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Request for Assitance with Central Apneas/Desats
#1
Request for Assitance with Central Apneas/Desats
Greetings All,

First my complements to all those on the boards helping apnea sufferers and developing tools like OSCAR to have insight into our treatment. I have found the medical community to be of marginal assistance regarding my sleep apnea treatment. Basically the doctor says that my AHI is good and see you next year. I am highly compliant with a AHI of .5 to 1.50 but continue to be fatigued. Additionally, I have noticed lately that I am beginning to get clusters of central apneas. Last week my AHI was elevated from 7.50 to 14 with a significant amount of centrals in a short time period. Last night I was back to AHI of 1.50. My sleep doctor ordered a oximeter study but working with the DME is quite a challenge and the study has yet to be accomplished. I went out and purchased a Wellue O2 ring and noticed that I am desating down into mid 80s a couple times a night plus my heart rate is dropping into the low 50s early in the morning. I have been tinker with the minimum pressure settings (8 to 5) and EPR (3 to 2) in the past day or two to see it has any effect but no real change. I am meeting with my sleep doctor next week and any thoughts or assistance world be greatly appreciated.

Gratefully

Hobbes42

[attachment=20551][attachment=20552]


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#2
RE: Request for Assitance with Central Apneas/Desats
Here is a capture from a couple days earlier before things got worse


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#3
RE: Request for Assitance with Central Apneas/Desats
G'day Hobbes42. And a belated welcome to Apnea Board.

Your numbers (on the face of it) are extremely good, so it's understandable the doc wasn't concerned. However we need to dig a bit deeper to see what's going on behind the headline AHI. First, can I suggest you turn off the mask pressure graph and turn on the flow limits graph. We see a lot of people with flow limitations which causes their breathing to be erratic and also causes the pressure to fluctuate. Can I also get you to zoom in on the period with the apneas (Sunday), so that about 10 minutes fills the screen. Likewise, can you zoom in on the period around 00:45 where there seems to be a lot of variation in the flow rate. I suspect there are a lot of near-apneas - breathing disturbances less than 10 seconds.

You have a few leak events. Although these don't go over the red line they are potentially disruptive to your sleep. Controlling leaks is important in getting a restful sleep.

Finally, you might want to increase your minimum pressure to around 7. This will allow the machine to respond more promptly to precursor events, and will also minimise the size of the pressure jumps.
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#4
RE: Request for Assitance with Central Apneas/Desats
Welcome,
Flow limits can be thought of as the junior partner for obstructive events. They are also the main driver of pressure increases on ResMed so they are important to monitor

On Centrals, what you show here is not a particular problem but is a signal to monitor them more closely. You mention much higher readings that have got my attention though.

I would like to see a 2 minute zoomed view of a couple of centrals to see what is happening and if any clues about their nature.
Also include a screenshot of your overview screen as that will show how your centrals have grown.

Centrals can be rather erratic, I frequently call it consistently inconsistent. But let's look for causes or changes.

How much playing with EPR have you done. EPR is extremely effective in minimizing flow limits and it also increases Your breathing efficiency which increases the clearing out of CO2 from the blood. Sometimes, in a few individuals, it lowers the CO2 to below the apneic threshold resulting in Central Apneas. Thus our 1st response is to decrease EPR or Pressure Support
Any meds in use especially painkillers, or anything that impacts the CNS. This includes marijuana which we are all aware is becoming legal in many locations. Head injuries, strokes and seizures?
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#5
RE: Request for Assitance with Central Apneas/Desats
Greetings DeepBreathing,

Thanks for both the welcome and taking the time to look over my charts to share your thoughts. This board and sleepyhead provided significant information on tweaking my cpap settings when I was originally diagnosed. This resulted in my ability to be as compliant as I was in the last 3 years. My biggest mistake was to try to tweak my settings to reduce the pressure from 8 to 6 to try to reduce the centrals. It seemed to improve my AHI and eliminate my centrals for a couple of days but then things have gone south as the saying goes. Here are the requested views and thanks again for the assistance.

Hobbes42


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#6
RE: Request for Assitance with Central Apneas/Desats
Happy to help..

Looking at your flow limitations graph, you'l see there is an event at 0:00, 03:00, 03:30, 06:00 and so on. At every one of these the machine jumps up the pressure to overcome the flow limitation and prevent an apnea from occurring. Looking at the more detailed charts you supplied, you can see how the shape of your breaths actually change when this happens. My guess is that these events are part of what's making you so exhausted.

I also notice there is a bit of waxing and waning in your flow rate, which can be associated with central apnea. Do you have any other conditions such as lung or heart conditions? They could be showing up in this manner.

No doubt Bonjour or Sleeprider will come in with some more detailed advice, but my suggestion would be to increase your minimum pressure and also increase the EPR to 3. These measures should help prevent the limitations and also smooth out the changes in pressure. The downside is that your breathing may become more efficient, reducing the amount of CO2 in your blood and inducing more central apneas. It's going to be a bit of a balancing trick to get things right.
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#7
RE: Request for Assitance with Central Apneas/Desats
Greetings Bonjour,

Thanks for taking the time for looking at my charts and for PMing/Testing OSCAR. Thanks for all the great advice and thoughts. I had not thought to look at the frequency of centrals over the long term. I have had a number of medical issues over the past 9 months (but nothing obviously CNS related) but I will have to revisit that. Same applies to meds but I will have to relook at that also. Regarding EPR, I have tried to dial that down from 3 to 2 to address the issues of central but I now see that the issues starts back in Oct. Hence I will have to take a look at this to see if my medical history is impacting my sleep apnea. Here are the requested screenshots and thanks again for the assist.

Hobbes42


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#8
RE: Request for Assitance with Central Apneas/Desats
Welcome to Apnea Board. My take: what others have suggested on settings, etc. are a good start. Since you're showing a below 5 AHI, we're already in the tweaking for comfort stage IMO. Yes certainly watch the numbers and graphs. They indicate setting adjustment pass or fail. Include a heavy emphasis on answering "how do you feel?" after a sleep session, and especially after any setting adjustment. How you feel is the reasoning behind adjustments now, again IMO.

Best wishes on success Coffee
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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#9
RE: Request for Assitance with Central Apneas/Desats
My impression is your CA events are related to sleep onset, disturbance, and arousals. Your settings appear to be Autoset with minimum 6.0, maximum 13.5 and EPR 2. There seems to be a tendency for your CA events to occur at the low end of that range, and your pressure does not go above 10.0 cm for any useful purpose. The strategy that works best for the events at sleep onset and arousal is to minimize pressure changes and try to minimize disruptions from changing PAP conditions. I think a very limited range of pressure from 7.0 to 9.0 would actually stabilize sleep and work pretty good. That said, your results are already pretty good, so given the inconsistency of CA events we may or may not see an actual improvement in AHI. That's my take from what we've seen so far.
Sleeprider
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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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#10
RE: Request for Assitance with Central Apneas/Desats
What happened around the 15th October was your machine settings changed, medication changed or some medical condition change as from that point forward your AHI and events have increased, this may point to a need to tweak your therapy
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