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Hypopnea, central and obstructive
#1
Ohmy 
Hey there,
I've been using a Resmed A10 since July last year. Initially I tested at 45 AHI and in a sleep test in Dec. also at 45 AHI. I've been doing a lot of self study and have made my own adjustments as time went on. And looking for a live sleep professional to help. I'm hoping to share what I've learned and learn more through others' experience.
I used auto pressure in the early stages and then settled at 8 with the help of a sleep tech. My results have been a great improvement over no treatment but have varied widely and I've been tweaking regularly when patterns emerge. My untreated apnea is primarily obstructive with a little central mixed in. Under CPAP my results are largely central (typically 75-90%) with a few obstructive and hypopnea added in.
It would appear my central apneas are largely caused by the CPAP treatment, again through watching the patterns over time. For the last 2 months I have been gradually lowering the pressure and went to 4.8 last night. The trend has been a decrease in the percentage of central apneas and a corresponding increase in the hypopnea index, while the obstructive share has remained small and stable. For most of this period, my AHI index has ranged from 1 to 11. I consider myself successfully treated but my has history is one of change so I keep watching for trouble and tweaking. Ideally, I would like to wear the mask and forget all about the condition.
I would appreciate any observations or comparisons that anyone has to offer!
Thanks,
Steve
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#2
Sounds very familiar. OAs stopped and CAs took center stage initially. I have been on CPAP for one year now and just now getting a full night sleep. Hypoapneas now take center stage and CAs are dwindling. 

It's a long journey but with time and patience, things get better.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#3
Steve there are a number of members that are using CPAP at low fixed pressure, or in a narrow range in order to deal with CPAP emergent complex apnea. I assume EPR is off as well. Let us know if there is anything we can do to help. It appears you have made smart decisions to optimize your treatment.
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#4
(03-24-2017, 12:21 PM)Stevie1under Wrote: Hey there,
I've been using a Resmed A10 since July last year. Initially I tested at 45 AHI and in a sleep test in Dec. also at 45 AHI. I've been doing a lot of self study and have made my own adjustments as time went on. And looking for a live sleep professional to help. I'm hoping to share what I've learned and learn more through others' experience.
I used auto pressure in the early stages and then settled at 8 with the help of a sleep tech. My results have been a great improvement over no treatment but have varied widely and I've been tweaking regularly when patterns emerge. My untreated apnea is primarily obstructive with a little central mixed in. Under CPAP my results are largely central (typically 75-90%) with a few obstructive and hypopnea added in.
It would appear my central apneas are largely caused by the CPAP treatment, again through watching the patterns over time. For the last 2 months I have been gradually lowering the pressure and went to 4.8 last night. The trend has been a decrease in the percentage of central apneas and a corresponding increase in the hypopnea index, while the obstructive share has remained small and stable. For most of this period, my AHI index has ranged from 1 to 11. I consider myself successfully treated but my has history is one of change so I keep watching for trouble and tweaking. Ideally, I would like to wear the mask and forget all about the condition.
I would appreciate any observations or comparisons that anyone has to offer!
Thanks,
Steve

Stevie - Are your centrals clustered?  Your experience seems similar to mine.  I have been using a Resmed A10 since my first sleep test (45 AHI, only obsructive apneas were scored) about 18 months ago.  I eventually found that my obstructive apneas disappeared at any pressure but clustering of centrals/hypopneas drove my pressure up to max range.  With help from reading this forum and using sleepyhead software I was able to optimise my results by ignoring centrals and hypopneas - a second sleep test had revealed that these were probably scored during periods of partial wakefulness (sleep/wake junk), when my respiration rate lowers and my breathing deepens.  During these periods I often experience what is described as lucid dreaming.  These periods can last up to 1 hour or more and occur 3-4 hours into my sleep and prior to waking up fully (after 7-8 hours sleep).  My AHI scores reported by the software can be misleading (sometimes as high as 8, triggering some warnings in sleepyhead) but are always well below 1 if I discount the clusters.

