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Help Understanding Central Airway Bunchups
#1
Help Understanding Central Airway Bunchups
    [attachment=32859]     As the title of the thread says, I am experiencing Central Airway bunchups. These are concerning as my sleep study did not show these as a problem. Also, it isn't really consistent. I have attached 3 screenshots; 1 with minimal Central Airway Events and 2 with major Central Airway Events. It appears that when the pressure ramps up higher that I start to experience a bunch up of OSA and CSA events. I looked into the granular information and it does appear these are true Central Events as I am breathing normally followed by a 10 second pause. However, I noticed that these events happen typically when I am toward the beginning and end of my sleep.

The last two nights, I experienced the bulk of these events in the last 1.5 hours of sleep. My wife gets up early with our toddler, so these last 1.5 hours of sleep during weekend days are typically on/off sleep.

Another note of potential importance, when I nap I have 0 AHI even if the nap is 2 hours long. I am only experiencing these bunchups with my overnight sleep. There are extended periods in every night of sleep that I experience 0 events.

If I'm interpreting the chart right, I am experiencing many of these central events during wakeups and when the pressure ramps up over 10. I often notice that when I wake up, the pressure is typically very high. Last night, I woke up with my mouth full of air and the pressure at its peak volume.

Please let me know how to interpret these events. And yes, I'm aware that my AHI for these nights is acceptable, but if without the Central Airway events, my AHI would hover around 1 or less every night, so I want to get these taken care of. I have been experiencing many issues with mask leaking, too, if that information is helpful.


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#2
RE: Help Understanding Central Airway Bunchups
Welcome, there are many people here that have a great deal of knowledge and will help you. As to why you have centrals - When the body gets rid of CO2 you pause in breathing. It is because your body is not use to the therapy and it is called emergency apnea. You get it when you first start and goes away as your body gets used to pap therapy. Usually in 6 to 8 weeks. And central are very inconsistent where one night you have very few and the next night a lot appear.

What to do while you are getting use to the therapy? Many people find that narrowing the difference between the Max and min pressures helps. Right now you are running wide open. 4 is the absolute lowest the machine can go and 20 is the absolute highest the machine can reach. I would try to cut down the size between the high and low.

My suggestion would be to set your min 7 and your max at 11. I think you will find that cuts down the centrals and will allow you better sleep. Give the settings a couple of days and post again.

If you do not know how to set the min and max you can look on youtube. search for Resmed and clinician menu. They have a number of videos showing how to adjust your settings. You can also download for free the users manual for your machine at the top of the site. That will also show how to change settings.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Help Understanding Central Airway Bunchups
Awesome! I was thinking I needed to change the pressure. I have modified the settings to 7-11 and will try sticking with that tonight.

I see why you suggested that. It looks like my events are minimal in that pressure range.
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#4
RE: Help Understanding Central Airway Bunchups
OK let's address some things. Edit your Min pressure from 4 to 7. EPR 3 can't do much to drop pressure at 4 when the PAP can't go below 4. So you've only experienced a small bit of EPR.

Let's dial back EPR to 2 in light of the CA. I'll mention CA again in just a sec. And to defer to CA and overall sleep therapy effectiveness, turn the Ramp off or at least shorten it a bit. I realize it's likely in auto timed ramp as well, but it's a variable that's not as useful as you may think.

Back to the CA, that cluster of Centrals was near the tail end of your sleep session so these are likely SWJ, sleep wake junk. This means that purple blob of a mess was an issue with a breathing handoff from sleep to wake and bouncing between these 2 states as you drift in and out of sleepiness. The significant part is at the beginning or end of a sleep session. Think hard about this, were you waking up about that timeframe? Probably. If true disregard that SWJ. The other bit of data that points to SWJ is that you stated no significant CA on the test results.
Dave

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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: Help Understanding Central Airway Bunchups
Sweet, thanks Dave! Lowered the EPR to 2 and changed range 7-11. Yeah I was guessing this was SWJ. The day I attached that was good, I got right out of bed when my alarm went off as I was going to work. 

I’ll try these settings for a few days!
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#6
RE: Help Understanding Central Airway Bunchups
Welcome. As with any setting, try it a full night if at all possible. Look at OSCAR and then decide if it affected sleep positive or negative. We can revisit OSCAR and settings pretty much at any time. If you change something and it feels like a trainwreck disaster, certainly feel free to revert that edit back. Otherwise try it maybe 2 days and review.
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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#7
RE: Help Understanding Central Airway Bunchups
So, I tried these settings and ended up with several leaks all night. I woke up every time the pressure got to 8.4 and it caused several artificial AHI events. My AHI skyrocketed to 6.0.

I cannot get the leaks to stop.
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#8
RE: Help Understanding Central Airway Bunchups
Leaks have many reasons. One is over tightening another is not cleaning the mask from oils. Shave and wash your face to get rid of oils. 

If leaks cannot be stoped try a lower max, in your case 8.?.  But truthfully many people have no large leaks at a much higher pressure.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#9
RE: Help Understanding Central Airway Bunchups
I think mine was too loose. I’ll wash my face tonight. Would running the mask fit program help me out? I know it’s something I’m doing, I can’t imagine it’s the pressure
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#10
RE: Help Understanding Central Airway Bunchups
I doubt it's the pressure. Look at the first chart you posted. Your 95% pressure was around 9cm or more.
That simply means that you were at that pressure for 95% of the night and below.
Now look at the leak rate... it was low.

Some of the smaller leaks on those first charts show mostly mask movement. It looks like you move around a lot at night.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

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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.
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