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Need Advice about Central Apneas
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #11
RE: Need Advice about Central Apneas
(07-03-2016 03:08 PM)justMongo Wrote:  Sometimes increased PS will increase CA because it permits CO2 washout. CO2 being a primary trigger for breathing while sleeping. PS is helpful for people who have resistance upon exhale: such as COPD. Also, PS gives exhale relief when using large Inhalation pressure (like me.)

I'd leave the PS at 3. But narrow the 4 to 25 cm-H2O pressure window.
If it were me, I'd set minEPAP to 6 -- which is your 95 percentile for 02JUL2016; and maxIPAP to 12. You only went to 10 last night, so that gives the machine 2 cm of headroom. That should take care of the HA and OA. The CA will bear watching.

I agree with Mongo. I think raising Min EPAP to 6 is warranted.

Notice how the first two CAs in the zoomed-in period on July 2 were preceded by sudden arrowhead-shaped recovery breathing (which clearly indicates something obstructive also going on), which likely washed out too much CO2, leading to the CAs. And many of the CAs in other zoomed-in periods appear to be preceded by less obvious sudden recovery breathing.

Sudden recovery breaths indicate an obstructive arousal to a more shallow state of sleep in response to obstructive apnea, obstructive hypopnea, Flow Limitation or other partial restriction of the airway. The sudden increase in the amplitude of the Flow waveform represents a sudden increase in breathing effort which, if we remain asleep, is typically followed by a steady reduction in amplitude, forming an overall arrowhead shape in the amplitude. When recovery breathing is not flagged as an event, it means these were probably respiratory effort related arousals which did not quite meet the criteria to be scored as RERA, or perhaps our machine simply does not detect/report RERA at all.

Higher Min EPAP would tend to help reduce the obstructive component of the problem, which may be triggering most of the CAs.

Regarding Pressure Support, I think that increasing PS would likely worsen the number of CAs.

Adjusting Min EPAP to 6 could be done in two steps of 1 cmH2O each, waiting at least a week between changes. (Raising the Min EPAP, like raising the Min Pressure in an APAP machine, is partly a comfort choice, but it is important that it not be adjusted too low.) After at least a week can decide what next.

If at least a week after raising Min EPAP the average number of CAs is still higher than 2 or 3 per hr, I would probably suggest lowering PS to 2 and retaining the higher Min EPAP.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 07-04-2016 01:05 PM by vsheline.)
07-04-2016 04:48 AM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,989
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #12
RE: Need Advice about Central Apneas
(07-03-2016 08:58 PM)wxmcpo Wrote:  I still find myself getting tired throughout the day much like I was before I even started my treatment 15 months ago so I have always questioned if it really is working for me.

Your periods of high leak rate could easily be responsible for your ailment. Perhaps this is due to a poor-fitting mask.

However it's possible, even likely, that when you reach the deeper restorative levels of sleep your jaw-closing muscles relax, the pressurized air escapes out your mouth, and your airway collapses just as if you weren't using your machine at all.

If a chin strap doesn't resolve this problem then you will need to switch from a nasal mask to a full face mask.

I can't help but draw an analogy with house painting. If you skip over the basics, like stirring the paint well or making sure the walls are clean, then you're bound to to get a poor paint job.

Likewise, these leaks will ruin your ability to get a good night's sleep regardless of all the attention you pay to pressure settings and AHI.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
07-04-2016 11:36 AM
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wxmcpo Offline

Preferred Members

Posts: 77
Joined: Apr 2015

Machine: ResMed AirCurve 10 VAuto
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Heated (attached to machine)
CPAP Pressure: VAuto
CPAP Software: ResScan SleepyHead

Other Comments: Looking forward to a good night's sleep

Sex: Male
Location: Texas

Post: #13
RE: Need Advice about Central Apneas
(07-04-2016 11:36 AM)Sleepster Wrote:  Your periods of high leak rate could easily be responsible for your ailment. Perhaps this is due to a poor-fitting mask.

However it's possible, even likely, that when you reach the deeper restorative levels of sleep your jaw-closing muscles relax, the pressurized air escapes out your mouth, and your airway collapses just as if you weren't using your machine at all.

If a chin strap doesn't resolve this problem then you will need to switch from a nasal mask to a full face mask.

I can't help but draw an analogy with house painting. If you skip over the basics, like stirring the paint well or making sure the walls are clean, then you're bound to to get a poor paint job.

Likewise, these leaks will ruin your ability to get a good night's sleep regardless of all the attention you pay to pressure settings and AHI.

Appreciate your's and all the other advice given thus far.

I had another below 5 AHI night last night on VAuto (I still need to adjust the min EPAP to 6 though). I find on VAuto though I get more leaks because when I had the pressure on the set 3-6 I pretty much eliminated all leaks so not sure why VAuto tends to give me so many leaks. I don't think the pressure is that much greater, but maybe I'll give some small tightenings on the mask tonight and see if that helps. Or do you think the higher pressures may be causing me to open up my mouth more frequently? Thanks
07-04-2016 07:33 PM
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Sleepster Offline
Wiki Editor
Moderators

Posts: 4,989
Joined: Feb 2012

Machine: ResMed AirCurve10 VAuto
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: HumidAir and SlimLine Hose
CPAP Pressure: MaxI 13.6 | MinE 5.2 | PS 4.4
CPAP Software: ResScan SleepyHead

Other Comments: Diagnosed Nov 2011. Conquered aerophagia.

Sex: Male
Location: Houston, Texas

Post: #14
RE: Need Advice about Central Apneas
(07-04-2016 07:33 PM)wxmcpo Wrote:  Or do you think the higher pressures may be causing me to open up my mouth more frequently?

If you're not wearing a chin strap, do so. If that doesn't eliminate the leak problem, then try a full face mask. Until you get your leaks under control, nothing else that you do will work for you.

Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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.
07-05-2016 05:23 PM
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wxmcpo Offline

Preferred Members

Posts: 77
Joined: Apr 2015

Machine: ResMed AirCurve 10 VAuto
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Heated (attached to machine)
CPAP Pressure: VAuto
CPAP Software: ResScan SleepyHead

Other Comments: Looking forward to a good night's sleep

Sex: Male
Location: Texas

Post: #15
RE: Need Advice about Central Apneas
(07-05-2016 05:23 PM)Sleepster Wrote:  
(07-04-2016 07:33 PM)wxmcpo Wrote:  Or do you think the higher pressures may be causing me to open up my mouth more frequently?

If you're not wearing a chin strap, do so. If that doesn't eliminate the leak problem, then try a full face mask. Until you get your leaks under control, nothing else that you do will work for you.

I actually have one that my doctor gave me, but it is way too wide and bugs the crap out of me. I need to look into getting a much smaller one. Thanks
07-05-2016 08:27 PM
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