My Data from 10/10/2017

[CZOscar]

You have come a long way and adapted well to CPAP using fixed pressure and no EPR. We know your results are "fragile" and would immediately increase if you changed any of the variables you have settled on.  These results are good enough that it is unlikely you will get recommendations to change therapy parameters unless your sleep is of low quality, unrestful or you have other issues that impair your daily function.  Those are things we can't read in any chart.

I think the statistics are that about 35% of people with CPAP induced complex apnea will adapt to CPAP while about 65% may need bilevel or bilevel with backup to resolve that.  From the evidence you have posted, you seem to have overcome the complex apnea that was prevalent in your early posts.

Thank you Sleeprider.  Pretty much where I felt I was but it has not been easy.  Really helps to get outside thought which provides a bit of encouragement to continue.

I have no other health issues (related) to sleep apnea other than being a very light and active sleeper.  Next hurdle is to control the positional leaks and leave CPAP setting alone since results are better.

In the meantime my search for the best CPAP Mask continues unabated   

[CZOscar]

Getting there - last nights data only minor changes. now 11 cm H2O with EPR of 1, and major leaks minimized.

[ajack]

That looks good to me.
It's been 3 months now, that is the time given for pressure induced CA to settle down. At 0.3 per hour, It seems that cpap is going to work for you. As you know there are still some leaks that need a bit of work.

[CZOscar]

That looks good to me.
It's been 3 months now, that is the time given for pressure induced CA to settle down. At 0.3 per hour, It seems that cpap is going to work for you. As you know there are still some leaks that need a bit of work.

Thank you Ajack & yes I agree - the early CA’s were a bit of a worry but I’ve had them under control for a month more or less.  The quest for the perfect comfortable mask that has minimal leaks continues.  But I have reduced them considerably from where they were and it is reflected but the data - but yes leak control is a work in progress.

Since I had a lot of help from forum wanted to share progress and also to donate for the management of this helpful forum. Donation sent.

[ajack]

They aren't critically affecting your cpap chart. I find leaks annoy me, disturb my sleep and is the reason I chase them down.

[Shin Ryoku]

I think the statistics are that about 35% of people with CPAP induced complex apnea will adapt to CPAP while about 65% may need bilevel or bilevel with backup to resolve that.

By some estimates, it may be closer to 65% who adapt to CPAP and 35% who do not:

NATURAL HISTORY — The natural history of treatment-emergent central sleep apnea (CSA) is not well defined prospectively. In observational studies, central events resolve spontaneously in 50 to 75 percent of patients who return for repeat polysomnography after several months of continuous positive airway pressure (CPAP) therapy [2,4,5,7,25,26]. Similar numbers were reported in the CPAP arm of a small randomized trial, in which approximately two-thirds of patients with treatment-emergent CSA achieved an apnea-hypopnea index (AHI) <10 per hour after 90 days of CPAP therapy [27]. This proportion improved to 73 percent when limited to patients who were adherent with therapy.

Confidence in these estimates remains somewhat limited by the retrospective nature of most studies and the significant number of patients lost to follow-up, which might lead to an overestimation of the true rate of spontaneous improvement.

Expectant management with CPAP — For patients with treatment-emergent CSA, we suggest expectant management with CPAP therapy, which includes repeat clinical evaluation and diagnostic sleep testing with patients wearing their device in two to three months. This approach is supported by retrospective and limited prospective data showing that central apneas improve or resolve spontaneously in approximately two-thirds of patients who continue CPAP for 90 days [27].

[Walla Walla]

"Confidence in these estimates remains somewhat limited by the retrospective nature of most studies and the significant number of patients lost to follow-up, which might lead to an overestimation of the true rate of spontaneous improvement".

That statement pretty much sums it all up.

[ajack]

I think sleeprider just mixed the numbers up, It seems 2/3 is generally accepted. It is also a similar number I also saw from a world leader at a symposium. If people are getting lost and not reporting back, one would assume a large percent of these people are doing fine, it may actually increase the odds. The ones having difficulties would be banging the door down

[Walla Walla]

If people are getting lost and not reporting back, one would assume a large percent of these people are doing fine, it may actually increase the odds. The ones having difficulties would be banging the door down

It could be that or it could be they just quit treatment.

[Shin Ryoku]

Another thing to keep in mind is that some of the studies considered an AHI less than 10 as representing resolution of treatment-emergent CSA. That is a cutoff commonly used by certain sleep experts and studies, but it falls far short of the standard which seems to be endorsed by outspoken members here and other patient support groups on the web.

If we use what seems to be the more prevalent forum criteria of AHI universally well below 5 and person lacking any symptoms, however nonspecific, which may possibly be attributable to sleep apnea, that number would drop from two thirds to something much lower.