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Please help me evaluate CSRs and what to do
#11
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 10:59 AM)Dog Slobber Wrote: Your periodic breathing is not a concern. And no, considering an ASV is overkill.

It is not unusual for new CPAP users to experience *some* centrals.

Now that you are using CPAP your CO2 is being washed out of your system very differently than pre-CPAP. Your brain needs to adjust to these new triggers.

Brand new users should not even look at Centrals, unless they are an absolute disaster (well into the double digits).

Get used to the CPAP, let your body adjust. There really is no point trying to optimize therapy that is still new and very foreign.

That makes sense. My original diagnosis was close to 50/50 OSA vs. CSA. I guess it makes sense that there will be some adjustment now that OSAs have dropped to zero.
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#12
RE: Please help me evaluate CSRs and what to do
That may make a difference.  In fact it explains why EPR is having so little effect on you.

Set min pressure = 7 so that EPR can be fully utilized.

Nights 1-3, No EPR
Nights 4-6, EPR=3, Fulltime (not Ramp Only).  If the centrals react in a negative manner, go high, we may shorten this part.  

Multiple nights cause we don't want to catch one bad night.

IMHO you should have a primary and a secondary diagnosis.  You don't really care which is which, but OSA for one, CSA for the other.  It is important that the CSA is recognized so that if/when your treatment indicates a failure, you have the diagnosis that will allow a trip down the CSA treatment path without having to take another sleep test to prove you have a documented case of CSA.

Most doctors will try to treat your OSA first and hope the CSA decreases sufficiently to not be a concern.  That is CAI of less than 5.
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#13
RE: Please help me evaluate CSRs and what to do
The significance of a diagnostic sleep test showing 50% central apneas is that they are there pre CPAP treatment.

Our task is to optimize your therapy as much as possible on your current device, then if needed guidance on what is next.
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#14
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 06:32 PM)Gideon Wrote: That may make a difference.  In fact it explains why EPR is having so little effect on you.

Set min pressure = 7 so that EPR can be fully utilized.

Nights 1-3, No EPR
Nights 4-6, EPR=3, Fulltime (not Ramp Only).  If the centrals react in a negative manner, go high, we may shorten this part.  

Multiple nights cause we don't want to catch one bad night.

IMHO you should have a primary and a secondary diagnosis.  You don't really care which is which, but OSA for one, CSA for the other.  It is important that the CSA is recognized so that if/when your treatment indicates a failure, you have the diagnosis that will allow a trip down the CSA treatment path without having to take another sleep test to prove you have a documented case of CSA.

Most doctors will try to treat your OSA first and hope the CSA decreases sufficiently to not be a concern.  That is CAI of less than 5.

Fantastic, this is a plan I can get behind. 

I'll set the machine to min=7 and:
  • For the next 3 nights collect results

  • Nights 4-5 EPR=3 full time

Two question - 
When you say "go high" if CAs react negatively, do you mean go higher on pressure?
Should I post daily updates with screenshots or is there a more efficient way of delivering 6 days of data?

Again, thank you for being active in this forum.  I'm sure there are plenty of people like me who benefit from your advice, and so immediately to boot.
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#15
RE: Please help me evaluate CSRs and what to do
No changes, the only difference should be the EPR.

Should CAI rise to more significant levels. We may need to correct for that.
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#16
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 08:15 PM)Gideon Wrote: No changes, the only difference should be the EPR.

Should CAI rise to more significant levels.  We may need to correct for that.

Roger that. 3 off, 3 on.
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#17
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 08:15 PM)Gideon Wrote: No changes, the only difference should be the EPR.

Should CAI rise to more significant levels.  We may need to correct for that.

Attached are screenshots of the first 3 nights.  This is Min=7, Disabled EPR.

FYI, night #3 I had sinus congestion (last night).  I also hit a new max pressure of 14.6.  I assume that's due in part to being congested.

Tonight I will turn EPR on full time, Level=3 and record that for the next 3 nights.

   
   
   
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#18
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 08:15 PM)Gideon Wrote: No changes, the only difference should be the EPR.

Should CAI rise to more significant levels.  We may need to correct for that.

I know we need to capture 3 more nights with EPR for comparison.  In the meantime, however, I'm curious what you infer from the zoomed section where CAs were most concentrated.  

   
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#19
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 08:15 PM)Gideon Wrote: No changes, the only difference should be the EPR.

Should CAI rise to more significant levels.  We may need to correct for that.

Hi everyone,
A couple days ago I posted 3 days no EPR.  I lost 1 day traveling, and then 2 nights ago the machine only recorded summary data (perhaps because I took a mid-day nap with the machine and then the date rolled over to the new month that night).

I would like to keep the conversation going, so here is the summary day showing an AHI of 4.3, mostly CA events. 

Last night collected good data.  AHI 3.69.  I have addressed flow rate and leaks, so those numbers are looking better.

I realize this is only 1 day of data with EPR set to 3, but it already seems like there is a direct correlation.  I'm including data from my first night on APAP which also had EPR=3.

In other words, it seems like Gideon's observation that EPR may be clearing too much CO2 causing the chain on CA events. 

I will continue to collect data for a couple more nights, but what are your thoughts on what the data shows so far?

Good data EPR=3 (8/1/2022)
   

Summary only (7/31/2022)
   

EPR=3 (7/23/2022)
   
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#20
RE: Please help me evaluate CSRs and what to do
(07-27-2022, 08:15 PM)Gideon Wrote: No changes, the only difference should be the EPR.

Should CAI rise to more significant levels.  We may need to correct for that.

Hi everyone, thanks for the continued help.  Gideon, as requested I have 6 nights of data; 3 without EPR and 3 nights with EPR=3.

Here's the link to my previous post with the 3 screenshots without EPR.

Attached to this post are 3 nights with EPR.

What are your thoughts on the pattern breathing and CA events?  They seem to show up consistently every night, but more so with EPR enabled.  

Any ideas on next steps would be greatly appreciated.

   
   
   
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