Central Apnea Help

[winterwaveforms]

Hi ApneaBoard!

21 yr old female (BMI=23), I have been using the Resmed Airsense 11 CPAP for a week. I had 2 days where I felt a little bit better during the day but generally I am feeling just as bad as before therapy.

My sleep study showed no obstructive apneas, 4 central apneas, 1 mixed apnea, and 46 hypopneas. Prescribed pressure =  5-15, EPR = 2.

I am seeing large clusters of central events and an average of 2 obstructive events a night. Last night I turned EPR down to 1 which may have had a minor improvement but I think it's too soon to tell. I'm thinking of turning EPR off completely and/or possibly limiting the pressure to 10.

Any thoughts or advice would be appreciated

[SarcasticDave94]

Hypopnea are what I'm assuming they're attempting to treat. Does the test state the diagnosis and/or doctor recommendations? You don't need to post a shot of them, just quoting it is sufficient.

It's possible for your no Obstructive Apnea present, with a few Central Apnea, to have the Hypopnea also be somewhat based on Central events. It likely will not state this though.

My suggested edits aren't based now on specific numbers. Maybe reduce EPR to 1 though, and see if it feels OK, if it reduces CA without reducing all/any other events. You'll aim for a balance between everything being acceptably low and feeling comfortably rested.

Note while dealing with Centrals, they are on one side of the treatment teeter-totter and everything else is on the opposite end. Push one end down (attempt to treat) and the opposite end goes up. There's the requirement to balance this out.

And it's perfectly OK to say things like I don't feel better for it. This is subjective, but we need to allow for it equally with objective data. You might need to fight doc more when basing issues subjectively, and that's fine.

You have to decide what the line is determining this CPAP therapy is acceptable or isn't. If it fails your personal grade, then fight to get a different machine. Next would be ResMed bilevel VAuto that can use the Trigger setting to diminish or avoid a few more CA than the AutoSet. You might need this next. Failing that ASV actually treats CA, while no other machine is capable to combat those consistently inconsistent Centrals.

[Deborah K.]

I see a couple of things. Your start pressure is too low for most adults. I suggest you raise it to 7. Leave your high setting as it is. Aside from needing more pressure, it will narrow your setting range which can help with sleeping more comfortably.

Since you had only 4 CAs in your sleep study, your high number of CAs now are treatment-emergent and will lessen on their own as time passes. Don't worry about them.

I would make the pressure change and set your EPR to 3. It will make your breathing more comfortable and, more importantly, it will lessen flow limits. Flow limits are short, unreported apneas, and we need to keep them low. Some lower or drop the EPR to try to lower the AHI, but I think it's more important to control the flow limits, and let the CAs decrease naturally.

Good luck!

[CPUpuffer]

I've had troubles with apnea for a good while and worked with CPAP, several masks and various ways to control leakage, etc, and finally addition of O2 at night, without good or lasting stability. Another doc took a look, said my problem was primarily central apnea, took me off CPAP, and put me on 2L of O2 alone by nasal cannula, with the freedom to adjust that somewhat depending on my sleep behaviors. Since then I have been more stable than anything I ever achieved with CPAP. (I also ended up moving to a lower altitude several years later which has helped some as well.) Just a thought, might be worth looking into if central apnea is really the big bug in the works.

[SarcasticDave94]

Adding oxygen might induce more CA due to it displacing more CO2. The lack of CO2 is why some to most get treatment emergent Central Apnea.

Not saying yours were this though.

You also moved to a lower elevation, where higher elevation induces CA in some.