I regress!

[Crimson Nape]

I too have had problems like you describe. I tend to look at the numbers as the gospel and forget that it's just a machine producing a number based off a narrow set of parameters. It can't account for human responses outside of breathing patterns. I've noticed that the nights that are hard for me to get to sleep produce a higher number of CA's at the beginning. They seem to diminish after I'm into the sleep mode. A look at your daily reports would give a better insight as to when your CA's occur. I would speculate, that while being stuffed up, you need to get as much oxygen as you can. Your breathing pattern would be more constant now as opposed having a normal airway. This would explain your AHI being lower and you still not feeling refreshed. You might try using your CPAP for an hour or so during the day while you're awake and not stuffed up and look at the data. I did and I was surprised how many CA's the machine thought I was having.

OK, I'll go back to my corner now. . .

[Terry]

First, you need to get the leaks fixed. I second nasal pillows and a chin strap. I think you'll be much happier. Every inch of sealing surface between you and the mask is another opportunity for a leak. Nasal pillows only need to seal the bottom of your nose, while a FFM needs to do your whole face.

That said, you have the wrong machine.

Your machine is not capable of fixing Central Apneas (CAs) and you seem to have a lot of them. You should probably talk to your doctor about changing your prescription to a machine that can actually fix them.

Just look at these stats since I posted "I regress!":

November 30
AHI: 6.59
CA: 28 events
OA: 9 events

December 1
AHI: 9.44
CA: 35 events
OA: 9 events

December 2
AHI: 8.23
CA: 28 events
OA: 2 events

December 3 - start of a cold/the flu
AHI: 1.91
CA: 9 events
OA: 2 events

December 4 - full-blown cold/flu
AHI: 2
CA: 9 events
OA: 0 events

Lamb

[Lambsydoats]

[quote='Terry' pid='94828' dateline='1419266293']That said, you have the wrong machine.

Your machine is not capable of fixing Central Apneas (CAs) and you seem to have a lot of them. You should probably talk to your doctor about changing your prescription to a machine that can actually fix them.
[quote='Lambsydoats' pid='92874' dateline='1417809142']

I haven't been on here in MUCH too long.

Terry, what do you mean my machine is not capable of fixing CAs? Why not? What machine would be capable?

My CAs are getting the best of me. My PA is (very reluctantly) going to "allow me" to try a lower pressure--from 9 to 8, but "if the numbers are horrible," we'll have to go back.

I don't get it. Disruption of sleep is disruption of sleep. I'm tired.

Are OAs worse for one's health than CAs?

Lamb

[me50]

it is my understanding that for central apnea or mixed apnea where Centrals are involved that it requires an ASV machine. the machine you have if your profile is what you are currently using is for OSA and does not treat central apnea I could be wrong but it would seem to me any kind of apnea is potentially dangerous because of the damage it can cause and other health issues that it can cause no matter what kind of apnea any of us have. an interruption in breathing no matter what the cause, can cause damage to our organs and other problems I am NOT a doctor and I could possibly be wrong but that's my undetstanding. what kind of doctor prescribed your machine for you? was it your primary care doctor or a sleep Dr or an ENT?

[quote='Terry' pid='94828' dateline='1419266293']That said, you have the wrong machine.

Your machine is not capable of fixing Central Apneas (CAs) and you seem to have a lot of them. You should probably talk to your doctor about changing your prescription to a machine that can actually fix them.
[quote='Lambsydoats' pid='92874' dateline='1417809142']

I haven't been on here in MUCH too long.

Terry, what do you mean my machine is not capable of fixing CAs? Why not? What machine would be capable?

My CAs are getting the best of me. My PA is (very reluctantly) going to "allow me" to try a lower pressure--from 9 to 8, but "if the numbers are horrible," we'll have to go back.

I don't get it. Disruption of sleep is disruption of sleep. I'm tired.

Are OAs worse for one's health than CAs?

Lamb

[me50]

it is my understanding that for central apnea or mixed apnea where Centrals are involved that it requires an ASV machine. the machine you have if your profile is what you are currently using is for OSA and does not treat central apnea I could be wrong but it would seem to me any kind of apnea is potentially dangerous because of the damage it can cause and other health issues that it can cause no matter what kind of apnea any of us have stopping breathing no matter what the causes can cause damage to our organs and other problems I am NOT a doctor and I could possibly be wrong but that's what I have learned or what I believe to be true according to what I have read what doctors have told me and what I have learned from educational websites. what kind of doctor describe your machine for you was it your primary care doctor or a sleep study Dr apartment near a doctor ENT?

[quote='Terry' pid='94828' dateline='1419266293']That said, you have the wrong machine.

Your machine is not capable of fixing Central Apneas (CAs) and you seem to have a lot of them. You should probably talk to your doctor about changing your prescription to a machine that can actually fix them.
[quote='Lambsydoats' pid='92874' dateline='1417809142']

I haven't been on here in MUCH too long.

Terry, what do you mean my machine is not capable of fixing CAs? Why not? What machine would be capable?

My CAs are getting the best of me. My PA is (very reluctantly) going to "allow me" to try a lower pressure--from 9 to 8, but "if the numbers are horrible," we'll have to go back.

