RE: Second night on APAP, lots of Central Apneas, is this normal?
(02-27-2021, 09:11 AM)Sleeprider Wrote: Teccrc be sure to include the chart that shows the full-night so we can see the relationship of events to pressure, and what your results actually were. If fixed pressure at 8.0 was uncomfortable, the fixed at 7.0 would be my next preference as fixed pressure is going to do better for most people at mitigating centrals.
Ok, I forgot to put the SD card back in for my first night on constant 8.0 pressure. I tried 8 again last night, here is the results from that:
and here are the results from the previous night with 7-10
RE: Second night on APAP, lots of Central Apneas, is this normal?
When doing your flow rate zoom, try to include a 3-minute segment. You are under 1-minute and a longer picture will give a better ideal. Your central event index has not improved with fixed pressure. Your events are entirely central. If you do not get the restful results you hope for from therapy, you will likely need ASV, and I think the way to approach this is a change in diagnosis to complex or central sleep apnea and a clinical titration that starts with CPAP and evaluates ASV. Your titration test found a lower AHI which was also all central. As you can see on your chart, there are periods of centrals and periods that are free of events. That is a common pattern, but there is nothing we can expect from CPAP that will change it. The AHI will stabilize over time and either justify more advanced therapy or not. You will need to keep your doctor involved if you want better therapy.
You can try using EPR, but I suspect that will increase the CAI. That would tell us if the central events have a relationship to your CO2 levels causing pauses in breathing. If the event rate rises with EPR, then it is possible you might benefit from enhanced expiratory rebreathing space (EERS) which moves the vent farther from the mask and allows a small segment of tube to be used for storage and rebreathing of exhaled air. We have a wiki on that topic if you're interested. Trying EERS will show us your responsiveness to ventilation and CO2 if you want to try it.
RE: Second night on APAP, lots of Central Apneas, is this normal?
Thank you for all your help on this. I did reduce the pressure to 7.0 last night and there are quite a few less centrals. The problem is, I don't know if this is because of reduced pressure or eliminating supplements I'm taking. I'm kind of afraid that I may have caused this myself. I just don't see based on SleepRider's last response that lowering the CPAP pressure would have reduced the centrals so much. This may be out of the scope of this forum, but I feel the need to share this in hopes of possibly helping others in the future.
Primarily what I'm concerned with is Kratom, which I was taking in powdered form (Kratom is a plant in the coffee family) daily for the last 2 years for pain. I stopped taking this on Friday evening 2/26. This has exploded in popularity over the last few years. I've been pouring over literature on central sleep apnea and found some interesting studies regarding Opioid induced sleep disordered breathing, specifically central apnea. Kratom is not typically considered an opioid, but some of the alkaloids are partial μ-agonists and meta studies suggest that even partial μ-agonists can cause sleep disordered breathing. There are also several studies that conclude stopping the use of the opioid stopped central events.
There are no studies on Kratom causing sleep disordered breathing, and maybe last night being lighter on CA events was a fluke, but I'm going to continue logging CPAP data to see what happens. I don't see any other reason these CA events would just suddenly reduce, and I don't have any other health issues that I know of that could be the cause of the centrals.
RE: Second night on APAP, lots of Central Apneas, is this normal?
Looks much better regardless of whether the change is related to the supplements or pressure. Once you get further along with this, it may be a good idea to circle back to a thread dedicated to the subject of Kratom. It's an interesting theory and a thread with that in the title might get some input from others with experience.
RE: Second night on APAP, lots of Central Apneas, is this normal?
Just posting here to document...
Night of 1/23: 6.30 CA/H (initial sleep study)
Night of 2/10: 4.24 CA/H (titration)
Night of 2/26: 8.80 CA/H (Stopped Kratom)
Night of 2/27: 9.48 CA/H
Night of 2/28: 2.06 CA/H
Night of 3/1: 2.98 CA/H
RE: Second night on APAP, lots of Central Apneas, is this normal?
(03-02-2021, 11:29 AM)teccrc Wrote: Just posting here to document...
Night of 1/23: 6.30 CA/H (initial sleep study)
Night of 2/10: 4.24 CA/H (titration)
Night of 2/26: 8.80 CA/H (Stopped Kratom)
Night of 2/27: 9.48 CA/H
Night of 2/28: 2.06 CA/H
Night of 3/1: 2.98 CA/H
Missed reports for some nights:
Night of 1/23: 6.30 CA/H (initial sleep study)
Night of 2/10: 4.24 CA/H (titration)
Night of 2/22: 7.20 CA/H (first night at home therapy, 7-10 cm)
Night of 2/23: 9.30 CA/H, 7-10 cm
Night of 2/24: 5.82 CA/H, 7-10 cm
Night of 2/25: 11.64 CA/H, switched to 8 cm fixed
Night of 2/26: 8.80 CA/H (Stopped Kratom, back to 7-10 cm)
Night of 2/27: 9.48 CA/H, back to 8 cm fixed
Night of 2/28: 2.06 CA/H, 7 cm fixed
Night of 3/1: 2.98 CA/H, 7 cm fixed
Certainly seems as though some events may be related to starting PAP treatment.
RE: Second night on APAP, lots of Central Apneas, is this normal?
With your low baseline AHI at your sleep study, I'd be asking if this is worth it.
03-02-2021, 05:02 PM
(This post was last modified: 03-02-2021, 05:06 PM by SarcasticDave94.
Edit Reason: edit
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RE: Second night on APAP, lots of Central Apneas, is this normal?
Hmm so what was the AHI etc. on the diagnostic?
It appears CA are here to stay if you continue therapy. I'm inclined to tell doc is not going to work. ASV would fix the CA but ...?
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RE: Second night on APAP, lots of Central Apneas, is this normal?
Back up to 9 Central per hour last night. Could not fall asleep due to mouth leak coming in and out and waking me up. Also fell asleep before putting on the mask.
Was on my back most of the time.
Should I try a pressure of 6? I'm still having no Obstructive.
RE: Second night on APAP, lots of Central Apneas, is this normal?
The problem with centrals and central hypopnea is that they are consistently inconsistent. You can make any change that feels comfortable, and I expect you will continue to see variable results. It's becoming clear that while you enjoy some improvement over your diagnostic study by using CPAP at low, fixed pressures, you will ultimately have to address your need for ASV with your doctor. If he /she does not recognize your problem is not central apnea and make an appropriate diagnosis, you will need to move on to find a doctor that does.
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