3 Months Until Sleep Study

[Gideon]

I don't like an upward trend in any apnea either.
See how ragged your Flow Rate looks at the beginning of the night, then how it smoothes out. For you that signifies the difference between awake and asleep and we 'don't care' about the awake part. To smooth out the awake part would take opiates or something similar and I don't like that option as, among other things, it would tend to increase Centrals. You may want to try a "sleeping pill" to ease into sleep, ask your doc and be sure to look for the impact on your charts.

You do have a tendency to get some central apneas. This is due to flushing out enough CO2 to approach your apneic threshold.
If you want to try a change try this
Reduce your EPR from 3 to 2
BUT, look for an increase in obstructive events to go along with a possible decrease in Central Apneas. The correct setting is the setting that FEELS better to you. You cannot determine this by liking at your charts. Sometimes we have to accept a little higher AHI when it makes us more comfortable, it feels better.

[Hoagie73]

Thank you again Gideon!

I don't have a sleep doc. My at home sleep study showed a high RDI, but low AHI with no concerning oxygen desaturation. So I'm on my own. 

I'll drop EPR to 2 tonight. Just hoping I don't end up requiring an ASV.

[Gideon]

If the centrals persist we do have a trick up our sleeve.
Basically, we rig it so you rebreathe a little bit of your expired CO2.

http://www.apneaboard.com/wiki/index.php...ace_(EERS)

We will wait and see if you need it first.

[SarcasticDave94]

Sounds like you're in the teeter-totter stage. Obstructive stuff on one side vs centrals on the other. If you act on one side, the other will go up. Finding a balance that feels good is likely your best action. And ditto, EERS may be a plan B consideration if CA keep heading upward. It's up to you to decide when they are too much, as in when it steals feeling comfortable and rested.

[Hoagie73]

Thanks! I just read about EERS. This is very interesting.

Some nights I'll have no SWJ. But I can tell the nights that I'm going to have it. I feel shortness of breath an hour or so before I hit the sac. I've also noticed when I'm anxious I seem to get more centrals. That's a strange correlation if that are related.

Dave- How is it going with getting the new machine?

[SarcasticDave94]

Well, they suggested I try the AutoSet. Trainwreck with terrible fatigue, brain fog, headache after using. OSCAR reported AHI 21.x for 4.75 hours I used it. Most events CA at 19.1 of the 21 AHI. Already called the RT at Lincare and said it's not working out. Going to my primary care office Thursday for Apnea and a few other medical concerns.

[Hoagie73]

Well, they suggested I try the AutoSet. Trainwreck with terrible fatigue, brain fog, headache after using. OSCAR reported AHI 21.x for 4.75 hours I used it. Most events CA at 19.1 of the 21 AHI. Already called the RT at Lincare and said it's not working out. Going to my primary care office Thursday for Apnea and a few other medical concerns.

I'm sorry to hear this Dave. How did things go yesterday at the doctor's visit?

[Hoagie73]

Ok. I dropped EPR from 3 to 2 on Monday night. It went pretty well where my AHI dropped to 1.5, then .8, then .7. Woke up this morning with a 2.6. Looking at my charts it looks like the majority of me centrals come directly after some deep breathing. I am assuming this is due to a CO2 flush? Does it look like it could be something else. I have noticed a small increase in flow limits since dropping EPR. Should I try dropping further from 2 to 1? 

Thanks

[Geer1]

Both higher pressures and EPR can cause these centrals. A lot of your apnea/hypopnea reported appear to be incorrectly flagged or post arousal and not real per say. They are increasing your pressure though which isn't ideal. I would try fixed pressure, 9 cm with 2 EPR, as you drop EPR you can also drop min pressure (you were previously using 10 cm min with 3 EPR which is the same EPAP as 9 cm with 2 EPR for example).

[SarcasticDave94]

Are the events bothering you in any way? If so then continue to address it. But it appears they're small in event count, there will be a point where further changes will make things worse on the other end of your teeter-totter.

What I'm trying to say is edits to EPR may in fact reduce the CA a bit, but expect something on the Obstructive side to go up. Maybe flow limits, or Hypopnea, full Obstructive Apnea.

Bottom line it's your call to address or not. If you do address them, make sure your reason is because they're interfering with well rested state of sleep.