[Treatment] New User Seeks Guidance

[Sleeper396]

Got it, thanks.

[SarcasticDave94]

For me, yes it's likely at some point your CA will counteract the therapy success and feeling well rested won't be as good as it could. And unfortunately not by a little bit, but it'll be fairly noticable. Of course, you'll not know how much better the ASV will be until you get it.

Just note your up and down CA will drain away the success otherwise gained. You have to decide what threshold you must cross before throwing in the AutoSet towel. Then once started, you'll need to be a strong and relentless fighter. And that's even with a strong stack of ASV necessity evidence.

[Sleeper396]

I will now be very aware of this, and do whatever is right to be successful at optimizing my therapy.  Thanks for the heads-up, Dave.

[Sleeper396]

As I fight this battle with Centrals, should I maintain the same pressures now 8-15, or should I experiment? I also have EPR off.  Do you agree with that?

[SarcasticDave94]

I'd keep it as is for now. You've gotten the AutoSet about as good as it'll get. Don't change it unless you must. Now it's about maintaining comfort and therapy effectiveness. If it starts going bad we can see what there is to change.

Maintain notes on how well you feel despite numbers. You may use numbers to measure aspects of therapy and well or not well rested status. But don't fall for the trap that if numbers are good your therapy is as well. There's a correlation between these, but also a distinct separation. Example when you have "x" AHI you'll have a good day prior to the well rested status that previous night. But you'll note that if AHI or some other aspects go higher than "y" you'll expect less good, more tired or something.

Those x and y are things you personally define. We know that medicals state AHI below 5 is the goal, but you react different than others, so you define well rested or not for yourself.

[Sleeper396]

Again, thanks so much for your input. It is great to have your perspective.

[Gideon]

Your comfort is very important. On any change you make determine, which is better, the initial settings or the new ones.

That said, try EPR=1 fulltime. I don't know if this will be better for you or not. Centrals may increase but flow Limits and hypopnoea should go down but your comfort is what matters the most.

If you are comfortable with your centrals you may not need an ASV. But that is yet to be determined. No matter what keep an eye on your centrals and they will be inconsistent

[Sleeper396]

Thanks for that, Gideon; and for your work on Oscar. Great stuff!

[Sleeper396]

See below post.

[Sleeper396]

Good morning.  As a follow-up to my previous posts and your insightful ideas, I am just trying to level-set by attaching last night's Oscar report, which is representative of what I am seeing nightly. AHI is coming down; I am feeling better, except for nighttime sleepiness while watching TV (resulting in a nightly crash).  My nocturia condition, which was severe, has improved dramatically (bathroom trips cut in half).  I believe that the pressures are working to manage my other apnea events, resulting in Centrals remaining -- just as you have suggested would happen.  

So, I am just checking with the pros for your preliminary read on the attached typical Oscar report, and your continued recommendation that I should keep doing what I am doing (including pressures).  I will keep the sleep journal, track all the data, and determine if my centrals are sabotaging my therapy. If things continue this way, in perhaps 30 days, I will prepare my case and confront my doctor in an effort to obtain an ASV.   

BTW, what am I doing wrong in sizing my Oscar report screen shot. It is much too large in screen shots, for you to see. I did another type of screen grab, but it is not right.

Thanks again in advance for your input.