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central apnea woes
Hi everyone,

I've just finished my third sleep study, and the results are crazy. I entered with an AHI of 25-35 with major CA's and OA's. The tech said I need to reduce my pressure from auto 7-15 H20 to 7-9 to eliminate my centrals. I've just tried that and the centrals went down quite a bit,  but my OA and Hypopneas are sky high in its place. I eliminate one and get the others. I feel an ASV machine would treat both, but my sleep study says not 50% centrals so Medicare will not pay for one. Any suggestions on what to do? Low pressure, little to no centrals, but high OA's. Higher pressure 15-20 H20 on auto brings centrals but seemingly treats OA's.
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That's the way it works for people with mixed apnea. Yes, the ASV would probably be ideal.

You are using a bilevel auto. Would you be more specific as to settings. Are you set to Auto mode? What pressure is EPAPmin? What is IPAPmax? If in auto mode, there is a third pressure, PS (Pressure Support). If auto, what is PS set to? For a Vauto, "reduce my pressure from auto 7-15 H20 to 7-9" doesn't make sense.

Reducing PS might lessen central apneas.

So, can we first get the actual settings for mode, minEPAP, maxIPAP, and PS?

BTW -- what's the altitude where you live?

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Someone more experienced with mixed apnea may have some ideas.

Do you sleep on your side or on your back? For one person here, sleeping on the back raised apneas 7 times higher then when side sleeping. A bolstering pillow may help you sleep on your side if it isn't your normal position.

Test it and see. It may or may not help with the centrals (a neurologically mediated issue). It may help with any obstructive apneas. Thus, if you set the machine to manage the CA, you might try sleeping on your side to help manage the OA.
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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G'day Fiur

Side sleeping is known to have a large effect on obstructive apnea, but peer-reviewed studies show it only has a very small effect on central apnea.

It would help if you could share some more specific details of the test results (ie actual numbers rather than vague descriptions) and also your machine settings as JustMongo suggested. In addition, can you post some typical SleepyHead charts of a typical night please? Format them like this: https://sleep.tnet.com/resources/sleepyhead/shorganize

I'm not familiar with your insurance policy, but I have seen on previous threads that an ASV machine can be authorised if the central apnea index is over 5. You should explore this with your insurance company (not the DME) to find out exactly what your entitlements are. ASV machines are expensive but almost 100% guaranteed to fix your condition.
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Fiur, I need to know exactly your settings to help. Your profile shows an Aircurve 10 Vauto at 10-15, but what I need to know is mode and pressure support. I sounds like you were using fixed VPAP-S mode at IPAP/EPAP 15.0/7.0 which a PS of 8. That would give me Central apnea for sure. It sounds like you have changed to 9.0/7.0 which is a PS of 2. That should work, but if you have OA, then we need to change your settings to Vauto so EPAP can increase.

If my assumptions above are correct, then you should change your EPAP min to 7.0 and IPAP max to 15.0 and set pressure support (PS) to 2.0. This will allow you the low pressure and pressure support to avoid CA, and will allow EPAP to increase as you need it to avoid OA. PS will be constant. Any questions?
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Hi fiur,

Yes, I am pretty sure USA Medicare does not cover ASV unless the number of central events (central apneas plus central hypopneas) before ASV treatment is higher than the number of obstructive apneas plus obstructive hypopneas before ASV treatment. With ASV, usually all CAs (and all or most OA) will be eliminated and only a few obstructive events will remain.

Looking forward to your answers to Sleeprider's questions.

After trying various adjustments with help of this forum, if you are unable to achieve a good AHI (or rather RDI, where RDI = AHI + RERA) I think the doctor should provide you with a prescription for the machine you need, even if it wouldn't be covered by insurance. At least that would make it easier to buy one for yourself, if it came to that.

I think often CA are far less stressful/dangerous than OA, because with CA as soon as we feel the urge to breathe, we do. With OA we are trying to breathe but are being strangled until our exhausted body arouses enough to take a few more breaths until OA begins again.

So, look at the CAs in the Flow waveform (zoom in until 2 minutes fills the screen horizontally) and if the CAs you see are fairly short I think they are probably causing less harm than an equal amount of OAs, even if the OAs are also fairly short. "Flow" is the machine's estimated rate (volume per unit of time) of airflow being inhaled or exhaled.

As others have pointed out, reducing Pressure Support (the difference between EPAP and IPAP) very often reduces how many CAs we get.

So it is important to reduce PS to see how much that may help.

Being in Auto mode will allow machine to increase EPAP when needed to treat obstructive apneas. The Max Pressure (Max IPAP) should be limited to prevent long CAs (longer than perhaps 15 or 20 seconds).
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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That's a nice summary, and sorry, but you need the ASV.  The best approach is what Sleeprider said, BUT...
Please post 2 things.  

1. The Detailed Sleep Study report because it contains details that are hard to determine with only a PAP and is especially valuable when a complex apnea is present.
2. Post the daily Sleepyhead charts,  and please pay attention to the organization.  This will show how 1 reading is interacting / triggering another.

Sleeprider and I both tend to include the how to in our signatures.

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