michaelyu15 - Therapy Help

[Sleeprider]

Sleep onset centrals are pretty common. Even though most people will tell you not to use EPR with centrals, I have found it often helps because when you "forget to breathe" you often are just breathing too shallow. When the CPAP detects that shallow inspiration flow, it usually triggers the CPAP or IPAP pressure, and that is just enough of of nudge to cause a spontaneous breath. We use this more often with bilevel which has a trigger sensitivity setting so we can make that trigger point very low. EPR will calm those pressure spikes and might just get rid of the CA events.

[SarcasticDave94]

A few Central events were present, amounts to 1.61 AHI under the Central area. While they were a significant aspect of your sleep, it was still well below the treated AHI level of 5. These aren't in a large enough amount to edit pressure.

[michaelyu15]

Thank you! I guess I get confused because people suggest turning off EPR to reduce centrals but in this case, I should turn on EPR to reduce centrals? I also turned off ramp time. Would you suggest turning that back on as well?

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Should I turn on ramp time? currently I have no ramp so when the machine turns on, it is already blasting a pressure of 9cm. I do notice that it is harder to breathe early on in the night. By morning, I am breathing very easily with a pressure of 9

[SarcasticDave94]

If you can tolerate it, it may be better without ramp. Or a minimalist usage way is use Auto ramp at your starting pressure.

[Sleeprider]

Thank you! I guess I get confused because people suggest turning off EPR to reduce centrals but in this case, I should turn on EPR to reduce centrals?

It really depends on the cause of centrals. Turning off EPR is helpful when centrals are the result of "washout", a lowering of CO2 from improved ventilation.  Sleep onset centrals are often just a matter of lag in the neurological handoff between voluntary wake breathing and the autonomic sleep breathing, and EPR sometimes helps as it gives a bit of a push to weak respiratory effort.  Anyway, you'll find much of sleep apnea "science" is nothing more than trial and error, so asking you to try something is an experiment to see if it results in an improvement.  We observe the results and get feedback, then decide whether to keep or reject the change.

[michaelyu15]

Thank you SleepRider! I tried EPR at 3 for two nights and found an increase in CAs. Now just sticking with a pressure of 9-15, EPR 0 in hopes the sleep onset CAs lessen over time. I do end up waking up at night around 1-2hrs (just bc I am anxious about it now) to check and my AHI around that time is usually 5-8. By morning, AHI decreases down to 2-3.

[michaelyu15]

            Hello, wondering if someone can please evaluate the last couple days of OSCAR data. Been on APAP for about a month and 2 weeks. Was previously using 9-15 cm with no EPR. Lowered down to 5-15 cm with no EPR in hopes of getting rid of centrals. Now obstructive and centrals are on the rise. Even bumped up to 9-15cm last night. Any insight would be great!

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Sharing two more nights of data.

[michaelyu15]

No centrals reported in my sleep study but not sure what sure what I can do at this point. Been using ramp at 15 mins and usually a pressure range of 7-15. Any insight would be great!!

[Crimson Nape]

michaelyu15 - I noticed all your threads were dealing with your therapy. For this reason, I have merged them into one thread. This allows the reader to see your history and prevent cross posting. I have renamed the thread to, michaelyu15 - Therapy Help, to have a more inclusive title. Please use this thread for all posts regarding your therapy.

I will be sending you a PM confirming my actions as well.

- Red