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Please help with dealing with central apnoeas due to CPAP
#11
RE: Please help with dealing with central apnoeas due to CPAP
No, the cluster of apneas implies that you are tucking your chin, Let it ride for now but if the clusters continue and grow larger consider a soft cervical collar.
Your changes should mostly be based on how you feel.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#12
RE: Please help with dealing with central apnoeas due to CPAP
Hi Fred,
Thanks!
Will post tomorrow with results.
Chen
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#13
RE: Please help with dealing with central apnoeas due to CPAP
Hi all,
I had one of best sleeps last night! Felt so good! The CA were down.
No changes actually to my normal routine!

Thanks so much!
Chen


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#14
RE: Please help with dealing with central apnoeas due to CPAP
Looks very good and you're feeling good for it. Congrats.
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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#15
RE: Please help with dealing with central apnoeas due to CPAP
(10-31-2020, 03:56 AM)bonjour Wrote: I want you to have comfort, but try to leave a little bit of centrals. They are under 2 and you have essentially the same for obstructive events.  Lowering EPR will likely increase your obstructive events.
This is an exercise in balance.  All the actions to reduce centrals have a tendency to increase obstructive events.

Fred, why would reducing EPR (effectively increasing EPAP) increase obstructive events?
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#16
RE: Please help with dealing with central apnoeas due to CPAP
Because EPR treats Hypopneas which counts toward, and Flow Limits, RERAs, and UARS which don't count in AHI but do count IMHO as Obstructive events.  The overall effect of lowering EPR is to reduce central events and increase obstructive events.  OA itself is treated by EPAP, the others are treated best by the difference between EPAP and IPAP.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#17
RE: Please help with dealing with central apnoeas due to CPAP
Just looking at this last chart, I would cap the maximum pressure at 13 cm. I just don't see any benefits in the pressure spikes above that level, and might even cut it off at 12-cm.
Sleeprider
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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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#18
RE: Please help with dealing with central apnoeas due to CPAP
Hi all,

Please see my latest Oscar result.
Unfortunately its worsened again Sad
Maybe because I was on my back more?

RE: maximum pressures - I had once reduced max pressures to 14 and I had AHI of 8 and woke up within 1-2 hours of sleeping so its a bad experience that I would like to prevent.

Would you suggest anything else or just to keep on recording and seeing what happens?


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#19
RE: Please help with dealing with central apnoeas due to CPAP
There are some encouraging things about this chart that you should be aware of. At 9 to 17 pressure with EPR 2, you are having about 50% obstructive and 50% CA events. Your median pressure is about 10.3 and it moves up sharply in response to OA events. The good news is that flow limitation is a very good 0.04 at the 95% which means you won't need more EPR and might be able to use less. I think the CA events are random, and will eventually diminish on their own without changes. I'm more focused on on the OA events, which often occur in clusters of 2 to 4 in a very short time. While you may not need a soft cervical collar, I think you should look for any situation that may promote chin-tucking that can lead to this kind of obstruction. Your one break in therapy occurs during one of these clusters.

I think you can safely limit maximum pressure to 14 cm and perhaps use the Soft Autoset algorithm to minimize some of the sharp pressure increases, but remember this looks positional, so evaluate that first. This should help with comfort and efficacy. If you want to try EPR at 1, that will reduce CA events in most people, but I'd rather see you focus on the obstructive events and ignore the CA for now. Its probably not very disruptive to sleep and at this level we can mostly ignore it and it will go away.
Sleeprider
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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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#20
RE: Please help with dealing with central apnoeas due to CPAP
Hi Sleeprider,

I think you are right! I had a look at my previous records. See attached, they do come in clusters.
Here is the bad night where I had max 14 then I raised it to 16, which seemed to reduce the OA episodes. But maybe I was just more conscious to sleep on my side rather than my back?

What would you recommend to prevent chin tucking? Would a CPAP pillow be good or a chin strap or cervical collar?

Chen


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