[Diagnosis] My first report here

[Frankiboy]

Thank you for your reply.
Central apnea has already been diagnosed in the lab and I am not taking any medication, fortunately.
I am thinking of lowering the minimum pressure by 1 to 10 to keep a little more CO2 in the body and eliminate the CA, which can be seen in the small sleep on 11.4 Is this a good plan?

[Expat31]

Hi again,

It is true that flushing out CO2 can encourage central events. But if my memory is correct, this flushing action is encouraged when there is a big swing in pressure, i.e. the gap between max and min is pretty wide, and this steep gradient creaes almost a "wind" effect clearing out the CO2, which is not what you want.

I think lowering the min CO2 would create such a steep gradient with the max pressure, and achieve the opposite effect that you want. 

I would say you need to do the opposite, reduce the gap, either by  increasing the minimum, or reducing the maximum.

Hope that makes some sense..

[Expat31]

I forgot to add that increasing EPR, whilst helping to reduce flow limitations, has the downside of increasing centrals!

It's a balancing act, you win, you lose.. It's trial and error over a period of time. You will know over time what is best for you.

In your last graph, you had a total 3mins 17secs of apneas events, the breakdown made up of 3 hypopneas, 5 obstructives and 6 centrals. We know in  hypopnea time, total just 30 secs, but you may like to see the total times for centrals and obstructives, to see which is the most important that needs attention. The events tab used to show this detail before the last Oscar update, but has disappeared, now you need to look at a 3 minute zoom of each event.

It is still early days, and by daily examination of your graphs, and the result of how you feel, will guide you.
I forgot to add that an individual's personal build characteristics (ex. BMI, body mass index) can for some people have an impact. 

Only a medical professional can advise on this.

[Expat31]

Sorry, I was wrong about event timings, it is still available in the events tab, (see insert) and when you hover over the events graph with the mouse.

This helps you identify the areas that could be causing you sleep discomfort. The ones in the example are no are not really significant, as not too long, and I don't have many.


In the beginning before I got my setting just right, I had tons of these.

[Frankiboy]

I am 58 years old, 178 cm tall and have a BMI of 27.5 with 87 KG, so a bit too much KG, but I feel very well.

The events are not long but they may wake me up and I assume it is better to avoid OA as the waking should be worse but I am not sure as I don't know why I wake up and I just don't get around to noting the time, that would be a way to control it but I don't wake up enough to note it down.

I'll probably leave it all like this for a few nights and then get back to you.

Thanks to everyone so far.

[Expat31]

Yes that's a good plan. You really need more nights' Oscar data to examine. I think you have made a good start, and any changes that are made I think it is a good idea to enter in the notes tab what has been done and how you feel. These could be of interest to review at a later stage.

If you wake up, you could of course pause the machine by pressing the top button briefly, and restart a few minutes after. You will then see the time when you awoke, and perhaps get a clue from the graphs why. Maybe once doing this just to see, but may not be right for you if you cannot get to sleep at all after, only you will know. Just an idea to consider.

Maybe do a test with a higher minimum pressure, reducing the gap with the maximum may help.

All this trial and error takes time.

[Frankiboy]

Unfortunately, it's getting worse and I'm waking up more often.
           

[Expat31]

The only potential setting change I can see at the moment is to seriously increase minimum pressure to say 12 or 13 cms to see if this will improve most of the hyponeas and obstructive apneas remaining.

The centrals seem still to be pretty stubborn. Sometimes the machine can interpret these events incorrectly, and may not be actually central apneas.

Let's see first what a higher minimum pressure does.

Looking elsewhere concerning the arousals, what about caffeine intake - just a thought.

I guess your sleep hygiene is pretty good, at least to have normal sleep times. Make sure you don't eat substantial evening meals before bedtime.

Consider general wellbeing,  stress, lack of exercise and anything else you can think of.

Some say that melatonin can help, I had initially some success to get over a bad patch at the beginning.

Let's see how it goes with the increased minimum.

[gainerfull]

You haven't changed anything based upon our advice so far so I'm resistant to offering any additional advice. However, lowering your pressure is unlikely to help you considering you're already using too low of a pressure plus EPR 3. You may benefit from a constant pressure.

[Frankiboy]

Yes, I have changed it. Epr is now 3.
I'm here to learn and find the right setting and take your advice, but I've come a long way from my titration with 7 and EPR 1, and nothing has really improved since then, so I wanted to sleep with the settings for a few days in the hope that I'll get used to them.
But that doesn't seem to be working and I will now really increase and thank you. Sorry, I really didn't want you to think I didn't respect your knowledge.