reducing centrals on Vauto

[Baushka]

Good morning. I am new to this forum and I have a question on how to reduce central apneas on a Vauto.

I was diagnosed with severe obstructive and central apnea in June 2021 – AHI 73.5. I started off with a CPAP machine in July but had a difficult time exhaling and gave up on it. I was then prescribed a bilevel machine which I received in mid February. I have been using it since then and have gotten my AHI down to an average of 6.3 most of which are registering as central events. I have been wearing a soft cervical collar for a few months and it has, for the most part, taken care of obstructive events.

Reading my Oscar data, I am not even sure if the central events are true centrals. From my very limited understanding many of them could likely be related to arousals or movements in my sleep. I have tried to self-titrate changing my EPAP/IPAP and pressure support, but I have gotten to a point where I don't know how to move forward.

My current settings are PS 2.0 over 6.0-12.0. The first two attachments my trigger setting was on medium. The last attachment my trigger setting was on high. The high setting seemed to help, but I only have one night of data.

The advice on this forum has been key in helping me reduce my apnea. A big thank you to everyone here.

[Gideon]

Welcome to the forum,
What is your trigger and cycle set to? I'm expecting Med.

If So Set Trigger to High. Then repost your results. You did that so try Very High.

[Baushka]

Thank you Gideon.

I posted data for two nights. One with the trigger on medium and one with the trigger on high. Cycle was set to medium on both nights. I will move the trigger to very high for tonight. I appreciate your help.

[Baushka]

I raised the trigger setting to very high last night. The number of flagged central events was lower so it seems to have helped. I will leave it on very high for a few nights to see if the lower numbers are a trend. Thank you for the advice.

Do you think my pressure settings are okay as they are?

[Crimson Nape]

Take a look at your Ti Max setting. You may wish to set it to 3.2 seconds or higher. Your 99.5%-tile is pushing near the limits of the default 2.8 second setting. Having this setting set for too short will cause you to experience a pressure drop before you have finished a really deep inhale. This is quite annoying and can cause a sleep disturbance.

[Baushka]

I had an oxygen saturation test done a few weeks ago. I spent 39 minutes below 88%. I read a post on another thread that said this might be a concern. I have not yet spoken to the doctor who ordered the test. I have an appointment in a couple of weeks. However, I did meet with a sleep specialist at a respiratory hospital about my apnea and she said not to worry about it. Should I listen to the sleep specialist and not worry about it? Or is it something I need to pursue?

I attached the summary of the test as well as the summary from my original sleep test. They were both done at home. The elevation at my house is 7000 feet. Sorry for the poor quality. I only have scans from the prescribing doctor and the office didn't do a great job with them.

[Gideon]

The O2 levels ARE of concern BUT the use of a CPAP (any variety) typically will correct this. I would suggest that you acquire a Pulse Oximeter that is compatible with OSCAR to Validate this. In otherwords you should watch your O2 Levels.

Also you have significant Central Apnea in your diagnostic study. Because of this I would push for the ASV Titration the Study suggested. I doubt that an APAP will significantly improve this. Also they reported a significant amount of CSR. This is often associated with significant heart issues, especially CHF. You need to talk to your doctor and your heart doctor about this.

[Baushka]

Thank you Crimson Nape. I really appreciate the help.

I will increase the Ti Max tonight. I have a feeling that you are correct and it might be causing sleep disturbances. It feels short at its current setting.

[Gideon]

Do you know what happened to your Central Apnea? Your OSCAR posts show it as insignificant. The above response was made without reviewing the rest of the thread.

[Baushka]

Good morning Gideon. My central events dropped 4 to 5 weeks after I started using the machine. The obstructive dropped first once I started wearing the cervical collar then a few weeks later the centrals slowly went down. During this period I was making small adjustments to the pressure. But to answer your question I don't know for sure what happened to the significant numbers of centrals in my sleep study. Maybe I got used to therapy? Maybe the pressure adjustments helped? Maybe wearing the cervical collar helped in some odd way? I just don't know. In the beginning I thought I would have to think about an ASV, but with the numbers as they are, and with the help you and Crimson are giving me I think I might be okay with my current unit.

I will get a pulse oximeter and monitor my O2 levels.

The pulmonologist who prescribed the sleep study never brought up the CSR. I will ask him about it and get a referral to a heart specialist.

Thanks again for the insights. I am very grateful.