Suddenly my Centrals got a lot more disruptive

[Sleeprider]

I continue to believe your CA events and all others are mainly obstructive and arise from extremely high flow limitation. While ASV can be used for this purpose, the Vatuo would likely resolve it through fixed pressure support. About the only thing that would be persuasive to me that ASV is the answer would be if a significant central and mixed apnea event rate was noted in your diagnostic test.

[tcinoz]

I continue to believe your CA events and all others are mainly obstructive and arise from extremely high flow limitation. While ASV can be used for this purpose, the Vatuo would likely resolve it through fixed pressure support.  About the only thing that would be persuasive to me that ASV is the answer would be if a significant central and mixed apnea event rate was noted in your diagnostic test.

So I had my CPAP review/titration test in a hospital last weekend. The result was an instruction to raise my fixed pressure to 13! I've tried going higher but have had to settle for 9.4 at the moment (about 2.0 higher than I had it before). Any higher and I'm unable to gulp down the air fast enough and I end up with a hurricane around my head.
Disappointingly, every chart since the higher setting has shown about double the number of AHI to what I was achieving last week with the lower setting.
I can see how the Vauto (or an ASV) might offer a better solution to dealing with the apnea, but I have noticed that many that have gone down that path end up having low O2 saturation figures, and some have to take O2 separately. I did notice that even with low AHI scores I was getting up with a certain amount of brain fog. Any comment on getting round that, Sleeprider?

[attachment=60691][attachment=60692]

[stevew168]

Your second screenshot resembles something approaching Cheyne-Stokes respiration, or at least periodic breathing. An ASV will likely be very helpful for this.

[tcinoz]

Your second screenshot resembles something approaching Cheyne-Stokes respiration, or at least periodic breathing. An ASV will likely be very helpful for this.

Thanks, yep, I've been thinking that too, ever since my first sleep study, but the clinic I go to has kept steering me away from that on the pretext that I don't have a medical condition that requires that level of intervention, and in any case the Airsense 11 is dealing successfully with most of the apneas. I'm still unsure and as I don't get any sort of refund I'm holding off buying a second machine unless I know it will improve my treatment. I have a post-titration debrief with my sleep doctor in a fortnight so will raise all this with her - again!

[SarcasticDave94]

Unless your Central events are predominant, the ASV will be a bad choice. The ResMed AirCurve 10 ASV doesn't have timing controls that you can select, whereas the VAuto has them. Manual timing is important here, as you can increase inhale sensing sensitivity trigger.

[Sleeprider]

You have been unable to raise your fixed pressure to 13, but I'd like to try something a bit different as an experiment. Let's change to Autoset mode, with minimum pressure 9.0, maximum pressure 13 and turn EPR on full-time at setting 3. This is either going to improve the centrals or make them worse, but we won't know unless you try. If you can't tolerate the auto pressure to 13, at least turn on EPR at 3 at your current pressure. I'm a lot more interested in your response to EPR than to pressure.

[tcinoz]

Unless your Central events are predominant, the ASV will be a bad choice. The ResMed AirCurve 10 ASV doesn't have timing controls that you can select, whereas the VAuto has them. Manual timing is important here, as you can increase inhale sensing sensitivity trigger.

Thank you - noted.

[tcinoz]

You have been unable to raise your fixed pressure to 13, but I'd like to try something a bit different as an experiment. Let's change to Autoset mode, with minimum pressure 9.0, maximum pressure 13 and turn EPR on full-time at setting 3.  This is either going to improve the centrals or make them worse, but we won't know unless you try.  If you can't tolerate the auto pressure to 13, at least turn on EPR at 3 at your current pressure. I'm a lot more interested in your response to EPR than to pressure.

OK, thanks - I've reset the machine as suggested, all ready for tonight. Will be interesting to see what happens.

Meanwhile last night's chart looks pretty encouraging, although there were some periods of high leakage which I suspect was due to my mouth coming open, which happened at least a couple of times that I was conscious of.

   

[Sleeprider]

Increase EPR to 3. It would be helpful to use Autoset mode at 9-11 pressure just to allow it to track obstruction, but as I said before, I'm more interested in seeing EPR 3.

[stevew168]

Based on the OSCAR printout, CAs are predominant over Obstructive Apneas. ASV has an adaptive backup rate which actually works better than one that has to be set manually.