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new to bipap, lots of central apneas
#31
RE: new to bipap, lots of central apneas
(04-25-2019, 04:16 PM)Sleeprider Wrote: Lowering maximum IPAP is a logical response.  As far as EERS, your mask can be adapted by occluding the vent where the hose connects, and moving it about 12" upstream using Corr-a-Flex tubing and the swivel vent mentioned in the article.  It simply replaces the existing vent but adds dead-space that does not currently exist.  It's a cutting edge approach, so I don't expect much adoption of it until the parts are commercially produced.
So an update. I lowered the maximum IPAP to 9 after this last post, two weeks ago now. It was definitely the right move, as both total AHI and centrals have dropped dramatically in the past week, most nights total is below 5 and one night less than 1(:-)). It's still not consistent, and I've had a couple of nights where it jumped to 9 or so, but the trend is still downward. So likely no need for an ASV.

But I'm still pretty sleepy, and I am wondering about RERAs, which were the most prevalent events during my in-lab sleep studies (which some people would call UARS), and which the Aircurve doesn't track. I still have what seems to me like a lot of flow limitations, though mostly they stay below .10, rarely above .20. But also, if I zero in on the clear airway apneas and look at the flow rate, it shows my breathing getting very ragged just before each CA -- yet without a flow limitation. This is from last night -- no OAs or hypopneas and not a lot of CAs, but rather a lot of (mostly small) flow limitations:
     



And this is a close-up showing the flow rate that happens before centrals- this is during a time when I know I was asleep:
   

If I am understanding  Barry Krakow's take accurately, I want to aim to even out that pattern. So I am wondering, should I maybe try tweaking the pressure support up a bit, to see if I can reduce the flow limitations more and even out my breathing (and hopefully not induce more centrals)? If I do that do I need to increase the IPAP max a bit -- I wouldn't think so, as it seems to be stopping the OAs just fine. Or just keep the settings where they are and give it more time?

I really appreciate all your help with this!
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#32
RE: new to bipap, lots of central apneas
Or, after reading other posts about inconsistent CAs, am I getting ahead of myself and need to give it more time?
   

I have a phone appointment with my doctor on Tuesday the 14th, how should I approach it?
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#33
RE: new to bipap, lots of central apneas
If they are emergent pressure induced CA, as a lot appear to be. They settle down over 12 weeks for most people. It would help if your turned off the pie chart. It will show the rest of the stats column. You may be able to go back to CPAP later.

I would email the charts, you want to talk about. So you both can refer to them. I think he will be very pleased with your results.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap from machine data, or software. Set the min pressure at 'med' median pressure or 90% OR 2cm below 95% pressure. max pressure at 20cm for now. Forum will help you fine tune settings
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