[Treatment] Seeking treatment guidance

[Geer1]

Anything under 2 AHI is not a "bunch of centrals", you are probably on the right track that these are actually SWJ and you holding your breath etc while changing position.

It is easy to tell by looking at zoomed in views of just prior to/during the central. If there is an obvious arousal (spike and erratic flow rate) before the central then it isn't a real central. If you were breathing normally and there are a couple smaller breaths followed by no breath then that is a real central.

The sensation of lungs taking more air is what you want if your issue is in fact UARS. Might take some time to adapt to though.

[SarcasticDave94]

I'll vote negative on SWJ/Sleep Wake Junk. Reasoning: I'm seeing the events aren't at the "bookends", near the beginning or end of a session. And there's not enough condensed chaos. A scattered event or 3 isn't nearly chaos. 2 strikes IMO and SWJ is out.

[sidetwists]

Welcome!  You gave us a lot of information.  Let me explain a few things that might help.

First how the setting work -

Min pressure is the inhale pressure
EPR is exhale pressure relief - It is subtracted from the min pressure to get the exhale pressure
Max pressure is the highest the machine will go when it detects obstructions. (O, H, FL)

Types of Apnea
Central - can not be controlled with the machine you have - you need a much more expensive machine.  But you do not have that many centrals so that should not be a problem.

Obstructive Apnea is the largest apnea (see my signature for percentage of blockage) and they must last for at least 10 seconds to be recorded.

Hypopnea Apnea - Just like obstructive but less percentage of blockage and also must be 10 sec

Flow Limits - They are also obstructive but they are the smallest percent of blockage and are not timed.

We use EPR to help with Hypopnea and Flow Limits.

The problem you have is that the min is to low.  All pap machines have the lowest setting possible of 4cm.  And that setting is used for children - same machine is used.

Your settings are Min 4, Max 8 and EPR 3 -  EPR is doing nothing because the min you have set is as low as the machine can go.  So what we need to do is raise the min and keep the EPR at 3 to help with the H events and flow limits.  Flow limits are small but for most people they interfere with sleep by not allowing you to get into deep sleep and sometimes waking you up.  Also the machine reacts to the flow limits by raising the pressure (max) to stop them from becoming larger events (H and O).

So the EPR is important and I think it is a reason you are not sleeping well.

Try the following settings for tonight and post tomorrow.

Min 7
EPR 3
Max 10

I think you will breath easier and sleep better tonight.

Eureka! Came here for a different reason and just had a read - and now I know why my EPR seems to be so inefficient on my new AS10 machine! You learn something new every day, thanks staceyburke!

[Ratchick]

As Geer1 said, you would have to zoom in on each central (and thank goodness, that's definitely not a "bunch" you do NOT want to see my chart LOL). I imagine that before each one you will see some erratic flow, probably bigger than the regular "sleep" breaths, and then the apnea before going right back to regular breaths again (or more of the irregular stuff if you were still awake and holding your breath as you rolled over, for example). If that's the case, and it's only a few scattered over the night, then you can safely ignore them.

[dreamingofsleep]

Thanks everyone for all of the feedback.  It sounds like it's just going to take me a little bit of time to adapt to the increased pressure.  I'm up to a min of 6 and will work on raising it to 7 to take full advantage of the EPR of 3, plus reducing the ramp time.

Sorry that I characterized my centrals as a "bunch of centrals".  I know that compared to others, this is not that many.  Whether sleep wake junk or not it seems like the number I am getting is not something to worry about right now.

Regarding a soft collar, I know I am not seeing clusters of obstructive apneas, but I thought it could potentially also help with flow limits which if I understand correctly are just smaller obstructions.  I have definitely noticed that I tuck in my chin too so was thinking that a collar could be worth a try.  Has a collar helped anyone with flow limits?

Thanks!

[SarcasticDave94]

Call it a learning session. There's no problem to ask about this. Keep track of the events to note any trend. If any events increase, you can ask about it.

[Gideon]

Yes a collar has helped with flow limits, but they showed as large clusters on the flow limit chart. We don't see that very often at all.

A SCC cam minimize mouth leaks, many like it much better than a chin strap. I for one do not like to add equipment (SCC) when you already have an alien on your face.

[dreamingofsleep]

Thanks Gideon.  I'd rather not add equipment either.  Just trying to figure out anything that has a chance of helping.

I'll focus on gradually increasing my min pressure to take full advantage of the EPR 3.

[Ratchick]

I'd definitely try going for EPR and pressure first, before resorting to a collar - I DO prefer it to a chin strap for mouth leaks but I can understand why it shouldn't be a go-to option for everyone.

No worries about the "bunch of centrals" thing, just a gentle reminder really - it's understandable that when you see these things on your charts you want to get rid of them. Hopefully knowing that you can tell that they're a consequence of an arousal like repositioning rather than a cause of anything is a reassurance.

I think you're on the right track. If you haven't already, maybe try wearing the mask (with the air flowing) during the day, when you're awake - just when you're reading or watching TV or whatnot. Hopefully, that will help you feel more comfortable with the pressures.

[Geer1]

For the record I just wanted you to realize that some centrals being flagged is not uncommon and if your bad nights are only 1-2 AHI of centrals then that is nothing to worry about. If you had a real central apnea issue then you would be seeing nights of 5+ CAI.

As discussed your centrals likely aren't real and are probably more of an indicator of poor sleep and tossing and turning rather than an actual central apnea issue.

Almost everyone early on thinks even the odd apnea is bad but the reality is the odd apnea is normal especially with these machines that aren't capable of determining when an apnea is real or not.