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Totally Confused by Airsense 10 Data - Centrals - Problem machine... ?
#11
Thanks Sleeprider - when I use the machine tonight, I will keep EPR off, but try reducing the max pressure from 12 to 10.
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#12
Let's see if this SleepyHead graph now uploads... Smile

This is from Weds night when I set EPR=0. CAs reduced, but still significant and 95%/max pressure was much higher (too uncomfortable and too many leaks):

[img][Image: YGR9PJAl.png][/img]
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#13
(11-11-2016, 05:10 PM)mymontreal Wrote: As a starting point, I turned off EPR on Weds night/Thurs am to see what impact it would have - it was a pretty bad night... It's only one night's data (so may be meaningless), but I did not expect it to have such a big impact... It did reduce the CAs somewhat (from 10/hr down to about 5/hr), but I saw a huge increase in my 95%/Max pressures, which made it very uncomfortable, lot of aerophagia problems and quite a few leaks - had to turn it off after about 4 hours... Sad
It can be hard to tease out what is and what is not working when you only have one or two nights data AND you know the sleep wasn't good in the first place. If the aerophagia continues at the new setting, then you may have to turn EPR back on. More on that in a bit.

Quote:Surprised that the pressure went so high (95% pressure was 11.4) , as it seems to have been averaging just 5-7 over last couple of weeks... Needed a break from the hose last night, but will probably try again with EPR=0 this evening
This is a bit unusual. Usually turning EPR off either doesn't affect the 95% pressure all that much or brings it down a bit.

You didn't post the Flow Limitation Graph on either the night with EPR = 3 (and lots of PB and CAs) or the night with EPR = 0 (and fewer CAs but more aerophagia). My guess is that flow limitation activity drove the pressure up on the night of 11/9/2016 since there's no snoring or obstructive events at the time of the pressure increase.

It is counter-intuitive and it doesn't happen frequently, but some people's breathing can become more unstable with the addition of too much pressure. And the unstable breathing can look like flow limitations to the machine, so the machine continues to raise the pressure or keep it at the max pressure setting, but the shape of the inhalations doesn't really improve. This is a case where limiting the max pressure can actually help things as long as the obstructive events are well controlled.

If aerophagia is big issue OR if you are game to experimenting and willing to run the risk of the number of obstructive events increasing for a few nights, you might want to LOWER the max pressure down to 8 or 9cm and leave EPR off. That would certainly take the edge off the aerophagia, but it still might help address the pesky CAs.

Quote:Sleeprider - Yes I did have a titration study 5 or 6 years ago when I tried CPAP initially - I can lookup the report, but I seem to remember initial CPAP pressure was set to about 10 and it caused Total AHI to be about 2.0 - don't remember any mention of Centrals, Periodic Breathing, Cheyne-Stokes breathing etc. - let me know if I should dig it out ?
If you can find it, it would be useful.

Quote:Robysue - I've only been back on CPAP for a couple of weeks, so it is early days - not really sure about the "tossing & turning" time... I certainly don't have much time where I seem to be wide awake... ?
Sleep-wake-junk stuff doesn't require you to be "wide awake". I'm talking about plain old tossing and turning---as in when you get up in the morning and you feel like you didn't get much sleep even though you don't remember any specific wakes.

Assuming that you are pretty much asleep the whole time you've been using the mask, it's still possible that those CAs are just being caused by your body having a bit of trouble learning how to maintain the proper CO2 level in your blood while breathing with the positive air pressure. And in that case, the somewhat large number of CAs may just resolve as your body gets used to sleeping with the machine. But if you are still seeing these kinds of CAs every night in a couple of months it may be time to insist on seeing the doctor to talk about what he thinks you might need to do to in order to not be swapping untreated OSA for pressure-induced problems with CAs.


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#14
Here is the data from last night (Friday), with EPR still at 0, and APAP max pressure reduced from 12 to 10.

Overall this was a much more comfortable night - with pressure at Max of 10, the pressure seemed to be more manageable (even with EPR at 0), aerophagia not too bad and don't recall any major leak problems.

Still quite a high % of CAs but does appear to be decreasing.

[img][Image: YfYzW1Sl.png][/img]

Couple of things that still surprise me:

1. Where are the OA events... in every sleep study I had, I had mainly OA (with quite a few H) - here, there appears to be no sign of any OA events, even when the pressure is as low as 4 or 5... ?

2. Still surprised that average pressures are so much higher since we turned off EPR ?

3. What is relationship (if any) between # of CA events, and the "Cheyne-Stokes Respiration %" that I oft see ?

I have moved "flow limitation" & "AHI" graphs so that they are visible - Let me know if I should zoom in on any particular area of the graph

Many Thanks!
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#15
I would avoid further changes for a few nights and see where this settles out. You are having somewhat better results here, and it's important to hear you say it feels more comfortable. Events are spread out and not showing any patterns related to pressure, or time of night. If anything, it looks like a higher minimum pressure of 6.4-7.0 may be appropriate to consider, and I still see no need for higher maximum pressure.
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#16
Hi Sleeprider

For the moment I have continued to leave EPR off and the Max pressure set at 10 for the moment - Centrals continue to decline slowly, so let's see how things progress over the next week or two Smile

If aerophagia becomes a big problem, I will consider lowering Max pressure further, but seems to be ok for the moment...

On a separate note, I did go back and review my original titration study from 6 or 7 years ago - it showed that they settled on and recommended a CPAP titration level of 13cm water - however, I am now confused when I review the titration report, as it appears the number of events with 13cm pressure, was much higher than the number of events at 10cm...
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#17
I have no idea why a titration study would have recommended a pressure of 13 cm when it apparently caused increased events. What I was seeing as we started this discussion was that you didn't have obstructive events. As CA becomes more controlled and you sleep better, I would not rule out reintroducing EPR at the lower max pressure. I think we have found the previous maximum pressure of 13 was not very good for you. I'm not so sure that you could not start adding back in EPR a little at a time and perhaps be even more comfortable. That is the bottom line objective.
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#18
Hmm... Central events seem to be on the way back up again and aerophagia appears to be getting pretty bad...

EPR is still off and APAP pressure is still set at 5-10. I am indeed sometimes hitting the max, but median pressure is about 8.5

Based on feedback, I think I will try setting max pressure at 8 instead of 10, see what impact it has

Aerophagia is now biggest problem (kept me awake much of last night), so if this is going to be helpful, I think I have to reduce the pressures a bit or slowly re-introduce EPR, regardless of what happens to total AHI score for a few days - does that make sense ?

Here is last night's Sleepyhead data, though it's pretty similar to last few nights:

[img][Image: 8CuL8mLl.png][/img]

Thanks
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#19
I think you need to start reducing pressure in small increments to see if the CAs and Hs start to disappear. Right now it looks like you are experiencing pressure induced CAs and possibly pressure induced Hypopneas. You also need to find out if there is a point where OA reappears. In other words, you need to confirm your diagnosis using your present machine. One thing to look for is to see if Hypopneas increase and CAs decrease as the pressure is lowered. You also want to see the CSR events disappear as the pressure is lowered. You are also going to want to post some detailed sections of your flow graph showing about 5 minutes of Hypopnea breathing. We can get an idea as to the type of apnea with which you are dealing. This will also help you with a strategy for working with your Doctor.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#20
I agree with your approach on this...not that you need my agreement Smile The reduction in pressure was key, and I don't think we ever really saw an association of EPR with your CA, rather we removed it to see if that alone could elicit a response. You still are not showing obstructive events, and EPR can probably help make you more comfortable with regard to aerophagia. Best of all, you're confidently calling your own shots, and that is great progress.
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