First night very high numbers

[Sleeprider]

I completely agree with Rich, and this was my original recommendation as well...not the minimum pressure, but the single CPAP pressure. This is characteristic of central apnea, and is what Richb went through when he arrived here. Notice he uses an ASV machine? I think you will too. It took Rich over a year to get approved an to satisfy all the testing to accomplish what he did. That said, we have had pretty good success in getting members with central and complex apnea into reasonable efficacy by limiting pressure and pressure fluctuations.

This is important, we are not talking about auto CPAP mode. We want to see CPAP mode with a fixed single pressure and no flex.

[fihappy]

Thank you for posting the clips.  Your graphs are showing the rising and falling patterns typical of Central Apnea even during periods that are not scored.  I would try the 6.5 with no flex.  The idea is to eliminate the pressure differential from inhale to exhale.  Your machine can just about eliminate Obstructive events but can cause Central events due to the washing out of normal blood CO2 levels.  This dual type of Apnea is often referred to as Mixed Apnea.  The first goal is to work with the settings to try and eliminate the Central events with lower fixed pressures while still keeping the Obstructive events at bay.  6.5 is a low pressure but is considered in the therapeutic range for Obstructive Apnea. Try tweeking your present machine before looking at other options.  

Rich

Good info Rich. Will give it a shot. To set a "fixed" pressure do I have to change the cpap mode from auto to cpap, or just change the min/max?

[Sleeprider]

You can achieve the same thing in Auto mode setting min and max to equal pressure. The advantage is that you retain data recording for flow limitation which will be disabled in CPAP mode.

[fihappy]

I completely agree with Rich, and this was my original recommendation as well...not the minimum pressure, but the single CPAP pressure.  This is characteristic of central apnea, and is what Richb went through when he arrived here.  Notice he uses an ASV machine?  I think you will too.  It took Rich over a year to get approved an to satisfy all the testing to accomplish what he did.   That said, we have had pretty good success in getting members with central and complex apnea into reasonable efficacy by limiting pressure and pressure fluctuations.  

This is important, we are not talking about auto CPAP mode.  We want to see CPAP mode with a fixed single pressure and no flex.

Last night I changed the settings to:
min 6 
max 6
Flex: OFF

Below is my results from sleepyhead. 
*Notes to consider in the data.
* I initially tried 6.5 when i went to bed but had a hard time breathing out and changed it shortly after to 6.
* I laid in bed for at least an hour awake after starting the machine and probably did not start falling asleep until around 3:15a-3:30a
* Sometime around 8:30am I woke up, turned off the machine and looked at the AHI to see it at 15. At that time I turned FLEX back ON and pressure to 6.5/6.5 and laid there for a few minutes but couldn't go back to sleep and turned the machine off.

My results confuse me, especially given how different they are from the previous day. Previous day showed the CA events high, now today its the OA events. I think the flex has a large effect on me ON/OFF.








Some clips

[richb]

Well, you now have the Centrals under control but now the pressure is too low to control the OSA. You are most likely a candidate for an ASV machine that can provide enough pressure to eliminate the OSA and can provide pressure pulses to stimulate inspiration to overcome the Centrals that the OSA treatment produces. Higher pressures will also create mask issues that are a separate issue. SR suggested a new sleep study and a titration on a new machine . Looks like that new machine should be an ASV machine. You can still try increase your pressures by 1 cm H2O at a time to see if there is a sweet spot with an AHI under 5. If you can't find that sweet spot it is a very good indication that traditional CPAP/APAP will not work for you. Medicare and most insurance requires that you fail at traditional CPAP/APAP before you can get an ASV machine. Using an ASV machine during a PSG/titration will determine if you can actually use the ASV machine. Leak issues and comfort issues can be worked out later. So, try some higher settings with no or minimal pressure relief but be prepared to make an appointment to discuss Complex/Mixed Apnea along with a new PSG and titration.