90 day update

[JohnnyGobbs]

Just have some questions and observations. So my pressure started at 5-18 initially and I eventually narrowed it to 7-12 (it's never gone over 11) and 95% it's like 8.5-9. I have the machine on auto ramp (6) and soft response. I've tried all the epr settings to see if they would effect the ca's and found no correlation so stuck with epr 1 as I find it to be the most comfortable. 

Results...

I would say my average ahi is 3-3.5. My cai avg is 2.5-3.0. Hyponea index avg is 1. Obstructive index .5

I've been using a chinatrap and my leak rates are pretty good. I feel like I'm as dialed in as I can get with this machine.

Regarding the ca's, I have about 25-30 of them scattered throughout the night, half are prob sleep junk lastingly under 15 seconds but the other half will have some 18-25 second ones. The only time they go down to like 1 index is if I take a Xanax/ativan some time in the evening. That's it. That's the only time my ca index will be 1 and not 2.5 or 3. 

So my first question is I'm wondering if my ca's are just spontaneous arousals (I had a lot of these on my sleep study) that the xanax helps me sleep through. Is there anyway to tell by the flowrate graphs an arousal vs a central?

And also, if I am having 25-30 scattered but legit centrals throughout the night. Should that be treated? (I know it doesn't meet the 5 threshold but just wondering).

I have my required doctor compliance check up tomorrow so I'm curious about the centrals/arousals and what to talk about. I don't think I can dial in my machine anymore though. I think the settings are perfect.

Thx.

[Melman]

I recommend you download SleepyHead software from here: https://OSCAR Official Download Page ----> CLICK HERE ./ and post some of your data in the forum. The links below tell how to organize and post your data. There are experts here who can analyze the data and help you better undersyand your CA events.

[JohnnyGobbs]

ĒHey Melman,

I've been using and analyzing sleepyhead since week 1 and have posted graphs in other threads. I've figured out most of the software and graphs except for some of the intricate flowrate stuff. I know that the machines can't truly detect a central but I was wondering if examining the flowrate could help determine an arousal vs central.

[Mosquitobait]

I would certainly bring in several days of Sleepyhead charts that show the Centrals as a concern. I only get 2-3 a night and that is on a BAD night, so 25-30 seems like a lot to me.

[Sleeprider]

One clue on CA vs OA is the flow around the event. When breathing ends on an inhale, it is almost always a SWJ change in position or CA. Most CA events terminate with normal breathing restarting, not a strong recovery breath(s). Events beginning in a flow limitation (down-sloped peak inspiration) and especially when followed by recovery breathing are clearly OA. It's not possible to accurately know what a CPAP flagged event 'really' is, but you can second-guess them pretty well.

[Marillion]

When you removed your EPR entirely (I assume you've already tried that) did you leave it off for a week to see if made any difference? It took a couple of days but for me removing EPR entirely quite reduced my CA events. If you haven't left it off for an extended period of time I would try that. Especially now that you are more used to the treatment. You may end up being pleasantly surprised. Or not. Either way, worth a try.

[JohnnyGobbs]

When you removed your EPR entirely (I assume you've already tried that) did you leave it off for a week to see if made any difference?  It took a couple of days but for me removing EPR entirely quite reduced my CA events.  If you haven't left it off for an extended period of time I would try that.  Especially now that you are more used to the treatment.  You may end up being pleasantly surprised.  Or not.  Either way, worth a try.

Yea the epr makes no difference for me (had it turned off for a month then went back to epr 1). I saw my doctor and he said basically he wouldn't worry about the 20 or so scattered centrals a night as there's so many variables etc and my ahi on avg is like 3 so there is nothing really to treat. The only thing is if I take a Benzodiazepine in the evening, then that really lowers the centrals noticeably, be it by affecting my sleep architecture or preventing arousals that accidentally get scored as centrals, I'm not sure exactly how it does it. 

Here's a graph of a typical night for me though: http://imgur.com/hnxkd7t

I may post some flow rate charts for you guys to check out.

[Crimson Nape]

JohnnyGobbs,
Out of curiosity, what sre the average CA duration times?

[quiescence at last]

the wiggle wobbles in your pressure chart are places where the machine senses pre-cursors of obstructive apnea, like flow limitations. I know this was at the beginning of the month, but if this were MY chart today I would ditch the ramp (or start at 7) and set my minimum at 8 (even if adding back EPR=1). This follows the basic rule of having your min at the higher of (1) median pressure compared to (2) 95% pressure minus 2 cm. [7.78 vs. 7.58]= 8

all in all, though, it is nice to be under AHI of 1.0 (pressure correctable apnea).

nice job and charts all around.

QAL

[ajack]

you have a longer inspiration and a shorter expiration than normal I:E ratio. I would only be guessing to give any reason or appropriate action. I would bring it to the attention of your doctor. 
If it was my chart, I'd try to lift minimum pressure to get the air in quicker. less of an auto and more of a fixed cpap type thing. I'd also increase the EPR if it does not increase centrals too much.