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CPAP Restart Problem - Sleepless Night - 03-18-2019
[attachment=10864]A couple of nights where my ResMed Autoset 10 APAP does not seem to come back to a higher pressure after an interruption for a bathroom break.
Is the machine not properly responding after the break or is something else going on?
Sleep was very good for the first 5 hrs (AHI 1) I woke up in an agitated state and it took some time to calm down.
After the break, sleep is very poor and I opted to remove the mask rather than continue.
This has happened before and I have continued with the APAP only to feel lousy in the morning.
I have attached last nights Sleephead screen shot.
Any thoughts would be most appreciated.
RE: CPAP Restart Problem - Dog Slobber - 03-18-2019
The events you're referring to are Centrals, the airway is clear. Autos don't increase pressure for centrals, no need.
Your flow limitations at that point are also very light.
RE: CPAP Restart Problem - Sleepless Night - 03-18-2019
So let me clarify, the machine is responding correctly to my situation.
Is there anything I can do to prevent the centrals?
RE: CPAP Restart Problem - Dog Slobber - 03-18-2019
Yes.
Don't work about them, there isn't enough of them to be a problem. And given that you had them at or about when you were awakening they may not have been real, just erratic breathing during sleep/wake transition.
I had similar Centrals, as I got my pressures dialled-in and as I got used to the machine they just gradually went away. Now I get the occasional one, but not many.
Now, your minimum pressure, I don't like that.
Your machine is living at 11 all night anyway, just move it there. Your machine always wants to get down to the minimum and likely missing events trying to get there or responding to slow.
RE: CPAP Restart Problem - Sleeprider - 03-18-2019
Sleepless, have you ever tried EPR?
RE: CPAP Restart Problem - Sleepless Night - 03-18-2019
I have used EPR early on but everything I read said I should turn it off and just get use to the pressure.
What are your thoughts on Dog Slobber's suggestion to just go with a constant pressure of 11.
I have tired it in the past at a higher pressure but there was increased leakage and mouth bubbles that were annoying.
Lately (on auto) I am seeing more lowering & variability of the max pressure. Earlier I would ride out the whole night with very little fluctuation at the max pressure.
RE: CPAP Restart Problem - Sleeprider - 03-18-2019
Sleepless, EPR is limited bilevel pressure. In addition to being more comfortable, it can treat flow limitations and hypopnea. It can also increase central apnea count. Your chart suggests to me you would benefit from using EPR to reduce the flow limitations, pressure changes and the hypopnea. I wrote the Flow Limitation wiki, and included examples of members that have achieved improved results by using EPR and pressure support (the difference between IPAP and EPAP). http://www.apneaboard.com/wiki/index.php?title=Flow_Limitation
It is a well-known and accepted therapeutic application. If you find EPR comfortable and it doesn't significantly increase CA events for you, I think it's something you should consider.
RE: CPAP Restart Problem - Broomstick - 03-18-2019
(03-18-2019, 05:33 PM)Sleeprider Wrote: Sleepless, EPR is limited bilevel pressure. In addition to being more comfortable, it can treat flow limitations and hypopnea. It can also increase central apnea count. Your chart suggests to me you would benefit from using EPR to reduce the flow limitations, pressure changes and the hypopnea. I wrote the Flow Limitation wiki, and included examples of members that have achieved improved results by using EPR and pressure support (the difference between IPAP and EPAP). http://www.apneaboard.com/wiki/index.php?title=Flow_Limitation
It is a well-known and accepted therapeutic application. If you find EPR comfortable and it doesn't significantly increase CA events for you, I think it's something you should consider.
Why would EPR (limited bipap) cause more centrals? Isn't the next step, for people with centrals, to try bipap?
RE: CPAP Restart Problem - Crimson Nape - 03-18-2019
(03-18-2019, 10:35 PM)Broomstick Wrote: Why would EPR (limited bipap) cause more centrals? Isn't the next step, for people with centrals, to try bipap?
EPR can cause CO2 washout, thus triggering Centrals.
RE: CPAP Restart Problem - jaswilliams - 03-19-2019
(03-18-2019, 10:35 PM)Broomstick Wrote:(03-18-2019, 05:33 PM)Sleeprider Wrote: Sleepless, EPR is limited bilevel pressure. In addition to being more comfortable, it can treat flow limitations and hypopnea. It can also increase central apnea count. Your chart suggests to me you would benefit from using EPR to reduce the flow limitations, pressure changes and the hypopnea. I wrote the Flow Limitation wiki, and included examples of members that have achieved improved results by using EPR and pressure support (the difference between IPAP and EPAP). http://www.apneaboard.com/wiki/index.php?title=Flow_Limitation
It is a well-known and accepted therapeutic application. If you find EPR comfortable and it doesn't significantly increase CA events for you, I think it's something you should consider.
Why would EPR (limited bipap) cause more centrals? Isn't the next step, for people with centrals, to try bipap?
The Bipap can cause CO2 washout increasing CPAP emergent centrals, but remember this process has been agreed with insurance so we have to pay thousands on another sleep test and machine trial before to get the Bipap which dose help some users, then yet another sleep test to then get a prescription for the correct machine an ASV if the user has complex sleep apnoea. An ASV is still a Bipap it just has a backup rate