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[Pressure] central sleep apnea because of high Bipap pressure??
#21
RE: central sleep apnea because of high Bipap pressure??
On the U.S. "S" model the option below EPAP is "Easy Breathe:" On/Off.   Your menu listings show an "ST" model. The "T" stands for timed.  Strange!   Thinking-about
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#22
RE: central sleep apnea because of high Bipap pressure??
Hello everyone,
I tried sleeping on my back with 14/11 setting but i woke up feeling very hard to breathe which appears to be only 38 minutes. I felt like chocking and tight chest(full chest) sensation when I wake up so I took off the mask and slept.

Usage hours-0:38
AHI- 14.2
Total AI -7.8
Central AI - 6.3

My two unresolved concerns:
1. Is it the centrals that is making it hard for me to breathe with bipap or is it the pressure settings or Pressure Support value that needs to be tweaked to adjust better? 

2. I had only 4 centrals recorded in 7 hours in my first overnight sleep study and only 1 central recorded in the second bipap titration.
Is the IPAP and EPAP of 14/11 still too high to trigger more central apnea or is it sth else?

Anyone gone through same situiation? Please advice. I am willing to try other pressure settings as well.


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#23
RE: central sleep apnea because of high Bipap pressure??
Even though it was a short night you need to post OSCAR data to help diagnose the issue further. Based on the numbers it seems like you were having central apneas and probably central hypopneas but that is just a guess.

Some people struggle with treatment emergent central apnea even at low pressure/pressure support. They key is trying to find just enough pressure/PS to treat obstructive issues without triggering centrals. Sometimes these centrals improve and go away with time as body adjusts to using PAP, sometimes they do not though.

Since it isn't clear that you need higher pressure I would step back even further. I would change EPAP to 6 cm, PS to 3 cm and change the mode from S mode to auto (can't remember if it is just called auto, vauto or vpap auto). This will be a lower pressure setting that will increase pressure on its own as necessary to try and deal with obstructive apnea/hypopnea.

You don't need to be afraid of these new settings. From an obstructive point of view they are better then sleeping without PAP as you did last night. So sleep on your back etc as you normally would so we can collect the best info possible. Try to sleep with the machine through the night if you can.
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#24
RE: central sleep apnea because of high Bipap pressure??
Thanks geer1. I forgot to put the memory card in the machine so I don't have Oscar data. Will post again tomorrow.

I have really high number of hypopneas. Half of the counts are hypopneas and half are Osas from previous sleep studies. Very few csas.
I am starting to think that those hypopneas could be centrals because high Csas were triggered with 18/11 bipap pressure. I hope I am wrong. Question is how do they test if these hypopneas were central or obstructive? In the sleep report they are only listed as hypopneas.
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#25
RE: central sleep apnea because of high Bipap pressure??
It is hard to tell, the main way you can sometimes draw a conclusion is if they are occurring in a periodic nature like the central apneas do.

Your original sleep study was most likely obstructive hypopneas as you had lots of obstructive apnea and no central apnea. Your titration study may have been a mixture though as you had a handful of central apnea as well as mixed apnea.

Trying lower pressure will be first step and seeing how machine reacts. Then will make further recommendations based on results. In short what I/we are doing is restarting titration phase but this will be a slower process collecting a day or more of data between changes rather than changing settings ever 15-50 mins like tech did in your titration study.
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#26
RE: central sleep apnea because of high Bipap pressure??
I was able to sleep for 54 minutes this afternoon. I do not have the oscar data again as i forgot again but i have attached the picture from the machine. I tried to sleep with 6 epap and 3 PS in automode as suggested by Geer1 but felt it was too low pressure so i changed the pressure to Min EPAP of 9 with PS of 3 in auto mode MaX IPAP 14.0.
Time slept 54 min
 AHI OF 26.6
Total AI 18.8
Central AI 4.4
spont cyc 86.0%

Thanks
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#27
RE: central sleep apnea because of high Bipap pressure??
Hi everyone,
Here is the oscar data for last night sleep of about 4 hours. 
I dont know what i was thinking but i set the pressure for of EPAP 8 with PS 5 and IPAP 14.
Please help with your input.
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#28
RE: central sleep apnea because of high Bipap pressure??
I am posting last nights data of about 3 hours sleep recording. Took off mask because i couldn't use it any longer.
ResMed AirCurve 10 VAuto PAP Mode: VPAPauto
PS 5.0 over 6.0-13.0 (cmH2O)

While using Pressure Support values i considered the following two points.
1. Higher EPAP value triggers more centrals so lesser EPAP is preferred because i seem to have therapy induced CSA.
2. Higher IPAP value is necessary for reducing OSAs and Hypopneas.

I am trying to breakdown my last nights Bipap Vauto recording based on this setting with my limited understanding. Somebody please put your input if my understanding is correct or not.

I used this setting (PS 5.0 over 6.0-13.0 (cmH2O)) thinking that with PS of 5 AND the minimum of EPAP of 6 the EPAP will stay only 6 and will not go higher than 6. But i forgot to change IPAP to 11 and left it at 13. So i believe the pressure support range kept moving from (6/11) TO (8/13) ?? There could have been fewer CSA if EPAP range didnt fluctuate and was constant 6?


Attached Files Thumbnail(s)
   
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#29
RE: central sleep apnea because of high Bipap pressure??
Your high OA is most likely positional. The tell is the clustering of obstructive events.. this needs to be fixed. See the soft cervical collar in my signature. Fixing this with either pillow mods or collar will likely significantly reduce your flow Limits, hypopnoea and OA events.

Higher PS also increases Central Apnea. So lower PS to 3.
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#30
RE: central sleep apnea because of high Bipap pressure??
I will use the collar. Will set ps 3 Epap 6 and Ipap9 tonight and update.
So, higher PS and higher EPap both increases/triggers central in my understanding. 
Pillow mods are sleep apnea pillows?
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