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Why a sudden increase in central apneas?
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onsonby Offline

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Posts: 19
Joined: Jun 2013

Machine: Philips Respironics System One 750P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX Medium
Humidifier: Philips System One
CPAP Pressure: Bi-Level: E:10, I:20
CPAP Software: SleepyHead

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Sex: Male
Location: Texas

Post: #1
Why a sudden increase in central apneas?
Over the past two days, my "Clear Airway" events as reported by SleepyHead -- which I think are basically central apneas -- have shot up. They've gone from around 5/hr (sometimes as low as 1, sometimes as high as 10), to the last two nights of a 49/hr and a 62/hr. The change corresponds (although I can't say for sure this is the cause) with my machine provider changing my settings from CPAP@19 back to their original Bi-Level@10:20 (because the CPAP@19 was uncomfortable).

Anyone any ideas why centrals could go up like that? I'd have thought the move from CPAP@19 to Bilevel@10:20 would have, if anything, made centrals go down, but certainly not up.

thx
06-24-2013 06:29 PM
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zonk Offline

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Machine: A10 AutoSet
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Sex: Male
Location: Australia

Post: #2
RE: Why a sudden increase in central apneas?
The discussion in this thread might helps
http://www.apneaboard.com/forums/Thread-...ring-Sleep
06-24-2013 06:35 PM
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onsonby Offline

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Posts: 19
Joined: Jun 2013

Machine: Philips Respironics System One 750P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX Medium
Humidifier: Philips System One
CPAP Pressure: Bi-Level: E:10, I:20
CPAP Software: SleepyHead

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Sex: Male
Location: Texas

Post: #3
RE: Why a sudden increase in central apneas?
(06-24-2013 06:35 PM)zonk Wrote:  The discussion in this thread might helps
http://www.apneaboard.com/forums/Thread-...ring-Sleep
Thanks Zonk, that's describing my experience pretty much exactly. But it goes against the reasoning behind my original titration (where they said CPAP was inducing centrals so they put me on a BiLevel for ongoing treatment). Hard to know who is right, but based on my current experience, something needs to change.

I guess I'll have to wait until I see the sleep doc and see what he has to say about it all.

Again, thanks for the info.
06-24-2013 07:38 PM
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Shastzi Offline

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Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #4
RE: Why a sudden increase in central apneas?
I used to have a lot more CA events while on the QuattroFX too.
I tried the FitLife total FM and that cleared a lot of them up.
(my eyeballs were getting pressurized from the backside too.. not comfy)
I imagine because that bigger mask has a lot more dead space and accumulates a bit of CO2
that helps stimulate breathing just enough.

Any studies on this, anyone?

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
06-25-2013 07:43 AM
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onsonby Offline

Members

Posts: 19
Joined: Jun 2013

Machine: Philips Respironics System One 750P
Mask Type: Full face mask
Mask Make & Model: ResMed QuattroFX Medium
Humidifier: Philips System One
CPAP Pressure: Bi-Level: E:10, I:20
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Texas

Post: #5
RE: Why a sudden increase in central apneas?
Last few days of data. Hardly a robust clinical trial but seems to match what that paper is saying. CPAP pressure is 19, BPAP (BiLevel) is 10:20

Code:
Day 1 - CPAP: OA/hr =  5.29, CA/hr =  4.78
Day 2 - BPAP: OA/hr =  8.57, CA/hr = 48.96
Day 3 - BPAP: OA/hr =  6.67, CA/hr = 61.55
Day 4 - CPAP: OA/hr = 10.45, CA/hr =  5.16
06-25-2013 08:18 AM
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Shastzi Offline

Advisory Members

Posts: 1,174
Joined: Dec 2012

Machine: ResMed S9 Autoset
Mask Type: Full face mask
Mask Make & Model: FitLife Total face mask
Humidifier: F&P HC150 with Hybernite heated hose.
CPAP Pressure: 15cm-20cm H2O (auto)
CPAP Software: SleepyHead Other Software

Other Comments: CMS50-F wearable Oximeter; Software: SPO2 Assistant

Sex: Undisclosed
Location: Florida, USA.

Post: #6
RE: Why a sudden increase in central apneas?
Can you use that thing in APAP mode?
That might get those numbers down by letting the machine try and "figure you out".

Wink

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
06-25-2013 10:01 AM
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mageon Offline

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Joined: Feb 2014

Machine: S9 VPAP Adapt
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Sex: Male
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Post: #7
RE: Why a sudden increase in central apneas?
C-PAP machine also made my central apnea shoot up as well. I found that the s9 VPAP Adapt work best for me. It figures out what is best for you.
02-07-2014 12:01 AM
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JWR Offline

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Posts: 455
Joined: Sep 2013

Machine: DreamStation DSX700 , PR 760 bipap auto
Mask Type: Nasal mask
Mask Make & Model: Resmed mirage FX
Humidifier: DreamStation DSXH , system one
CPAP Pressure: min EPAP = 17.5max IPAP = 21
CPAP Software: SleepyHead

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Sex: Male
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Post: #8
RE: Why a sudden increase in central apneas?
I'm on board with let the Auto see if it can find the right setting for you . Also remember if you sleep on your back the numbers usually go up move to your side they usually go down . Point being The auto can change with you and find that sweet spot . my auto found my sweet spot , most mornings when I check the #s are around .14 to .59 AHI and maybe 1 CA a night . Dreaming

02-07-2014 12:27 AM
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eviltim Offline

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Posts: 408
Joined: Aug 2013

Machine: Resmed S9 VPAP
Mask Type: Full face mask
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CPAP Pressure: 5 exhale/9 inhale
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Sex: Male
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Post: #9
RE: Why a sudden increase in central apneas?
Sounds like the other guys have a good explanation, but just a shot in the dark -- have you been drinking or taking medication? That can also do it.
02-07-2014 01:29 AM
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igdoc Offline

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Posts: 13
Joined: Feb 2014

Machine: PR S1 Bipap ASV Advanced 961
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
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CPAP Pressure: EPAP 7.5. PS 0 to 7
CPAP Software: SleepyHead EncoreViewer EncorePro

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Sex: Male
Location: England

Post: #10
RE: Why a sudden increase in central apneas?
New to this forum but not new to this. The increase in clear airway events is indeed due to reverting to bilevel. The explanation is that on bilevel the large pressure difference between inspiration and expiration is causing hyperventilation induced central events. The hyperventilation is lowering your CO2 levels below your apnea threshold causing you to reduce or stop breathing (unless your machine has a backup rate). After a short period (maybe 25 seconds) your breathing will restart and hyperventilation returns and the whole cycle starts again. Most people are not prone to this but unfortunately (like myself) you are.

One solution is to have a bilevel machine with a backup rate which stimulates breathing when the apnea occurs (but is not good for the already low CO2 levels). Reducing the pressure difference between inspiration and expiration will reduce the central events but a big change would be necessary. The best treatment is an ASV machine which will help both the hyperventilation and the hypopneas/apneas. Alternatively you can go back to CPAP if you can tolerate it (preferably at a lower pressure just enough to control obstruction) and without too much expiratory relief (CFLEX). If the expiratory relief is too high this will also cause hyperventilation central events.

I don't know if any of these suggestions are going to useful but hopefully understanding what is going on may help your discussions with your doctor. Good luck.
02-07-2014 03:51 AM
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