Second opinion - Central Apneas ?

[restless51]

           
Just upgraded to an ASV machine and am trying to dial in the best settings ....

In the attached screenshots, I had a rough time around 3AM.  Before adjusting the pressures, I'd like a second opinion that the Apneas shown are indeed Central rather than Obstructive.  ... TIA

I seem to have difficulty falling asleep with a higher pressure support setting (e.g. > 8), as I usually have one or more Centrals in the wake->sleep transition, and the rapid pressure increase wakes me back up

Thanks !

[Gideon]

You are on a ResMed ASV in ASV mode, is there any reason you are not showing us Minute Vent, which is what your machine maintains? Or Tidal volume, it's full breath companion stat?

Go to view, reset graphics, advanced please.

FYI the UA and your hypopneas are a) showing the characteristics of obstructive events, not central.

[restless51]

           
To answer your (rhetorical ?) question ... only because I am sufficiently unschooled so as to not know what is useful/helpful ...

I have rearranged the graphics for the same night in the attachments.

Based on the periodic nature, declining ventilation, and Cheyne Stokes labeling of my previous CPAP, I was assuming that these were Central.  But if these are indeed obstructive, then I believe it would mean that I should raise EPAP and/or address a positional issue ... rather than trying to crank up the pressure support.

Thanks again !

[Gideon]

Sorry, I looked at what you asked me to look at and missed the obvious. That is a positional apnea, most likely you tucking your chin in toward your chest. If this is a one off, ignore it. The tell us the cluster of obstructive events.

If clusters like that are showing up on a regular basis first look at a pillow modification, think 1 vs 2 pillows, flatter or less firm to help keep your neck straight, if that doesn't work you may need a soft cervical collar, see the link in my signature for a description.

Because these events are hypopneas and assuming they are not clustered the correction would have been to increase the min PS to the default of 3, not increase EPAP.

[Sleeprider]

You will benefit from increasing PS min to 2 and may need PS max at 9 or 10 to maintain differential. Respiratory stats show inspiration time is longer than expiration time, which infers flow limitation at the current settings. A higher PS min will make breathing easier. I agree with Gideon on positional "chin-tucking" being the likely cause of the cluster of hypopnea. For ASV these are very low pressure settings. How did you arrive at them? Do you have additional issues like aerophagia that caused you to use these very low settings?

[restless51]

           
Sleeprider:
  - Thank you for the insight on Inspiration vs Expiration times as the key to identifying flow limitation ... and presumably thus differentiating between Obstruction and Central.
  - Before switching to ASV, my Airsense reported lots of CA (attached shots on CPAP, different night).  Since the new graphs looked somewhat similar to me (e.g. periodic), I had assumed (apparently erroneously) that the cluster was still Central.
  - As per my original post, thus far I have been unable to increase MaxPS to significantly higher numbers, as it repeatedly wakes me up as I am drifting off to sleep (i.e. I frequently experience Centrals in the wake to sleep transition and have not "acclimated" to the sudden pressure increase).
  - The two sleep titrations that I have had (CPAP only) recommended pressurses of 8, and then subsequently 5 ! ... so it is not clear that I need really high pressures.!  And I have experienced aerophagia with higher pressures, but may be able to increase somewhat.
  - I will certainly increase MinPS as recommended ... but it sounds like my biggest problem now is chin tucking ...
  - Any further insights/suggestions are certainly appreciated !

Thanks again !

[restless51]

           
Latest screenshots attached - seems like I'm moving in the wrong direction - and don't feel well rested in the morning.  These seem somewhat less "clustered".  Are these likely chin tuck, obstructive, or central ?  Are there pressure adjustments that I should make ?  Thanks again for the help - MUCH appreciated !

[Gideon]

Those are all obstructive, not central and look positional so yes a likely chin tuck.

In addition to resolving the positional, I would bump your min pressure up to 6 for now looking to slightly reduce the obstructive events.

[restless51]

Sorry ... just to be clear bump: EPAP or Min PS to 6 ???  Thanks again.

[Gideon]

Sorry EPAP