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New machine, high centrals & periodic breathing
#1
New machine, high centrals & periodic breathing
   
One week into using my new Dreamstation Auto Bipap, with what appears to be very high central apnea and high periodic breathing. Big differences in AHI from night to night. When I turn IPAP and EPAP down from 9/15 to 7/13, obstructive apnea goes up but centrals persist. 

My pulmanologist thinks the night-to-night differences are positional, and also due to my medication (OxyContin 80mg tid, Klonopin 1.5mg at bedtime, plus meds for high blood pressure). We've talked about turning pressure support to 0/0, but he's never made that change. I do tend to take the settings into my own hands after reading as many relevant posts here as possible, but of course my doctor isn't thrilled about my tweaking. 

I've been on CPAP for 5 1/2 years and have not been able to reliably adjust for acceptable AHI; once in a while I'll have a 2 or 3, then it goes up to 11, then 22, then back down to 2 or 3, with no adjustments being made. When IPAP/EPAP is lowered, retaining the 6-point range between them, centrals and periodic are reduced, but obstructive goes up, and vice-versa. I'm wondering whether that 6-point difference between IPAP and EPAP is too wide. And I don't know what to do with the pressure support (it's a Respironics, so there are two settings, PS min and PS max). Hope one of the pressure/settings experts can help! This fight is getting old after almost 6 years. Thank you!
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#2
RE: New machine, high centrals & periodic breathing
Do you have your copy of the sleep study? It would be a great idea to get that detailed report, post a redacted of personal info copy here. We are looking for info on the CA events during that study. As you may notice, CA events are consistently inconsistent. I'm meaning they appear to happen on random nights and in varying amounts despite therapy settings not changing.

It is possible some of these events are positional. We've been having others that suffer from positional apnea and chin tucking by having them consider a soft cervical collar. This reduces the chin tuck restrictions.
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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#3
RE: New machine, high centrals & periodic breathing
And I'd bet your Obstructive numbers while varied are somewhat constant right? That the variability is mostly CA events I call that as typical consistent behavior, consistently inconsistent that is. To be clear that is very common with Central apnea
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#4
RE: New machine, high centrals & periodic breathing
Pete, your doctor is probably a good pulmonologist and a clueless sleep doctor. It happens. These guys get it in mind that central apnea hss a physiologic or neurological origin, and they just can't wrap their minds around the fact some people had idiopathic central or complex apnrea that is resolved completely with ASV, and for some reason their patients seem to have a lot of Philips machines. Anyway, the question you need to ask your doctor, is if he will order an ASV titration evaluation. That is the logical solution of central and complex apnea, hypopnea and periodic breathing. If the answer is no, or denial you have CA, then you need to find a new doctor or consider buying your own machine out of pocket.
Sleeprider
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#5
RE: New machine, high centrals & periodic breathing
I'm not sure if any of my suggestions short of ASV can clean that Etch-A-Sketch mess. In cases like this, we do try to limit pressure swings, but that's still very likely not going to clean this up by much. Get a doc that will discuss getting you on the ASV path. That is assuming the current Duck isn't open to taking you onto the ASV path. Just ask nicely before you roast the Duck.
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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#6
RE: New machine, high centrals & periodic breathing
     SarcasticDave94, my last sleep study was 6 years ago, I've attached it here. We had one scheduled for late March, but had to cancel it due to the Covid-19 shutdown. So my doc has been winging it. 

Yes, my obstructive apneas have been low, as long as my IPAP pressure is set high enough to control them (15 seems to do the trick, they start to go all over the place below that). 

I've ordered a soft cervical collar as suggested. Had to get a size XL to accomodate my neck. I should mention I'm about 90 pounds overweight, working on it but it's a struggle.  

And believe it or don't, but my AHI was 1.1 last night! I did nothing different! With roller coaster results like these, my doctor is going to have little choice but to try an ASV. I wonder if he'll know how the settings work.

(05-12-2020, 03:05 PM)bonjour Wrote: And I'd bet your Obstructive numbers while varied are somewhat constant right?  That the variability is mostly CA events  I call that as typical consistent behavior, consistently inconsistent that is.  To be clear that is very common with Central apnea
Exactly. You described me perfectly.
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#7
RE: New machine, high centrals & periodic breathing
On how to set an ASV, the doc may not as both my doc and the RT had to guess. I am sure there's enough with knowledge on pressure settings, we can help you get it dialed in. I would suggest the ASV is the ResMed AirCurve 10. The 4 pressure settings under ASV Auto mode should be more than capable of giving great therapy.
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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#8
RE: New machine, high centrals & periodic breathing
Thank you for your help so far! We’ll see how things go. Appreciate the assistance.
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#9
RE: New machine, high centrals & periodic breathing
I couldn't see any breakdown on the sleep report (actually seems to be a titration study) between CAs and obstructive events. So I do wonder whether reduced pressure support (to see whether that puts a dent in the CAs) with a higher EPAP (to address obstructive events) might be worth a try while you're waiting to find a doc who will reconsider your case. But I don't have the expertise to know whether this is worth trying, or to suggest details, so I hope we can get one of your other advisors back.

The other thing that might be worth doing is to zoom in on an area of periodic breathing to see what it looks like. Maybe a 5-minute zoom so the experts can take a look.
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#10
RE: New machine, high centrals & periodic breathing
(05-12-2020, 10:53 AM)petemsw Wrote: One week into using my new Dreamstation Auto Bipap, with what appears to be very high central apnea and high periodic breathing. Big differences in AHI from night to night. When I turn IPAP and EPAP down from 9/15 to 7/13, obstructive apnea goes up but centrals persist. 

My pulmanologist thinks the night-to-night differences are positional, and also due to my medication (OxyContin 80mg tid, Klonopin 1.5mg at bedtime, plus meds for high blood pressure). We've talked about turning pressure support to 0/0, but he's never made that change. I do tend to take the settings into my own hands after reading as many relevant posts here as possible, but of course my doctor isn't thrilled about my tweaking. 

I've been on CPAP for 5 1/2 years and have not been able to reliably adjust for acceptable AHI; once in a while I'll have a 2 or 3, then it goes up to 11, then 22, then back down to 2 or 3, with no adjustments being made. When IPAP/EPAP is lowered, retaining the 6-point range between them, centrals and periodic are reduced, but obstructive goes up, and vice-versa. I'm wondering whether that 6-point difference between IPAP and EPAP is too wide. And I don't know what to do with the pressure support (it's a Respironics, so there are two settings, PS min and PS max). Hope one of the pressure/settings experts can help! This fight is getting old after almost 6 years. Thank you!

I would like you to set your PS =0.0-0.0, that is min PS = max PS =0.0  The goal being to try and make a dent in the CA events.  
The next step is to remove the pressure variability with min EPAP = Max IPAP = 10.0 which is your median EPAP pressure.

My gut says that you are using the wrong machine, but lets try this before we go there.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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