bonjour

I'll point out that while it is not uncommon, most Apnea patients do not have a problem with Centrals, Sierra is one of those uncommon patients. I recently had Centrals to a level of .14 AHI. I ignored it. That will in no way influence me in my settings. When reviewing others data I always observe the Centrals, and address them when they need to be addressed. I look to see how they respond to pressure and pressure variance. The settings I suggest tend to probe to see how your body reacts and ultimately look for the settings that minimizes your apnea and provides you good comfort.

IMHO your at altitude chart shows the need for an ASV. That is to titrate out the Obstructive Apnea to a level of less than 5 AHI (you have) and demonstrate a remaining Central index of greater than 5 AHI ( yours is 15 ).

Your 500 ft numbers do not meet these same criteria, though they too would benefit from an ASV though you would definately have far fewer "triggered" breaths at lower altitudes. In the past I have recommended that a user maintain 2 sets of settings, one for altitude, and one for not.

I do see an ASV in your future, unfortunately, it takes the medical community some time to reach this same conclusion.

Obbyone, 20/14 w backup at 8 is the only successful trial that you had. NOTHING else was trialed with a backup.
The machine you are on is a fixed pressure bilevel machine with a backup rate. This means that your pressures MUST be set (high enough) ALL the time to manage the worst of the Obstructive events. Now that the Obstructive is managed, you have to manage the centrals. This occurs by setting a timed breath at 8 seconds. This is why your PS is set at 6, which for this purpose I believe is low.

An Auto machine would only go high when it needs to, which means that your Median pressure should be lower with an auto machine which should help mediate your aerophagia.
The approach with an ASV is an algorithmic one, to automatically and quickly provide pressure increases to manage obstructive events and when, and only when, you need it to provide a boost in Pressure Support to assist your breaths that are missing because of central events.

If I had been working with you thru the process I would have been talking about an ASV machine for you.

To step backward and reduce pressure to help relieve your Aerophagia I would do it 1 cmw at a time starting with 19/13 and observe for a couple of days before making another change, looking to see what happens to both your Obstructive and central elements.

Of concern in your sleep studies are your desats. Medicare says 8 minutes at or below 88% SPO2 is justification for oxygen supplementation. You have DeSats for most of the settings but we are not looking at whole report which should show the duration of the DeSats which would indicate how serious they really are. You should consider getting a recording pulse oximeter that is compatible with SleepyHead and see what it shows over night.

Also I would complain to your doctor frequently (squeaky wheel) about your Aerophagia. The purpose to show that you are not satisfied with your treatment because of the pain from your Aerophagia. The end goal to get an ASV which should run at mostly lower pressures and thus help your Aerophagia.

IMHO when you have some time set it up as close as you can to your current machine. Why? A backup. What are you going to use if your current machine dies tomorrow night?

Did you have any mention of Central/Mixed/Clear/Complex/Emergent apnea anywhere in your diagnostic study? If not your Central Apnea will likely clear in 2-3 months. It doesn't always, just ask Sierra.

These results are essentially the same as before, Centrals are marginally better, but not significantly so. You are missing 2 significant charts that showed a significant amount of activity last time. Flow Limit and Snore.

Your numbers are good, and with the Centrals warrant watching at the very least. With your numbers and seeing no significant changes in your therapy, I do like to base advice on the elimination of symptoms, your comfort, and how do you feel? I will not suggest changes that would impact your flow limits and/or snores without seeing the impact on those charts from the changes that you made.

If it's called SleepyHead it is exactly the same software

Sierra, I would appreciate it if you would use the Apnea Board link for SleepyHead, [https://www.apneaboard.com/sleepyhead/] I have good reasons but I'd rather not sling mud in public. Email me at fred@beerdujour.com and I'll fill you in privately.

Welcome,

I on the other hand like to use EPR full time especially when I see the flow limits on your flow limit chart. I do not believe that it pushes your Inspiration pressure higher. BUT, as Sierra pointed out you have a fair amount of central apnea/clear airway events, not enough to worry about but enough to avoid.

EPR can treat hypopneas and flow limits which is a good thing but the pressure variation between inhale and exhale can, and frequently does, contribute to Central Apneas. My recommendation would be to reduce EPR to 1 and full time and observe and if the central apneas persist I would turn EPR Off to avoid the Central Apnea. And if that doesn't work to lower your max pressure for 2 reasons, reduce the variation which is known to bring out centrals and higher pressures are known to do the same thing.

It is not uncommon to have to go to a narrow band of pressure or a fixed pressure to find the right balance between avoiding the central apnea and treating your obstructive apnea.

Note: It is possible to lower the IPAP pressure by increasing the EPR and better managing the flow limitations which do trigger pressure raises. The only way to know for sure in your case would be to try it.

Fred

When Taping your lips you should always test to make sure you can easily and quickly remove the tape. Your jaw is opened and closed by some of the strongest muscles in the body, simply because you are constantly exercising it eating and talking. If you want to open your jaw it will open, that is unless you have it wired shut.

Yes I do. MW has thought on several occasions that individuals that were trying to help him were actually trying to take SleepyHead away from him. (Not true). As a result he chose to shut down SleepyHead. After, and only after, he shutdown SleepyHead a group of developers decided that the Apnea Community needed software to support new machines and to fix the issues that are within SleepyHead (What we were trying to do for SleepyHead) and so we created OSCAR which should be released soon.