[Health] Central apneas can depend on the sleeping position?

[becker44a]

. . .
After some tests, I have the strong impression that when I sleep on my back the AHI rises. 

Does this make any sense? For central apneas the sleeping position should make any difference? If so, why? 
If not, what else could be causing such variation?

Hi kurata,
When I was tested for apnea, my AHI was 36.  I found out later that my AHI when supine was almost 60, on my sides was about 3.  I had been having trouble getting my AHI down below 10.  After I discovered the position effect, I started trying things to avoid back sleeping.  Eventually, I found that wearing a school backpack full of light, lumpy objects like plastic dog toys etc. worked well.  My AHI is now averaging well under 0.5.  So Yes, position can have a large effect on your results.  

The current thought here on this board is to use a Soft Cervical Collar to avoid chin-tucking.  I tried that, but it did not work for me - I don't tolerate things around my throat very well, and it certainly didn't work without the backpack.  So I abandoned that.  
Good luck on your journey.

[kurata]

Hey guys

So i set EPR=1 and narrowed pressure range to 6-8 cm H20 (it was 4-13 before).  I'm attaching a typical night graph.

CAs are still present, didn't notice an evident reduction. My sleep is still fragmented, but I can say it was slightly better with the lower pressure variation.

Also noticed a slight raise on RERAs (one night it reached 2.43/h).


1) Is it ok to slowly reduce the max pressure until I reach a minimal value so that OAs are low? 

2) Any explanation why RERAs raised? 

3) Any suggestion?

thank you very much!

[Sleeprider]

As EPR is reduced, flow limitations and RERA will rise. The basic principle of CPAP titration is that pressure prevents OA and helps keep the airway open to prevent obstructive hypopnea. Due to your high central index, there is no confidence that your hypopnea is obstructive. It is worth noting that your central and hypopnea events are only present during periods with significant leaks. With the Airsense 10 and bilevel PAP, we actually look at the EPAP as being the pressure that prevents OA, and IPAP is used to treat flow limitations, RERA, snores and obstructive hypopnea. The problem in your case is that as pressure support (the difference between IPAP and EPAP) rises, it can increase CA.

[kurata]

As EPR is reduced, flow limitations and RERA will rise.  The basic principle of CPAP titration is that pressure prevents OA and helps keep the airway open to prevent obstructive hypopnea.  Due to your high central index, there is no confidence that your hypopnea is obstructive.  It is worth noting that your central and hypopnea events are only present during periods with significant leaks.  With the Airsense 10 and bilevel PAP, we actually look at the EPAP as being the pressure that prevents OA, and IPAP is used to treat flow limitations, RERA, snores and obstructive hypopnea. The problem in your case is that as pressure support (the difference between IPAP and EPAP) rises, it can increase CA.

So, if I understood you correctly, to reduce CAs maybe turning off EPR would help but, on the other hand, it would increase RERAs, is that right? (please bear with me, i'm just really a newbie trying to learn here from someone more experienced ;-) )

What about just lowering the max pressure (from 8 to 7.8 or lower?) until the point where OAs get high? That would be ok? My hope is that this would make my sleep more comfortable. 

thanks

[Sleeprider]

CA events tend to be minimized by lower pressure, lower EPR and less pressure fluctuation. You can work with fixed pressure between 6 and 7, with and without EPR and see what works best. If OA reappears, increase minimum pressure.