[CPAP] Trying to identify whether these are real central apneas

[dogfish1977]

Hello - I've been lurking around here on and off during my treatment over the past year and almost 6 months. The CPAP, Resmed Autoset 10 set to min 7, max 20 and the pressure relief to 3. The CPAP really helped after my sleep study (in which I slept for maybe 2 hours) showed an AHI of above 50. I had no idea I might have had sleep apnea. I am 42, 6ft and a little over 200 pounds (up from about 185 a couple years earlier).

Anyway, my AHI has been pretty consistently on average below 5, and I have been getting by, but feel anything but great.

I visited my sleep doc in September and because my AHI average was under 5, I was sent on my way as "good".

My sleep apnea was identified because I grind my teeth and my dentist noticed it. They recommended an oral appliance to bring my jaw forward, but i knew I wouldn't be able to tolerate anything like that. I've since also seen an orthodontist who has recommended braces to open my mouth up a little, and apparently it will help with my gag reflex, although they admit more is going on.

Just last Friday I saw an ENT who put a very expensive camera up my nose and identified I have a pretty tight airway all the way and there are several causes (deviated septum, huge tongue, and my bottom jaw is too far back).

I sleep on my side, use a nasal mask (Eson 2). I got to be at almost the exact same time every night, wake up almost exactly the same time each morning.

I've come to understand that my problems are likely caused by a number of issues, but I am trying to work out whether central apneas are real or not, and can't seem to find a doctor that will help. I do have an at-home sleep test being scheduled soon, and hope that provides some extra info.

Based on this forum, I have dropped my pressure relief back to 1 (and that seems to have helped), and I have tried a soft cervical collar for about a week, and it didn't seem to make any different. The images I have attached are from where my pressure relief was at 3. I haven't seen anything this clear or obvious since changing it to 1. My CA's have dropped to between 6 and 14 a night recently, and they got up to 40 one night prior.

The pictures show some centrals in increasing detail. These happened in a cluster and I'm not sure what I was up to at the time, but these do seem to occur at around this time of the morning.  Hoping someone might have some insights.

   

   

   

   

   

[dogfish1977]

This is a different day.

   

[Sleeprider]

Dogfish, it would be a huge help to us if you will follow the tutorial on how to organize your OSCAR chart in my signature links. We want to minimize the monthly calendar, and show the Events, Flow Rate, Pressure, Flow Limits and Leaks. That will show us exactly what is happenng with your settings, and much more valuable information than the Events summary can.

Based on what I'm seeing here, all your doctors are deep into boat payments or college tuition for their kids because you don't have much obstructive stuff happening, and that is what they are selling. We can help you to reduce or eliminate the CA events, but let's start with some charts that tell us what we need to know.

[dogfish1977]

Ok - I think I have it. This is the chart from last night.

   

[dogfish1977]

Based on what I'm seeing here, all your doctors are deep into boat payments or college tuition for their kids because you don't have much obstructive stuff happening, and that is what they are selling.  We can help you to reduce or eliminate the CA events, but let's start with some charts that tell us what we need to know.

Unfortunately I'm still feeling really tired most days and seem to be still grinding my teeth a lot, they are quite sensitive. I'm really trying to work out what the issue is seeing my OA's seem to be all good.

[Sleeprider]

Much better, and if you can add just a bit more room to the left column information, we will see all the information and settings. As you said, AHI is well under 5 and at 7.0 to 20.0 with EPR 2, the events are mostly just a few hypopnea, and centrals. The hypopnea appear to coincide with increases in flow limitation, suggesting obstruction, but overall, flow limitation is not that bad. This result from 11/16 looks pretty good compared to 11/6, 11/7, etc.

I'd like to move the minimum pressure to 8.0 and keep EPR at 2. This may drop back flow limits and hypopnea on the obstructive side. I'd like to get EPR up to 3 to address the flow lmitation and if it results in a significant increase in CA, we can reduce EPR or consider adding a little bit of enhanced expiratory rebreathing space (EERS) to increase the CO2 loss from ventilation. We can address both obstruction and treatment emergent CA, but I think we will start with the 1-cm increase in minimum pressure. A couple wikis to read are:
EERS: http://www.apneaboard.com/wiki/index.php...ace_(EERS)
and Treatment Emergent CA http://www.apneaboard.com/wiki/index.php...tral_Apnea

[dogfish1977]

The EERS looks really interesting and seems to correlate with other things I am reading on the board, so you may be onto something there. I had been messing with different settings quite a bit.

Here are where I had the pressure at 7.6 and one with the pressure relief at 1, one with it at 3. I also have some data at 8.4 with the pressure relief at 3 as well.

   

   

[dogfish1977]

One other thing to note is that I think I managed to get my hands on an Resmed 10 ASV machine. Would I still need the EERS with the ASV machine or would that take care of the centrals?

[Sleeprider]

I'm pretty sure you would find the ASV to be overkill, but you won't have centrals with it.

[SarcasticDave94]

If you have an ASV like the one I've got, it will beat your CA into submission without EERS. As Sleeprider just said, it's probably overkill for you.