Stubborn Centrals

[sheepless]

something to keep in the back of your mind: plm complicates cpap use and some ca may be related to plm.

I was dxed with central apnea many years ago. with age and weight gain I developed obstructive apnea as well. during 3 years trying apap, asv and vauto, I've learned that I also have plm which in respiratory terms results in a sharp inhale, frequently associated with a grunt or moan, followed by some relatively flow limited breaths. the machines tend to ineffectively and disturbingly drive pressure up against these non-passive flow limitations.

long story a little shorter: I have come to think many of my events, especially ca, occur during and are caused by plm episodes. even with the highest allowed dose of ropinirole, I still have plm occasionally most nights (shorter in duration and maybe intensity than without the medicine). I'm not aware of the plm but have learned to see it my respiratory response in the flow rate.

no cpap can treat plm and the resmed machines' (the only brand I've owned) response to these non-passive flow limitations can be quite disturbing to sleep.

lately I've been going back and forth between the asv and vauto trying to decide which is better for mixed apnea and plm. fewer disturbing pressure fluctuations are possible with vauto but ahi is higher. ahi is much lower with asv but swinging pressure support (of which I'm usually unaware, except when they contribute to leaks) can be exhausting.

hopefully your plm is well controlled and none of this applies (although I don't know how one could know without video or closely scrutinizing the flow rate for periodic patterns), but it might be useful info to be aware of as you optimize your apnea treatment.

[kevrx]

My Central ahi has been very sporadic.  I think to keep it so I can breathe,  I will try to tweak my pressures with EPR 2 and see if I can get my centrals down to a decent number.  To keep my o2 sats up I will try a min of 9 up to 12 to start and maybe pull back to 11 max to see if it improves.  I may even try cpap around 10.  If I can't minimize the centrals enough, I could pursue an ASV machine.  I do wonder if some of the centrals are plmd related or due to struggling to breathe or from when I wake up.  Hopefully my body could adjust to this setting.  I know it is not used to breathing well at night and snoring a fair amount.

The chart was not showing ipap because I turned it off trying to compare the number of centrals to the epap pressure from different days when I used different EPR's.  I will change the settings back.  I will upload some of my results to see if anyone has any thoughts on how it is going.

Thank you,

Kevin

[kevrx]

All,  I am posting my last night's OSCAR graphs.  It was one of the best nights I have had since starting last December.  My average o2 sat was 97% with a low of 91%.  It has never been above 95%.  With my original settings of EPR 1, it was always around 89-90%.  Although, when I turned EPR completely off, the central index was lower, but I slept terribly and felt terrible the next day.  I couldn't make it through the whole night.  The AHI last night was one of the lowest I have had.  It seems that when I increased the EPR above 1, my o2 sats got better to around 94-95% even if my central #'s was still somewhat high.

Could anyone help me determine if a change in the min or max pressure may dial me in more?  Does anyone notice anything about the centrals that would give me a clue as to why or when they are happening?  They may be idopathic; however, I think the settings worked pretty well for me at least for one night.  I know they can be sporadic.

I would appreciate any thoughts regarding my situation.  Although I feel much better, it seems that it would be nice to try and lower the number of centrals.

Sincerely,
Kevin

   

[Sleeprider]

Kevrx, I'm going to suggest fixed pressure with no EPR as a possible solution. I'd like to stay in Autoset mode, but just use a fixed pressure of 9.0 (same minimum and maximum pressure). If you comfort demands, the EPR 1 is okay. Fixed pressure can help us to sort out most effective therapy pressure and sort out exactly where you need to be. The pressure changes can make CA worse and cause arousals in sensitive individuals. Fixing the pressure lets us know whether we need to prioritize CA (lower pressure) or OA (increase pressure).

[Gideon]

Centrals very often are consistent, that is they are consistently inconsistent!! That is to say that you can expect them to be all over the place. They will get you to think that you finally have them under control and then flare up again, fo no apparent reason. The way to make them consistent is to use an ASV machine. That will make them consistent and near-zero once adjusted.

[kevrx]

Sleeprider,

I do have a night of fixed pressure at 8 with and without EPR.  Would this help?

   
   

[kevrx]

Bonjour,

I will have to bring up the ASV machine with my MD when I see him next.  They definitely had my machine set too low to begin with and it wasn't doing anything for me.  Since I have made a few changes, I have been feeling better and my o2 sats have improved, but like you said, the centrals are very unpredictable.

Thanks,

Kevin

[SarcasticDave94]

Try this, stay at Autoset and plug in 9 for both pressures and consider trying no EPR. An ASV would be really the best if you can do some effective complaining IMO.

[Sleeprider]

I seem to recall we stayed with fixed pressure for quite a while.  I'm all down with ASV.  If all else fails, there are some hacks published that will let you convert your machine to ASV for about $50.  Jaswilliams just modified his machine.

[kevrx]

Thanks.  I will try a fixed pressure but I think I would like to try it with EPR 2 for tonight.  I have felt so much better with EPR 2.  Maybe over the weekend I will try a lower EPR or off.

I appreciate your suggestion.

Kevin