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[Pressure] Centrals increasing; new to BiPap
#1
Centrals increasing; new to BiPap
I am new to BiPap;  started around 5 weeks ago with pressures of 10 / 25.   When I was diagnosed I had 53 events / hour, 8 of them were "Centrals".  When I started therapy, I evidently had massive air leaks, which weren't noticed for 2 and 1/2 weeks.  I thought it was leaking only now and then, but according to the sleep tech, the leaks were so bad that the therapy was useless.  So, he worked with me so that the leaks for the last 2 and 1/2 weeks have been within guidelines.  

My "events" during the first 2 and 1/2 weeks were averaging about 15 / night with 4 centrals.  Then for the next week, after fixing the leaks, according to Sleepyhead, I had about 15 / hour with 12 centrals.

Last week, the sleep doctor changed my readings (she was going by the ResMed software, which showed more AHI obstructive events than centrals) to 11 / 18.  Now, I'm having around 21 events / hour, almost exclusively centrals.  

The sleep doctor is looking at my data every two weeks, which won't occur for another 7 days.  How do I reduce the centrals in the meantime?  In looking at other suggestions on these forums, it states that the EPAP should be lowered to lower the number of centrals.  So, why was mine raised?

I should also note that this doctor, who is fully certified, works in a sleep lab only 1 day / week.  The rest of the time she's a family physician.  I am a little worried about the whole situation, especially since I'm going night after night with these centrals occurring.

Advice appreciated!
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#2
RE: Centrals increasing; new to BiPap
You need to give some more information on your settings.

For starters are you on VAUTO and if so what is your PS setting?

It also helps if you could download your data onto sleepyhead and post your charts here.

Guidelines for downloading and posting are below in the links in my post.

Welcome to the Board!
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Beginner's Guide to SleepyHead
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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#3
RE: Centrals increasing; new to BiPap
If 8 centrals per hr in a sleep test without a mask, I think you may need your meds looked at or a more advanced machine. I can't see cpap/bpap working well for you at this stage.

the doctor may be setting the course of action for this to happen. part of the data needed is to fail the CA with the OA/H treated
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#4
RE: Centrals increasing; new to BiPap
Well, I am certainly hoping that is not the case, as my heart ejection fraction is less than 50%, and I don't want a machine like the ASV to kill me?  I may just have to discontinue and take my chances.  I do feel better with the therapy, though, I must admit.  My wife has been working with my data on  Sleepyhead, and she noticed that the CA's do appear to coincide with massive mask leaks, which I still have a number of.  My Resmed machine gives me a smiley face, but Sleepyhead says my leaks are " horrible".  It's a puzzle, and I appreciate the support here!
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#5
RE: Centrals increasing; new to BiPap
Once again, what are your settings? If you're using fixed BiPAP at 18 IPAP and 11 EPAP, that is a pressure support of 7.0, and that will cause centrals. Simply reduce the IPAP and make it closer to EPAP if you are not having obstructive apnea, or if OA is still an issue, increase EPAP and make it closer to IPAP. Most people don't tolerate pressure support greater than 4 or 5 unless they are relying on the machine to do most of the work of respiration.

Your bilevel without a backup rate does not switch to IPAP until you take a breath, so this is not a ventilator, but if you have COPD, or other condition that requires high pressure support, that is something we don't know until you tell us. If you like high pressure support, but continue to have centrals a ST is your next stop short of ASV.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#6
RE: Centrals increasing; new to BiPap
I really don't know the actual settings; I will do some checking and post it here. Thanks for your help and patience!
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#7
RE: Centrals increasing; new to BiPap
Hi cdbeardie,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting your settings fine-tuned to better meet your needs; you've come to the right place for guidance.
trish6hundred
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#8
RE: Centrals increasing; new to BiPap
G'day cdbeardie. Welcome to Apnea Board.

Without going into the technicalities of your case, can I suggest that you do as much reading as possibe to understand what's happening with your apnea and the machine. (There are lots of good articles around this Board and in the wiki). You need to review your #SleepyHead output daily and not rely on your doctor or family to do this for you. We've seen so many people come through this forum relying on others, and in too many cases they end up dropping out of the therapy. You need to manage this yourself (obviously with the help of your good wife and the advice of your doctor) and fully "own" the treatment.

Sleep apnea science is very much a numbers-driven discipline. We need to see the numbers and charts in order to give advice, otherwise we're all just guessing. That's why we will keep asking to see your #SleepyHead outputs and exactly what your settings are. We're not medical practitioners here, and our advice is based purely on our own experience. "Patients helping patients". However, several of our members have been able to help others to a successful outcome.
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#9
RE: Centrals increasing; new to BiPap
Hi and  Welcome

Best wishes on getting this all figured out regarding the therapy. Not attempting to be a mean broken record type, but others gave great feedback already. Do your best to post the machine and/or prescription settings. Hopefully you have a copy of the script as it's lawfully your info and rightfully you should have a copy. Then once you know that info, there's great guru setting guys and gals here that can suggest edits you yourself can choose to do that will make this therapy work wonders for you.

Again, best wishes on success, agents we do hope to hear back from you soon,

Dave B

Coffee
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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#10
RE: Centrals increasing; new to BiPap
Thanks again for all the offers of assistance!  I went to the clinician's settings on my machine, which is a ResMed AirCurve10.

Mode:  V Auto
Max IPAP:  18.0
Max EPAP:  11.0 (this was changed by my sleep doctor from 10.0 a week ago, and the CA's have climbed since then)

Ti Max 2.0
Ti Min 0.3
Trigger Med
Cycle Med
Mask Full Face
Ramp Time 20 min
Start EPAP 4.0
Climate Control Auto
Tube Temp 81 degrees

Since the pressure was changed a week ago from 10.0-25.0 to 11.0-18.00, I've had an average of:  AHI 27.32, Obstructive Index 1.62, Hypopnea Index: 0.16, Clear Airway Index 23.12.

Before then, the average was AHI:  16.17, Obstructive Index 1.18, Hypopnea Index 0.43, Clear Airway Index 10.21

What's interesting to me is that the ResMed data showed many more obstructive apneas than the Sleephead data shows, which is why the sleep doctor raised the EPAP last week. 

I have never met this doctor, who is a family practitioner 4 days a week in a nearby community, and one day per week she runs our small town sleep clinic.  I meet her for the first time in the middle of December, when they do the Medicare compliance, but she looks at my ResMed data every two weeks, and makes changes accordingly.  The sleep technician who did the sleep study initially told me that I have some unusual breathing patterns, maybe 1 / 25 people they see have that.  She mentioned that the doctor might want to do a follow-up sleep study before giving me a machine.  After that, I didn't hear anything, and no follow-up.  I eventually called and they said there was a mix-up on paperwork, but that the doctor had ordered a machine.   So, it took 2 and 1/2 weeks to from the time of my sleep study to get the BiPap machine, and then another 2 and 1/2 weeks where I had such massive air leaks that the data wasn't usable.  

 My wife thinks that this might be a good time to look for a different sleep clinic to work with;  one who has more experience with unusual breathing issues, or knows what to do.  That's why I'm online here with you : )  I'm not certain what to do, and I'm not really trusting of the doctor and the orders that have been given.

I am trying to post a screen shot of Sleepyhead, but right now I'm not being successful.  I have some techie friends that can help me, but I'm not able to post now.
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