Apnaes: difference between Central / Obstructive ?

[Karlin]

I used a CPAP for years before I was diagnosed with central sleep apnea. Therapy worked for a while with a CPAP, then quit working and my AHI climbed. Then they gave me a bipap, and it was the same story -- it worked great for a couple of months and then the AHI climbed to 50/hour. That's when I had a new sleep study and they found CSA. After that I got an ASV. So far (6 months) it has been great with an AHI usually below 1.0. Why does CSA happen? It is associated with heart disease and drug abuse. Then there are the cases where it happens for no identifiable reason, which seems to be the case with me. I have a Resmed Aircurve 10 ASV, and recommend it highly.

[Sleeprider]

Hugosnel, I think your apnea problems, including the CA events arises from positional obstruction. There is a clear pattern of apnea to cluster in your charts with very erratic tidal volume and before concluding this is actually central apnea, you should try a soft cervical collar. If it is possible to zoom in on the flow rate during events, we may be able to make additional interpretation. I'll link to our wiki articles on positional apnea and soft cervical collar for consideration. What are your pressure settings including any pressure relief?
Positional apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
soft cervical collar http://www.apneaboard.com/wiki/index.php...cal_Collar

[Camera Obscura]

Thank you for all your contributions!
As I already said I have a APAP machine, not a CPAP, so I suspect, like an ASV, the pressure is raised as the need is higher.
Maybe drug use is influencing my CA's as I am still on a mild opiate after an operation on a finger.
That should be over as of now. Also, I will try to avoid positions that allow my head to touch my chest...
Time will tell.
My age is 68, I have overweight and high blood pressure.
The good resolutions of 2021 include more exercise and weight loss .. LOL

[Camera Obscura]

Hello,

I forgot to mention my pressure setting:
7-12, no soft-start.
I have suffered a moderate COVID in March 2020

I am including my sleeping test results in PDF!

[Sleeprider]

After looking at your results, I think you may soon be using ASV (adaptive servo ventilator). If you can get a Resmed Aircurve 10 ASV or CS Pacwave, that will resolve both obstructive and central. Your test results documents central apnea at 50% of obstructive apnea, but the hypopnea can easily be central, and there was a lot. It is fairly common for individuals with a central apnea component to have that become predominate after starting CPAP therapy. In your previously submitted chart, the lowest event rate was when pressure was at or near the minimum pressure setting. it might be useful to limit the range of pressure in your machine and see if that improves results.

[SarcasticDave94]

I'm seeing a very high amount of hypopnea at 297, high level of obstructive apnea at 107, and a high but not as high level of Centrals at 48. The CA in this test, which is just a one sleep session snapshot, are about half the amount of obstructives while the hypopneas were about 6 times more than CA. This does mean all 3 are an issue, but despite the presence of CA, it is the least of your concerns of these 3. This does not mean we ignore the CA, just that it's the least to concern yourself over. It does need factored in though, so we must be mindful to not induce higher Centrals by higher pressure swings than necessary to what we must use to combat the obstructive and hypopnea.

Note that the hypopnea may be either obstructive or central, these tests typically do not determine what type of hypopnea event just a count. So these hypopnea can range anywhere from pure central to pure obstructive, or a mix of anywhere in between those 2 extremes.

An APAP is an auto ranging CPAP. It does not in itself have backup rate like an ASV for central combat duty. An ASV is an enhanced BPAP or 2 pressure which the APAP is not either of these. An ASV may be discussed if the APAP cannot treat properly, but my own experience tells me that APAP is better for Central combat than a BPAP without backup rate. That BPAP without backup will potentially drive up CA even more.

[Camera Obscura]

After looking at your results, I think you may soon be using ASV (adaptive servo ventilator).  If you can get a Resmed Aircurve 10 ASV or CS Pacwave, that will resolve both obstructive and central.  Your test results documents central apnea at 50% of obstructive apnea, but the hypopnea can easily be central, and there was a lot. It is fairly common for individuals with a central apnea component to have that become predominate after starting CPAP therapy.  In your previously submitted chart, the lowest event rate was when pressure was at or near the minimum pressure setting. it might be useful to limit the range of pressure in your machine and see if that improves results.

Thank you Sleeprider. My last count was 6/hour. I forgot to reinsert the Datacard last night but I was able to retrieve the count online. How many obstructive/central.. no idea. 
Hoping for a good night of data with the card inserted 
What pressure do you think I should use? I went up from 6>7 yesterday. Max is at 12.
Do you have any idea of what data I may be able to submit to OSCAR?
Are there many Loewenstein users in the forum?

[Camera Obscura]

Hello Dave. Thanx for your input!
I have changed my pillow for a more rigid one. maybe I can prevent positional CA's a bit. Tomorrow I hope to have complete output from the Loewenstein software, which should shed more light on the different forms of the apneas.
My machine is an APAP which I can set to CPAP. I have a vague idea of what an ASV is but you puzzle me with the BPAP (BI pressure?) and the backup funtion is not clear as of yet.
I am using 7-12 as pressure range, having an issue with my mask, but getting there bit by bit.

Last night was hopefull, see my response to Sleeprider!
Bye

[Sleeprider]

Just lower the maximum pressure to 8.0 and turn off any form of EPR or pressure relief. Let's see if things get better.

[Camera Obscura]

Changing the pillow was not a success. I woke up and changed back as I felt uncomfortable. This can be seen in my graph.
I have slept with pressure 7low 8 high, no EPR as suggested but max level appears to restricted IMHO. I consider 7-9 for this coming night... Not using EPR did not bother me at all. I also do not see the need of using soft-start.
The graphs are below, I took off the mask for some time during the night. I will be pleased to receive constructive comments!!!
I am aware of having some leaks. Is it an issue?