How to make the best of it?

[Schlafer]

Another newb to the forum, making first post. So let me first thank you all for the amazing effort you have put into this site, and the OSCAR app folks too. Wow. Actually too much to absorb quickly.

So yeah, barely started on CPAP, only 5 weeks in - and from what I've read so far, likely a ways to go. I'm trying to get my original sleep study, as it was only read to me verbally in a fog...but do recall that it contained centrals and was a reasonably high AHI. I've just had a second sleep study to titrate, but no results yet. My numbers are chaotic, but never great. Even when I get an AHI below 10, it still looks to me like there are chunks of time where my O2 could be dropping, doing harm.

Meanwhile, I've been pretty diligent about compliance and sleep hygiene and getting as much time on the mask as possible to try to adjust to it. However, even though I feel like I've progressed on adapting to the device - I'm more exhausted than ever & suddenly gaining weight faster. I almost never feel rested, and have to nap more often than pre-treatment. I don't feel "treated" yet at all, although it's hard to judge. Other than elevated BP and overweight, I have no other issues. Well, it is allergy season...

From what I can tell from posts here, there's a probability that I have centrals, and will need to go through weeks & months to end up on BiPAP and then ASV. So maybe I'm doomed to "fail" on CPAP & BiPAP - but perhaps I can get some better treatment during that process? I don't understand much of the OSCAR data yet, and maybe there are some low-hanging issues someone can spot for me to work on and make the best of the time spent slogging it out for the duration :-)

p.s. Please note that since I'm still in the "trial phase" I can't override the prescribed settings - but maybe there are items I can ask my doctor and provider about working on.

Thanks!

[SarcasticDave94]

Hi Schlafer,

Welcome to the Apnea Board. We'll do what we can to help. Currently those Clear Airway events are high, and it's possible these actually are Central Apnea events. Do your best to get your copy of the sleep study detailed report posted in redacted form.

[Gideon]

Welcome to the forum

Can you make changes to "Comfort" features?  Your EPR is set to 3.  It is very likely that this is what is causing your Centrals to be running high.

The centrals are likely high because you are "Breathing Better".  That is to say that CPAP has made your breathing more effective and the elevated EPR is helping to wash CO2 out of your blood.  pCO2 is one of the primary drivers of central apnea in that a "high" pCO2 is sensed by chemoreceptors and when it is "high" a breath is triggered.  When pCO2 is washed out (higher EPR or PS will do that) the pCO2 drops to where a breath is not triggered.  

The "fix" is to decrease or eliminated your EPR.  (EPR=0 or 1)

[Schlafer]

Welcome to the forum

Can you make changes to "Comfort" features?  Your EPR is set to 3.  It is very likely that this is what is causing your Centrals to be running high.

The centrals are likely high because you are "Breathing Better".  That is to say that CPAP has made your breathing more effective and the elevated EPR is helping to wash CO2 out of your blood.  pCO2 is one of the primary drivers of central apnea in that a "high" pCO2 is sensed by chemoreceptors and when it is "high" a breath is triggered.  When pCO2 is washed out (higher EPR or PS will do that) the pCO2 drops to where a breath is not triggered.  

The "fix" is to decrease or eliminated your EPR.  (EPR=0 or 1)

I've seen this advice posted before, and was wondering if this "suddenly lower CO2" central inducing effect is expected to self correct in a few weeks, or months? It was one of the few items I was already curious to try. 

I will ask my provider about that comfort adjustment, who might likely defer to a doctor if it's "off script". They are following some pre-programmed sequence of steps. Would it make sense to complain about effort to exhale? Or am I way off?

Thanks,

[SarcasticDave94]

Typically CPAP can cause centrals when starting therapy. If so, then these should diminish in a few weeks to a month. Sometimes reducing pressure variations helps this, hence reducing EPR.

[Gideon]

 I'm more exhausted than ever & suddenly gaining weight faster. I almost never feel rested, and have to nap more often than pre-treatment. I don't feel "treated" yet at all.

Complain about this
Complain about your numbers, the number of centrals.  Ask what you can do to minimize them.

[DeepBreathing]

G'day Schlafer. Reducing EPR as Bonjour has suggested may reduce or eliminate the central apneas, all going well. It will make exhaling more difficult - however your pressure is really quite low, so exhale shouldn't be too much of an issue for a normally healthy person.

Bonjour has a greater in depth knowledge of these things than I do, but I don't share his optimism that changing EPR is going to be the fix. (But you should definitely give it a try). Your central apnea is pretty high - it's important to see if it was pre-existing so get hold of the full test report. Make sure you get the numbers and tables, not just the written summary - it's not uncommon for central apnea to be ignored and a diagnosis of obstructive apnea is given. I do't know if this is some kind of medical tunnel vision or maybe they just have stock phrases in their word processor. Either way we see misdiagnosis fairly frequently.

[Gideon]

I strongly suspect that these are Treatment-Emergent Centrals and they can take 2-3 months to go away, and they don't always go away.

[Dormeo]

Schlafer, you can change your settings yourself, even if you are locked out. How would you feel about doing that? More information here:

https://www.apneaboard.com/adjust-cpap-p...tup-manual

[DeepBreathing]

I strongly suspect that these are Treatment-Emergent Centrals...

Do you see a pattern or other characteristic which leads to this view? In other words is it possible to tell if central apnea is treatment-emergent without seeing a pre-CPAP diagnosis?