(06-21-2015, 12:11 PM)tedburnsIII Wrote: Wow! Might suggest speaking to another board-certified sleep doctor or pulmonologist. It sounds as if your case is not run- of- the mill.
Dial-winging and fussing with the EPR just doesn't sound like it's the best solution. Seems as if it's a 'shot in the dark'.
Too early to tell if an Adaptive Servo Ventilator (ASV) machine may be needed, but probably not.
More often than not, the number of centrals continues to lower during first few weeks or months of therapy, as our system gets used to breathing against pressure.
There are probably many potential causes for centrals, but in common cases where Carbon Dioxide washout is a contributor then reducing EPR or Pressure Support or turning off A-Flex tends to reduce the number of centrals.
The nice thing about EPR or A-Flex or Pressure Support is these all tend to make it easier to breathe and increase comfort. But some (a minoriy) have found that using high amounts of EPR or Pressure Support can significantly increase the number of centrals.
An average of two or three centrals per hour of sleep is widely considered nothing to be concerned about, unless the centrals are long in duration (longer than 30 or 40 seconds, I think) and result in deep desaturations in SpO2 levels. Usually the average number of central apneas per hour (the CA Index) needs to be at least 5 before health insurance companies will consider covering an ASV machine which can treat both obstructive and central apneas.