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[Diagnosis] Central Apnea associated with mask leakage?
#1
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Central Apnea associated with mask leakage?
This is my first post here, although I've been using a CPAP device for 6 years.  I'm glad to have discovered you.  I have a question about CA events.

My CPAP therapy seems to work well on giving me more restful sleep.  I do wonder, however, about the CA events that it detects.  As you can see from the attached OSCAR chart, it appears that I am breathing somewhat normally until my breathing becomes a bit ragged and then shuts down for up to 30 seconds.  Sometimes the CA event is preceded by some mask leakage; other times it isn't.  Could there be a causal link between mask leakage and my CA?

If I'm awake and relaxed, I find I can manually exhale, stop breathing, and feel comfortable for about 20 seconds before I feel the need to inhale.

I initially got my CPAP device because I was suffering from obstructive sleep apnea, which I'd guess was probably brought on by weight gain and age.  Also, I was told by the therapist that I have a "small mouth" (he might have said it was a "5").  But with the CPAP system, the charts seem to indicate that there were central airway events occurring as well.

Are there any red flags here?  I'd guess everything is okay, although it does seem unnatural for your breathing to stop and then start up again after a few seconds.
-- Wayne Farmer


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#2
RE: Central Apnea associated with mask leakage?
Hi Wayne and welcome to Apnea Board.

This may not be the definitive and direct answer you seek, but it is possible the leaks setup a CA event in this way. If the leak is bad enough to make the machine jack up the pressure to compensate, it may cause an imbalance in the oxygen to carbon dioxide ratio called wash out. At least in theory it may be happening. With CA events, the thing to note and help correct when using a standard style CPAP is that pressure swings may initiate a CA event. You may first want to look at your machine settings and things like Ramp and EPR could be considered needing to be reduced or turned off and see if the CA diminishes.

Also of note is that time may change our apnea therapy needs. You are on an S9 I think. It may be time to evaluate getting a new ResMed. It may require a sleep study, but your therapy needs may have changed to adding in some CA events that might need a machine called ASV to address it. I can't predict anything of the sort about therapy needs and whether or not it did change, but it's possible that CA events were happening all along. I wouldn't know that for certain, but it's something to consider, given that most of these doctors become blind to CA events. The normal way doctors handle apnea: Oh you have apnea means it's always Obstructive and it only needs to have a CPAP. Here's your cookie cutter solution. You may have had that happen, as for me I am only guessing at possible scenarios.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#3
RE: Central Apnea associated with mask leakage?
Thanks, Dave.  I'll keep an eye on things.  I looked through my OSCAR chart, and in many cases an increase in leak rate happened before the breathing cessation that seconds later got flagged as a CA.  I also know that my S9 makes more noise than it used to, and I suspect it has an internal leak.  A med supply store associated with our local hospital has said they could help me with getting it fixed or replaced if there's a problem, so I'll pursue that first.
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#4
RE: Central Apnea associated with mask leakage?
OK I copy on the increased noise. Certainly explore every avenue available to see if your S9 is working properly. Best wishes on a quick and inexpensive fix.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: Central Apnea associated with mask leakage?
I have had central apneas since 2001, and I don't buy the leaks or small mouth theory. I know that for some people CO2 is an issue, but I'm not strongly in that camp, especially for someone who has been on therapy for a long time and has what I would consider long centrals; 30 seconds. Also, I doubt that you will go half a minute not breathing when you turn over, plus you would probably take a deeper breath just prior to a position change.

I quickly "glanced" at my numbers and it seems that when my central apneas were better controlled my duration was in the teens, but those times when I started to be impacted with them the duration was higher. I didn't do scientific analysis, I just went back to different periods of time at looked at Resmed detail data.

If your are getting more now than before, or if your sleep in being impacted by them, you might have to think about going to a different therapy. If there is no impact to your sleep quality, then carry-on. I eventually agreed to an ASV titration as things got worse, and it has turned out to be great decision.

John
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#6
RE: Central Apnea associated with mask leakage?
If you are on Medicare and your machine you could probably get a new sleep test and a new machine. Some secondary insurances pick up a lot or all of the remaining cost. My husband's S9 was getting really noisy and occasionally not writing to the SD card properly. We checked the run hours and date of manufacture--the VA hasn't been able to find his original home sleep test--and I took him to my civilian sleep doctor as the machine was 6 years old. He said get rid of that machine and then the VA gave him a Resmed Auto S10 Autoset.
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#7
RE: Central Apnea associated with mask leakage?
SideSleeper, you are correct, that is my situation.  Once the ResMed is over five years old, I'm eligible for a replacement.  I really do like the S9; I'm hoping I can get it repaired.
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