central apneas after treatment none before

[G. Szabo]

You might want to take it down, remove your personal details, and upload it again.

[quiescence at last]

Something is definitely happening to have the machine kick your pressure up. The posted chart from Aug 30 shows the pressure does not often drop below 10 before getting kicked back up, and most of the pressure hikes occur at pressures around 11.0 and I few even at 12.0.

If it were my chart I would trial a few nights at 11.0 minimum, and see if any OAs will occur. 14 maximum is still ok.

Can you provide a 12 minute close up snapshot of the time 21:35 to 21:47? Thanks.

Best of luck.

QAL

[jquintero]

I will adjust the settings as described. Please let me know if you see anything that can help. Although i get AHI 8s if my end of the night skyrockets so half of night nice at 3 then end of the night 20 so average. The reality is that the end of night is horrible.

[jquintero]

This is last night's results with all of the changes i have made. (Trigger set to very high, TI max was 2 now 3.5, PS .8 was 2) I still woke up 4 times, end of the nights AHI 12 always happens around 3am and this was a great night. usually, it is in the 20s end of the night.

I had the UPPP surgery that did improve obstructives as I previously had IPAP pressure of 5 and still had obstructives unlike now I think it can be 10 or even lower and i am still good.

Guessing obstructive, if any, are not there even if I lower the IPAP to 10 so I can then lower EPAP to 7. The lower the EPAP the better for my centrals? The small the PS the better too, correct?

[jquintero]

sorry i meant to type
had IPAP pressure of 15 not 5

[Grandpapa-G]

Your pressure changes are primarily driven by flow limits and changes in pressure are not effective in reducing CA's. You would be much better off using a fixed ipap and first manually varying pressure support to minimize flow limits (99.5% level below 0.10). Once an optimum pressure support and ipap range is determined you can adjust trigger and other settings. This will be a slow tedious process as you will have to make daily adjustments to the fixed ipap and pressure support to reduce the minimum possible flow limit (as measured by the 99.5% level).

[quiescence at last]

thanks for the close ups. when this starts out it looks like you were drifting in and out of sleep with some potential discomfort and may have been moving to reposition yourself, or at least holding your breath, but only momentary, then you sink into a fairly calm state with significantly lower depth of breath.

during this calm state I think we can see that there is flow resistance in both inhale and exhale. this resistance does not seem to phase you, or disturb the calm. I would guess you were in deep sleep, or possibly REM sleep.

anyway, hope the process goes well and you can get those CA to not happen so often.

QAL

[quiescence at last]

generally the higher the PS pressure support (or EPR setting for me) the greater the breathing will exhale more CO2 than your lungs are accustomed to and lungs will pass the word to hold off breathing (CA) while they regain the level of CO2 that makes gases exchange appropriately.

so CAs generally are reduced by reducing PS.

Most types of flow limitations are really helped by the extra PS. If flow restrictions are impacting the therapy too much, the PS or EPR is increased, allowing the pressure difference drive more flow.

So, you can see the dilema and the eventual balancing act.

QAL