Although I have experienced a great benefit from using the cpap from day 1, I think that this benefit derives reduction from the reduction in obstructive apneas and does not appear to correlate with the central/hypopnea indices.
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#5
Grandpapa - G
Your experience does seem similar to mine. And yes, my central apneas used to be clustered around sleep/wake periods for sure. I would typically wake after about 4 hours of good sleep and not be able to return to sleep for up to an hour or not at all. Aside ... after the Dec. sleep clinic the sleep doctor suggested I learn and practice good relaxation techniques to return to sleep. My pressure was about 7-8 then. That's when I began lowering the pressure to new territory and started to sleep 7-8 hours most every night. And the centrals were then spread out and as I lowered the pressure the hypopneas started to appear with more frequency. 
How low have you tried your pressure?
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#6
I too lowered my pressure and almost immediately started sleeping all night. Max 6.6 and reduced my centrals to just 2-3 events per night. 

In fact my sleep has been so good I have had a 100 on MyAir score EVERY night for the past 2 weeks. To get a 100 , you need at least 7 hours of CONTINUOUS mask on, leaks under control, and AHI <5. 

Better sleep has allowed for more Hs but with an AHI < 2 I'll take the sleep.  like

I may try raising my pressure to reduce my Hs but if the CAs come back, the pressure goes back down.
Dont-know  I am an accountant so any advice given here is not medical. If I give any financial advice, you can take it to the bank. However, you will have a hard time cashing it in. Okay
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#7
(03-24-2017, 04:14 PM)Stevie1under Wrote: Grandpapa - G
Your experience does seem similar to mine. And yes, my central apneas used to be clustered around sleep/wake periods for sure. I would typically wake after about 4 hours of good sleep and not be able to return to sleep for up to an hour or not at all. Aside ... after the Dec. sleep clinic the sleep doctor suggested I learn and practice good relaxation techniques to return to sleep. My pressure was about 7-8 then. That's when I began lowering the pressure to new territory and started to sleep 7-8 hours most every night. And the centrals were then spread out and as I lowered the pressure the hypopneas started to appear with more frequency. 
How low have you tried your pressure?
Stevie
Below 7 I feel I am not getting enough air flow. I usually use medium pillows with my mask and am uncomfortable at lower pressures. Going to large sized pillows helps with the flow but leakage can become a problem - so I fixed pressure at 7.2.  I recently had an extended cold / sinus problem and moved pressure to 7.4 with a noticeable improvement in comfort so I stuck with it even after the cold subsided.  I still occasionally use the large pillows (there just taking up space in my drawer) when I am too lazy to have cleaned the medium sized ones I had used the night before. Months ago when I was in the process of slowly lowering the pressure I had a feeling that I was trading off some of the clustered centrals for more distributed hypopneas but I didn't really analyse this in detail as I really noticed no difference in my sleep pattern or how I felt.
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#8
(03-24-2017, 04:14 PM)Stevie1under Wrote: Aside ... after the Dec. sleep clinic the sleep doctor suggested I learn and practice good relaxation techniques to return to sleep. My pressure was about 7-8 then. That's when I began lowering the pressure to new territory and started to sleep 7-8 hours most every night. And the centrals were then spread out and as I lowered the pressure the hypopneas started to appear with more frequency. 
Over 50 years ago, while in high school, I read about using long deep breathing to relax and overcome sleep problems. I learned to do this and the habit has not gone away.  I have since discovered that my lung capacity is larger than normal so I was not surprised to find (from sleepy head) my respiration rate drops to around 8/min during the sleep/wake periods - triggering events falsely reported as centrals. After my second sleep test the sleep doctor saw no true centrals but saw times between breaths exceeding 10 seconds when I was known to be awake (which was most of the time).
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#9
   
Last night's stats are attached. I'm going to use a pressure of 4.8 for a week or two to see what develops. I posted this one because of how colorful it's become, but the real winner is the average length of the apneas, which is about 11-12 sec.  This is a huge improvement over previous pressures.
Having the lowest pressure possible is important to me as my nasal passages become inflamed easily and apparently I have cute little passages that become restricted to breathing easily. I've been using a steroidal nasal spray since September. According to the doctors and my experiences, the steady pressure from the CPAP causes inflammation for some people.
And the only real consistency in my treatment has change. I find a combination of mask fitting and CPAP setttings that gives good results and then the results change. So, with bated breath I look forward to the next week or two's results, hoping for the grail!
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#10
Fingers crossed for you Stevie. But remember, don't worry so much about the numbers. Be more mindful of how you feel!
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