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How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
#1
How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
First off, I'm pretty certain I have UARS or possibly sleep apnea.  Long story short, I had a WatchPat study come back with AHI of 20 and RDI of 40.  2 PSG's however came back with AHI's of 1 and 4.8 and no RDI scores.  My research leads me to suspect that the WatchPat is more sensitive than the PSG's.

I've been trying to self treat with Bipap for the last few months.  I'd say there's been a noticeable improvement in how I feel however I'm still having some pretty bad days where I'm still exhausted and completely unmotivated despite a full 8 to 9 hours of sleep.  Also experiencing pretty bad bloating in the morning which is super fun...

7 EPAP, 11 IPAP PS 4.0-4.0 seems to help the most with fatigue however it leads to a lot of central apneas in the 3 to 4 per hour range.  However, there still seems to be a lot of flow limitations (images attached).

Different pressures like Min EPAP 9.0 Max IPAP 14.0 PS 1.0-5.0 reduce centrals to under 1 per hour but I'm finding the fatigue comes back.  Flow limitations are still there as well.

Any advice on reducing flow limitations and centrals?

Also, in the second image attached there are wavy flows in between inspiration and expiration.  I'm wondering if that's indicative of something because I see it a lot in my flow rates.


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#2
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
With Central Apnea and flow limits on opposing ends of the Apnea teeter-totter, you will need to find a balance between these. What I'm meaning is that to reduce centrals on one side of the teeter-totter, you will push up the Obstructive side. And of course vice versa.

Try lowering PS to 3 and see if the CA begin to drop. But do expect Obstructive based events to increase. Also turn off flex.

You can post redacted versions of these sleep studies if you have them. Did any site high levels of CA, or did they show any CA at all?

Update your left panel user info on machine so it's clear what your using.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
A balancing act is sort of what I suspected.  Thank you for clarifying though and I will turn off Flex.

I've attached my WatchPat study.  I also only have the report from the first PSG which I'll include in the next post.  No reports of CAs although the WatchPat I used can't tell if they're CAs or obstructive.  However, the PSG would have undoubtedly picked up CAs.  I'm certain the CAs I'm experiencing are treatment induced.

I updated the left panel with my machine info.


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#4
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
Here's the PSG.  I don't have insomnia BTW.  Just couldn't fall asleep in the lab with all the wires.  Normally I'm out in 5 mins.

You'll also notice they don't score RERA's or RDI. They also wouldn't give me their scoring criteria.


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#5
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
OK thanks, it's what we both probably expected. CA weren't on this, but likely weren't set up to detect. By this I mean no effort belt on the chest.

Do try to minimize the CA while keeping Obstructive events in check. How long have you had this PAP therapy? Most treatment emergent Centrals will begin reducing by 3 months.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
I'm right around the 3 month mark now.
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#7
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
OK got it. Anything special about where you live? High elevation over 6k can make you more susceptible to Centrals.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
Nope. Right around sea level.
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#9
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
What do your Flow Limits look like.  Maybe it's just a ResMed proprietary calculation based on wave shape changes & a few other mysterious things.  My flow limitation, loss of the peak seems to be more variable than yours.  I'm getting a BiPAP but the prescription is fixed 16/11.  He said my pressures with CPAP were so consistent that he didn't think I needed the Auto feature.  What do folks think about the Auto feature & again asking for general advice?  Good answers so far
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#10
RE: How to Fix Flow Limitations and Treatment Induced Centrals with BiPap
My personal take is an auto machine or Auto setup can be more comfortable as it doesn't always have to supply x pressure to treat you. If an auto range is in place, the machine can dial it back when not required to have higher pressure. I see a comfort increase for that reason.

Reason 2, an auto machine can become static AKA single pressure if needed by editing the settings, but static machines can't become Auto. This also can mean static BPAP where it just has exhale and inhale pressures. There's Auto BPAP that can have a range from lower to higher and the machine detects what's needed. Again I'd say an auto should increase comfort and flexibility of therapy for most.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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