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New APAP user, worried about centrals
#11
RE: New APAP user, worried about centrals
Attaching a few more screenshots from last night.


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#12
RE: New APAP user, worried about centrals
Last batch from 4/13/21. Just want to make sure I'm being sufficiently thorough.


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#13
RE: New APAP user, worried about centrals
The last page has centrals,. The post before that has arousals leading to 'holding your breath' o e has a following CA that is real.

Per medical standards you are very well treated with AHI under 5.

Try turning off EPR.
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#14
RE: New APAP user, worried about centrals
Thanks Gideon. Do you see anything particularly concerning on the data for the ACTUAL central apneas, like evidence of CSR, or should I assume that they’re likely treatment emergent and/or related to CO2 levels in the blood?

I’ll try turning off EPR tonight. If that doesn’t reduce the number of centrals, what would you advise?
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#15
RE: New APAP user, worried about centrals
Believe me, if I saw Something of serious concern you would not be asking me that question. It would be explicitly clear and without question. The closest thing you have to CSR is the label ResMed uses for periodic breathing, and OSCAR uses that label simply because that is what the vendor calls it, which is unfortunately CSR. CSR is serious but very uncommon.
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#16
RE: New APAP user, worried about centrals
(04-14-2021, 02:53 PM)mollyjz Wrote: If that doesn’t reduce the number of centrals, what would you advise?

Waiting to see if they disappear on their own. Like Gideon said, your therapy is working well for you. If you went for a sleep study and your AHI was under 5, you would not be prescribed a CPAP machine. There is no clinically significant difference between a AHI of zero and a AHI of 4.
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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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#17
RE: New APAP user, worried about centrals
What to do?
Don't worry about the numbers, watch them, but don't worry. You are looking for either obstructivve or central events to make a significant increase for a few days. Then bring it up here.

Time, it can take time, months for the centrals to diminish. During this time IMHO you want some CA present as that helps your body reset it's threshold.

Lastly, the most important thing is to focus on comfort, how you feel. Changes for you should be based on this, not numbers. For example, when I was put on a pressure of 6 it felt like I was sucking air through a collapsed straw. It makes no sense as that is 6 cm of water more pressure than without the system. I needed 10+ cmw to feel even a little bit comfortable. At that time my Rx was 19 cmw.

Comfort is king.
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#18
RE: New APAP user, worried about centrals
What Gideon is correctly telling you is that you are not having real central apneas. If you were having a sleep study done the technician would be able to tell you were awake and these would not be scored as a central apnea (at least the majority of them). The machine flags these as central apnea because it is not capable of telling when you are sleeping so assumes you always are. We can tell they are false events based on experience and knowing what arousal breathing looks like, whenever an apnea follows arousal breathing it usually isn't real, when arousal breathing follows an apnea that is an issue.

Looking at your sleep study two things stood out.

1) Your apnea is positional, it only really occurs when you are supine (sleeping on your back).

2) You had a significant number of spontaneous arousals. Spontaneous arousals are likely the cause of these falsely flagged central apneas. What happens is you have a spontaneous arousal (which means arousal for unknown reason) which causes a couple larger breaths and then your body relaxes and holds breath as you transition back to sleep. If you change position a false apnea is very common as well (since we hold our breaths when moving).

These "centrals" are not a problem and they and the spontaneous arousals may go away with time as body adjusts. Instead of looking at your data each day I would recommend reviewing once a week just to see if there is anything that looks really off (AHI starts spiking to 10+ etc) and judge your progress more on how you feel rather than over analyzing the data (easy to do, we have all been there).
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#19
RE: New APAP user, worried about centrals
Thanks everyone for your helpful responses! I tried decreasing the EPR to 0 but found it really uncomfortable and ended up switching it back to 1, and then back up to 2 again. My results look about the same whether EPR is set to 1 or 2.

I'm going to give the therapy some time and hope that the centrals decrease on their own as my body adapts. If they don't, I'll definitely follow up with my sleep doctor and ask what might be causing the spontaneous arousals that look like centrals. I'll check my data weekly, as suggested, and will post an update in a week or two.

Thanks again for the advice! I'm so grateful to have such experienced and encouraging people to help me along the way Smile
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#20
RE: New APAP user, worried about centrals
OK, my opinion then is run the PAP in the most comfortable setting. Then monitor your numbers, something like maybe once per day for something like 5 days worth. Establish a trend of whatever it becomes that 5 days. You may post that here if you'd like, including a running commentary on how things feel. After that 5 days if things are trending to stay in a treated area, run it and look at data every few days instead of daily. I get a sense that your Centrals are going to start dropping the longer you have time on the PAP clock, meaning the longer you'll use it, measured in weeks to months, it's going to start having a diminishing trajectory.
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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