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Please help with dealing with central apnoeas due to CPAP
#1
Please help with dealing with central apnoeas due to CPAP
Hi all!
I am a new CPAP user 32 year old male, slim with normal BMI. Being using it for about 1.5 months now. Finally got a mask that works well for me (Resmed F30i) with minimal leak rate and I find it super comfortable.
My AHI at diagnosis (home test) was 8.7 but I felt really tired with that and I feel so much better with CPAP.
However, my residual AHI is mainly about 3 which I still feel tired with. I wonder if I can get it down further?
I have been playing around with the APAP pressures (I have a Resmed Airsense APAP), high max APAP levels seems to correlate with reduced OA but increased CA events. My experience with max pressures is that 14 = terrible levels of obstructions. So the max needs to be higher than this. I have been trying to reduce the max pressures to reduce the CA events.
I also wake up around 4 times at night.
I wonder what you would recommend to reduce the central apnoea events or reduce the night awakenings?
I use EPR level at 3. I understand that some recommend to reduce this?
Thanks!


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#2
RE: Please help with dealing with central apnoeas due to CPAP
Welcome to Apnea Board.

The charts show that at least half your events that still exist are CA, which OSCAR and the PAP calls Clear Airway, but refer to Central Apnea. These are where you are not breathing without a blockage.

Do you have a copy of your sleep study report? If you do, consider posting a redacted/blackened out personal data version. We would like to identify the CA type you are getting. For now, try these edits to your settings, No Ramp at all, and lower your EPR by one number for the next sleep session. Post the OSCAR after you use it with these edited settings. I want to see if or how the CA respond.

After we get the CA addressed, there's other things to address. Let's see what these edits yield as results first. Also when you post next, tell us how you feel during and after therapy, as in did it help or did it get worse. It helps us decide how to assist.
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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#3
RE: Please help with dealing with central apnoeas due to CPAP
Welcome to the forum.

The first thing we look at where Centrals are present is what the EPR or PS is set at. In general, the higher the value the more efficient your breathing is. For the most part, we are not trying to increase efficiency but to improve the quality of your sleep by reducing interruptions. This higher efficiency increases the flushing of CO2 out of your system. A relatively "high" level of CO2 in our system is the primary driver of our breathing cycle. When the CO2 goes below your apneic threshold a central apnea occurs. We are trying to see if you are one of these "lucky" individuals.

To do this we need to lower your EPR, I suggest lowering it to 1 so

Set EPR = 1

This should give us a good indication if this is happening to you.

That said, this is optional!!! The big question is how do you feel? This NEEDS to be the driver of changes at this time. You do not want to chase numbers.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#4
RE: Please help with dealing with central apnoeas due to CPAP
Thank you both for your prompt suggestions!
I will:
1. Drop the ramp off
2. Reduce EPR to 1 (I am comfortable with mask wearing/pressures so hopefully this would help)

Attached is my sleep study report. I thought I had no central apnoea previously but I noted I had mixed apnoeas (!?).
I dialled into the OSCAR data and the central apnoeas are real with flat lines in the flow rate graph. In fact, all my obstructive events are real.

Will report back with the results tomorrow!

In terms of how I feel, I feel much better than prior to CPAP but still feeling sleepy towards the middle of the day hence I would really want to drop the central apnoeas.
The times in which my AHI got down to 1.4 or something, I felt so good!


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#5
RE: Please help with dealing with central apnoeas due to CPAP
Mixed apnea events is a combo of Obstructive and Central. If these were the majority, we'd need to see how apneas respond to these suggested edits. It is possible the CA will not respond as we'd hope for, then we have to discuss plans to take care of these. Let's wait until we see how CA respond. We can see something by next use whether or not it's going the right way.
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: Please help with dealing with central apnoeas due to CPAP
Based on your diagnostic sleep study I recommend that you maintain the EPR = 3 and the Central Apneas. These appear to be Treatment-Emergent and yes it is likely that we can reduce them via a lowering of EPR.
Why, by maintaining a higher EPR we can over time, that being 2-3 months, get your body adapted to the lower CO2 concentration and thus minimizing the Treatment-Emergent Central Apneas. This is the standard treatment for this.

Your sleep study shows no apneas, obstructive, central, mixed, or otherwise. Just Hypopneas and Flow Limits (RERAs)
If the central are bothering you, reduce EPR by 1.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#7
RE: Please help with dealing with central apnoeas due to CPAP
Hi Fred,
Many thanks!
I think I will drop the EPR by 1. Would this slow down acclimatization towards the central apnoeas?
If I drop EPR completely, would the CA just go away? But then re-emerge later down the track?
Chen
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#8
RE: Please help with dealing with central apnoeas due to CPAP
As these are likely treatment emergent, they're going to diminish sooner or later regardless of what you do with the settings. I would rather you play the avoid game at first to make it comfortable to use. This way you're likely to mask on each night with some level of comfort and gaining the therapy benefits and restoration of damage can begin quicker. I do not think we can speed up adjusting to PAP therapy and CO2 washout by making you endure CA. These CA, regardless of type, are consistently inconsistent and contrary to boot. You can try EPR at whichever level you want just to try it out. If the discomfort gets bad, drop EPR down.
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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#9
RE: Please help with dealing with central apnoeas due to CPAP
I want you to have comfort, but try to leave a little bit of centrals. They are under 2 and you have essentially the same for obstructive events. Lowering EPR will likely increase your obstructive events.
This is an exercise in balance. All the actions to reduce centrals have a tendency to increase obstructive events.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#10
RE: Please help with dealing with central apnoeas due to CPAP
Thank you for both of your advice. Here is my stats for last night. Fitful sleep (got an exam in the upcoming week).

Would you increase the Max pressure to overcome any potential apnoeas? It seems like a pattern where there are times where I get really obstructed but am fine other times.
EPR at 2. Ramp off. 

Would love your suggestions!


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