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+--- Thread: new to cpap - waking up and central apneas (/Thread-new-to-cpap-waking-up-and-central-apneas)
new to cpap - waking up and central apneas - chavill02 - 02-10-2022
Hello,
I was diagnosed with OSA and have been on cpap for a few weeks. I'm struggling with constantly waking up and my OSCAR data shows central apnea events around the time I'm waking. Sometimes when I wake, I can't fall back asleep for 1-2 hours (I seem wide awake until I eventually get tired again). I'm definitely more tired during the day than before starting cpap. The cpap has helped bring my OSA events down to zero, but it's causing these other issues.
Is there a correlation between central events and waking up? Any advice on what I should do? I've read about an EERS modification, so am considering trying that.
Here are some OSCAR charts attached.
I'm using the Airsense 10 auto cpap. Pressures 6-12, no EPR, ramp off.
Thanks!
RE: new to cpap - waking up and central apneas - Dormeo - 02-12-2022
It can take a while to get used to the machine, so you’ll need some patience.
The CAs may be occurring after a brief arousal; if that’s what’s going on, the arousal rather than the CA is the problem.
You have a fairly active flow limitation graph. FLs are limitations on the flow of air through the airway. They are sometimes in the nose and often in the pharynx. They may not be interfering with good sleep at all, or they may be causing extra and disruptive effort as you inhale.
The best way to treat them is by using EPR. Start by turning on EPR at 2. The machine will drop your pressure by 2 when you exhale; by the same token it will increase your pressure by 2 when you inhale. That will help to overcome FLs in the pharynx.
Try it for a night and then post your daily chart so we can see how it went. Some further adjustments might then be appropriate.
RE: new to cpap - waking up and central apneas - staceyburke - 02-12-2022
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.
RE: new to cpap - waking up and central apneas - chavill02 - 02-13-2022
I tried EPR 2 earlier this week. It brought the flow limitations down a bit. However, I had more central apneas. See attached. I also seemed more tired the following day than compared to when I didn't use EPR.
I had read some info about using an EERS modification (on the mask) to reduce central events. Should I try that while trying EPR again?
Thanks.
RE: new to cpap - waking up and central apneas - Dormeo - 02-13-2022
The number of CAs you are experiencing isn't at a level that makes them problematic. I'd recommend trying EPR of 1 and sticking with it for a week. Sleep is variable from one night to the next, and CAs are notoriously variable. You need to see more than one night's worth of information to make good decisions.
Have you zoomed in to see whether you're having arousals before the CAs? They will look something like this:
RE: new to cpap - waking up and central apneas - chavill02 - 02-13-2022
Gotcha. I'll try EPR 1 for a while and see how that goes.
Here are a few attachments of the flow rate with CAs happening. Some of them show a steady flow rate, then a CA. Others show the flow rate getting weird, then a CA (or multiple CAs). Do you know the difference with these? Do some indicate I'm waking up, then having the CA? And others are the CA is waking me up? How do you make sense of the 3rd one with multiple CAs in a row?
Also, what is a good number for flow limitations? I have some congestion in my nose while sleeping, so wonder if that's causing high flow limits. I'm talking with an ENT and considering nasal surgery possibly to help.
Thanks.
RE: new to cpap - waking up and central apneas - Dormeo - 02-13-2022
Ideally your 95% FL number would be 0. All three of the zoomed-in views show irregular breathing patterns consistent with mini-arousals. It's clearest in shot #2 but discernible in the other two as well. In #3 you are having a little spell of "periodic breathing." Nothing to worry about in the least. It starts off at around 2:00:30 with arousal breathing. Then you do some deeper recovery breathing, which leads to a dwindling, which is then followed by recovery breathing, etc. The CAs are part of that pattern.
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.
RE: new to cpap - waking up and central apneas - chavill02 - 02-13-2022
That makes some sense.
On a side note, my recent sleep studies show an AHI 5 and RDI 14. With a higher RDI, does it make sense that I'm having multiple arousals throughout the night but they aren't showing as "AHI arousals" on Oscar?
RE: new to cpap - waking up and central apneas - Dormeo - 02-14-2022
Yes, that would be possible.
RE: new to cpap - waking up and central apneas - CorruptAlligator - 02-14-2022
I had the same issue as OP, and I believe the autoset mode was disturbing my sleep.
I have it set on fixed CPAP pressure that doesn't cause OAs, and I don't wake up for long periods anymore unless I have to go pee. I go back to sleep much quicker.
Another change I made is strict sleep hygene. I wake up at the same time everyday, and I use bed for sleep only. Anything else, off the bed.
Take a look profile on what I use. I have same level of FL and that wasn't the case of sleep disturbance. It was the auroset moving pressures up and down.
Try fixed pressure with EPR of 3 so you can breath easy. If CA increases that means your body is getting more O2 than it's used to and it will settle down with continual use of the saame pressure use.
It took me a year to figure this out on my own. When I just took the step to experiement with fixed pressure was the big step forward.
My pressure is low enough to not cause mouth leaks and OAs. That is my correct CPAP pressure. FL at undee 1 doesn't matter. I also don't think Resmed's FL is all that precise anyhow. Ixm starting to think this board focuses on FL mkre than necessary.