I don't get it. Disruption of sleep is disruption of sleep. I'm tired.

Are OAs worse for one's health than CAs?

Lamb

[quiescence at last]

can you post a chart like this that shows your pressure and AHI lately?



from the old data, it does suggest lowering pressure some to combat the onset of centrals, but a graph will give us a better picture.

[Lambsydoats]

Hmmm. Every time I click on the down arrow to choose what graphs to display on the overview tab, SH crashes. I checked for updates; there are none.

Advice?

The last time OA was over 1.5 was on December 24, but that was a real anomaly. The time before that was December 15. The time before that was November 29.

CAs are rarely under 5.

I'll post graphs as soon as I can...with someone's help!

Lamb[/i]

[Lambsydoats]

So I should talk with my RT about maybe renting an AirCurve 10 ASV?

[vsheline]

Hmmm. Every time I click on the down arrow to choose what graphs to display on the overview tab, SH crashes. I checked for updates; there are none.

Advice?

The last time OA was over 1.5 was on December 24, but that was a real anomaly. The time before that was December 15. The time before that was November 29.

CAs are rarely under 5.

I'll post graphs as soon as I can...with someone's help!

Lamb

Hi Lamb,

ResMed A10 machines will need to use (either ResScan or) SleepyHead version 0.9.8-1-testing:

http://www.sleepfiles.com/SH/index.html?TestingVersions

USA Medicare and many private insurance companies will cover an ASV machine (which can treat both obstructive and central sleep apnea) if the CAI (Central Apnea Index, which is the average number per hour of Central Apneas while asleep) is at least 5 and makes up a majority of all apneas. I think this would apply in your case on most nights, according to what you have reported. However, some insurance companies require the CAI to be at least 10 or 15 before insurance would pay.

In any case you can ask your doctor to prescribe (and to gain preauthorization on your behalf for) an ASV titration.

If insurance preauthorizes the ASV titration and the ASV titration results show that the central apneas are being adequately prevented by the ASV therapy, I think an ASV machine would be covered.

ASV machines like the ResMed AirCurve 10 ASV or the Philips Respironics BiPAP autoSV Advanced automatically adjust the EPAP (exhale pressure) to reduce/avoid obstructive events, similar to how your present APAP machine adjusts its pressure to minimize obstructive events.

With your A10 AutoSet, when you neglect to make effort to breathe (when a central apnea is occurring) the machine does not react to the apnea, except after about 10 or 15 seconds it will let EPR end (if EPR is being used), which returns the pressure to the normal IPAP (inhale pressure). Eventually the central apnea will end (as soon as you again make effort to breathe). This is the same way your APAP machine responds to obstructive apnea, except that in the case of obstructive apneas the machine takes note of how long the obstructive apnea lasted and the machine will take this into account when deciding how much to raise the pressure after the apnea has ended, in order to help prevent a reoccurrence of the obstructive event.

An ASV machine, in contrast, would have noted within a few seconds that inhalation had failed to start and would have begun gently cycling back and forth between a higher IPAP (to cause your lungs to inhale) and a lower EPAP (allowing the air out of your lungs) in order to keep you adequately ventilated. As soon as you were making effort to breath on your own again, the machine would return to its normal EPAP and IPAP.

With an ASV machine, the difference between EPAP and IPAP is called "Pressure Support" and might normally be only around 2 cm H2O, but if we stop making any effort to breathe the ASV machine may raise Pressure Support up to 6 or 8 or 10 or higher, however high it needed to be raised in order to keep us adequately ventilated while we are making no effort to breathe.

Getting used to the ASV machine jumping in while we are still awake (when the machine attempts to end a nascent apnea which was, instead, merely a natural pause in our breathing) is one of the challenges we face when using an ASV machine, but I think we usually don't have any great difficulty learning to avoid this.

The other challenge we may face when using an ASV machine is the higher pressures needed to treat our central apneas do tend to increase the amount of air we swallow. If the amount of air swallowed becomes painful or excessive, we may need to limit how high the pressure is allowed to go, which may reduce the effectiveness of the ASV therapy. If the Max Pressure Support setting or the Max Pressure setting are set too low, perhaps the machine would only be able to change central apneas into central hypopneas, rather than completely treating/preventing the problem.

Take care,
--- Vaughn

[Lambsydoats]

Hi, Vaughn!

Thank you SO MUCH for taking the time to provide such a detailed and easy-to-understand explanation for me. This really helps.

One thing I don't understand is why my healthcare provider (the PA--I am not allowed to schedule an appointment with the MD) isn't as concerned about centrals as he is about obstructives. As you know if you've read many of my posts, I'm more concerned about the CAs, considering it's unknown what's causing them. Could be nothing, but unless someone helps figure that out, how will we know?

On Thursday, the medical assistant said the PA reluctantly agreed to lower the pressure to 8 (from 9) to see if it helps the CAs without wreaking havoc on the OAs.

I've been using SleepHead all along just fine, but I hadn't imported data in awhile, and now that I have, I can't get it to let me choose which graphs to display. What's up with that?

Again, THANK YOU for your kind assistance. 'Hope you're enjoying your weekend.

Lamb