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First Night on Therapy -- CA worries
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AndyB Offline

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Machine: ResMed AirSense 10 Autoset with RERA
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CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #1
First Night on Therapy -- CA worries
Received my new ResMed A10 Autoset yesterday, and with great anticipation had my first night of therapy last night. It did not go as I hoped, and I'm very concerned about the number of central apneas that I experienced.

Here are the basics: I had a lab split-night sleep study performed that established an untreated AHI of 41, consisting entirely of OSA/Hypopnea events (zero CAs prior to being titrated). Titration in CPAP mode lasted 3 hours, with pressure from 5-7-9-11 cmH2O. An AHI of 4 was established at the end of the titration phase; only 2 CAs occurred during titration, neither of which happened when the pressure was at the maximum of 11cmH2O.

My settings: APAP mode, min pressure 6.0, max pressure 11.0, EPR level 2 full time, 90% Leak Rate 0.00, % time above Leak Rate threshold 0.61%, median pressure 8.58, 95% pressure 10.26. I had therapy for just under 8 hours.

My first night on the APAP produced an AHI of 15.22, of which 14.84 was a Clear Airway Index, 0.13 was an Obstructive Index, and 0.25 was an Hypopnea Index. Many of the CA events were 20-40 secs long, and several were 60 secs long.

I realize that my data set is very limited, consisting of only one night of home therapy, and I also realize it's way too soon to start fiddling with settings; nevertheless I'm very freaked out by these results. Virtually all of my OSA and Hypopnea events disappeared, but a ton of CA events occurred.

For what it's worth, I am a reasonably fit and active male, and had no idea that I might have sleep apnea until recently, when my wife told me that my snoring was getting worse and that occasionally during the night she'd hear me gasping for breath. That, plus several friends talking about sleep apnea and their use of CPAP/APAP machines, prompted me to ask my doctor to prescribe a sleep study for me. I'm very glad I did, but now I'm really worried.

Any insights, educational comments, and/or general words of wisdom will be greatly appreciated!

Thanks,
AndyB
06-13-2015 12:45 PM
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justMongo Offline

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Post: #2
RE: First Night on Therapy -- CA worries
During sleep, the blood CO2 level is the key trigger for the brain to trigger a breath.
Perhaps -- just perhaps, the EPR relief of 2 cm-H2O is permitting you to blow off too much CO2 on exhale.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 06-13-2015 01:02 PM by justMongo.)
06-13-2015 01:01 PM
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AlanE Offline

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Post: #3
RE: First Night on Therapy -- CA worries
That's actually more common than not. It happens to me when I change my pressure. My CAs spike and then settle down. It should work itself out in a few days but if not maybe you can post up some charts and the fine folks here can weigh in.

Going from 41 to 15, even if they were mostly CA, is a decent start.

Also remember in the titration they are routinely varying the pressure to see what your limits are. Now that you are on a steady range you'll need time to get used to it.



Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie
(This post was last modified: 06-13-2015 01:28 PM by AlanE.)
06-13-2015 01:25 PM
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surferdude2 Online

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Post: #4
RE: First Night on Therapy -- CA worries
Andy, Give it some time. Acclimation to this therapy takes time. You can speed it along by using CPAP while watching TV or reading. That will give you more confidence in the therapy and make getting to sleep easier. The CA's will usually vanish once you get comfortable with the therapy and equipment. The good news is, your OA's are being handled nicely so your wife won't be hearing you snore or struggling for breath. Sometime CA's are scored in the early stage of CPAP treatment merely because you are being bothered by the therapy and are drifting in and out of sleep. That will take care of itself in time. If you are still bothered with CA's after a month of use, inform your doctor.
06-13-2015 03:18 PM
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AndyB Offline

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Machine: ResMed AirSense 10 Autoset with RERA
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Mask Make & Model: F&P Simplus, ResMed AirFit F10; PR Amara View
Humidifier: ResMed integrated heated
CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #5
RE: First Night on Therapy -- CA worries
Thanks for the sensible and positive advice. I know one night's data isn't enough to determine anything, but I was spooked by the many CAs nonetheless.

I've climbed off the ledge and will give my body and brain more time to adjust to this new experience. I'll report back after I accumulate more data.

Thanks again, AndyB
06-13-2015 03:28 PM
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AlanE Offline

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Sex: Male
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Post: #6
RE: First Night on Therapy -- CA worries
Keep us posted. You don't have to go at it alone. We all get frustrated from time to time. Like I am now. I seem to have taken a step back but I will work through it.



Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie
06-13-2015 03:31 PM
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jen45 Offline

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Post: #7
RE: First Night on Therapy -- CA worries
Thanks for posting this... I too am new to cpap & didn't know that often central events were common when first starting. Although I'm going to my dr, I'm not so worried now that I know others are experiencing this. Good luck w/ your therapy!
06-13-2015 03:48 PM
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surferdude2 Online

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CPAP Pressure: 12 ~ 20 & 11 ~12 if nasal mask
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Post: #8
RE: First Night on Therapy -- CA worries
You're welcome Jen and Welcome, I was only passing along the advice I got when first coming to this forum. I half heartedly believed what everyone said about eventually being able to tolerate the backpressure and the discomfort of the mask, etc., but I can now tell you that all of those issues will fade away completely and you'll have a new lease on life since you'll be sleeping well. Thanks for chiming in and letting us know you have taken some comfort from the thread.

All the best, Dude
06-13-2015 04:16 PM
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jen45 Offline

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Post: #9
RE: First Night on Therapy -- CA worries
Thank you!
06-13-2015 04:38 PM
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AndyB Offline

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Machine: ResMed AirSense 10 Autoset with RERA
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CPAP Pressure: 10.4-13.0
CPAP Software: SleepyHead

Other Comments: Diagnosed May 2015; EPR @ 1cmH2O; Ramp off; ResMed Climateline heated hose

Sex: Male
Location: SE Wisconsin

Post: #10
RE: First Night on Therapy -- CA worries
This is a followup to my original post, which started this thread.

I've now had 7 straight nights of therapy, averaging 7.5 hrs per night. I've had mediocre results so far, but I'm hopeful that things will improve as my body and brain get used to the CPAP. The first night was the worst, by a good measure (AHI 15.22, of which 14.84 were CAs). The last 6 nights I've had AHIs of 8.41, 8.65, 3.53, 4.10, 7.55 and 10.11, in each case almost entirely comprised of CAs, as the therapy has apparently completely eliminated the obstructive apneas that caused my sleep study AHI of 40.8.

I had significant large leaks on 3 of the worst nights (although not the first night, oddly), and even on the nights where the leaks weren't significant it seemed like I woke up on and off all night long with bubbling lips or partly open mouth. I picked up a full face mask (F&P Simplus) today from my DME, which has so far been very supportive (American HomePatient -- I know, it has occasionally been lumped in with "Crapria" and "Lincareless", but my experience to date has been excellent). I'm anxious to see how things go tonight with the full face mask.

Thanks again to everyone for your encouragement and good advice.

Andy
06-19-2015 07:22 PM
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