new to cpap - waking up and central apneas

[mper6794]

I don’t think your centrals are the problem - it looks like your flow limits are to high. Flow limits are apnea also and it is treated using Epr (exhale relief pressure). To use EPR need to raise the min to 7 and EPR on full time. EPR seT at 3. 

This could raise the centrals and we could need to back of EPR   We won’t know till you try the settings.

Hi,
agree upon, FL all night long as likely the main culprit......at least FL, to beggining with, would have to brought down to zero (p95), ( maximum < 0,1). Later on, what remains would be seen. However, it would be very  unlikely OP would succeed with only EPR (in 4 years, I am afraid I have seen one or two cases in this Forum person succeed on controlling FL with EPR (pressure support) < 4.0.

all the best and luck

[pholynyk]

>>>in 4 years, I am afraid I have seen one or two cases in this Forum person succeed on controlling FL with EPR (pressure support) < 4.0.

Please add me in to your count . On the two occasions in the past year when I set EPR off, my Flow Limitations were 0.17 and 0.21. With EPR = 3, my FL is usually 0.04 or 0.05. Not perfect, but well controlled, to the point where my doctor saw no need for a bipap sleep test.
Chasing zeros has to be balanced against the cost involved.

ETA - Those are my 95th percentile values; the median is always zero (therefore useless).

[Crimson Nape]

Count me as a plus 1 for EPR, by reducing my Flow Limits to a livable range. I attribute the EPR option for providing a positive therapy.

[chavill02]

Thanks for the responses.  

So, I will keep trying the machine with an EPR of 1-3 setting to see if FLs will drop down.

If that doesn't help (or if it increases my arousals), then should I do a split night sleep study with titration?  The doctor recommended doing that.  After the split night study, does it then put me on a bipap or some other machine at a set cpap pressure all night?

Thanks.

[Sleeprider]

A "split-night" titration typically refers to a study divided into a diagnostic portion to qualify you for insurance coverage (or not), followed by a titration using CPAP. In your case it may be a split titration between CPAP and bilevel or preferably ASV if centrals are present. You should clarify with your doctor his plan for the study. If it does not include ASV or at least bilevel with a backup rate, it is not going to resolve the centrals.

I don't think you have exhausted the potential for self-titration on CPAP yet. Your periods with central apnea appear to also be associated with flow limitation. We could look closer at events, but I strongly suspect your mild therapy onset centrals are actually arousals caused by the flow limitation, and it will be improved by using the EPR that many have recommended above.

[SevereApnea]

Hi chavill02

I agree with all the comments above.

I can see on your charts your starting minimum pressures are well below your achieved Median and 95 centile pressures.
Is there a reason your pressures are so low?

For my own part I have less FL when I increase my minimum starting pressures.
And I have less CA when I increase my minimum starting pressures.
Just like you, I use a nasal pillow mask.

Dormeo has mentioned (post #7 and elsewhere in the forum if I remember correctly) that she thinks EPR does not work as well at reducing FL due to Flow Limitations. nasal congestion.

Have you tried increasing the Minimum pressures to above 6.0 yet?

As CorruptAlligator indicated in post #10 the pressures are more stable on fixed CPAP for them and this causes less arousals.

If you can stabilise your FL a bit more with higher Min Pressure (with whatever level of EPR is best for you) then you just might have less pressure excursions and less arousals.

Something else to try for a week or so?

[Dormeo]

Just to clarify, here’s the point I was making:

“Yes, nasal congestion could contribute to FLs. But I think FLs due to nasal congestion don't really respond to EPR. Your good response suggests that your FLs are at least in part due to relaxation of tissues lining your pharynx.”

There may have been a typo in SA’s post above.

[SevereApnea]

Hi Dormeo, thanks for pointing that out, duly corrected!

[chavill02]

Hi chavill02

I agree with all the comments above.

I can see on your charts your starting minimum pressures are well below your achieved Median and 95 centile pressures.
Is there a reason your pressures are so low?

For my own part I have less FL when I increase my minimum starting pressures.
And I have less CA when I increase my minimum starting pressures.
Just like you, I use a nasal pillow mask.

Dormeo has mentioned (post #7 and elsewhere in the forum if I remember correctly) that she thinks EPR does not work as well at reducing FL due to Flow Limitations. nasal congestion.

Have you tried increasing the Minimum pressures to above 6.0 yet?

As CorruptAlligator indicated in post #10 the pressures are more stable on fixed CPAP for them and this causes less arousals.

If you can stabilise your FL a bit more with higher Min Pressure (with whatever level of EPR is best for you) then you just might have less pressure excursions and less arousals.

Something else to try for a week or so?

I could try increasing my min pressure, or using the same min/max pressure to see how it helps.  I've just kept it at 5 min pressure since that's what the prescription shows.  

With using EPR, do I need to increase the min or max pressures to offset EPR?  How does that work?

[chavill02]

A "split-night" titration typically refers to a study divided into a diagnostic portion to qualify you for insurance coverage (or not), followed by a titration using CPAP.   In your case it may be a split titration between CPAP and bilevel or preferably ASV if centrals are present.  You should clarify with your doctor his plan for the study.  If it does not include ASV or at least bilevel with a backup rate, it is not going to resolve the centrals.

I don't think you have exhausted the potential for self-titration on CPAP  yet.  Your periods with central apnea appear to also be associated with flow limitation. We could look closer at events, but I strongly suspect your mild therapy onset centrals are actually arousals caused by the flow limitation, and it will be improved by using the EPR that many have recommended above.

I'll find out more about the split-night titration from my doc.  

When you say "exhausted the potential for self-titration on CPAP", do you mean trying to figure out the best pressure on my current machine myself (before doing the split-night study)?

Also, someone had mentioned that my central apneas appear shortly after an arousal (based on my flow rate chart showing my breathing changing right before the central apnea), and that there isn't a big issue with those.  Does that mean the central apneas aren't "bad"?  The OSCAR data shows some of the central apneas as 10 seconds, while quite a few are still 20-25 seconds long.  That still seems bad to be holding my breath for that long.  

Thanks.