Central apneas and tips to improve CPAP therapy

[jcp519]

I tried the new settings, definitely had more centrals than what I typically have, but the flow limits dropped significantly. Despite the higher AHI, I feel more awake today, with much brain fog than usual, but still a little tired. I woke up around 5:20am and took my mask off for a bit. Then I put it back on for the rest of the morning, but I couldn't really fall back asleep fully. Seems like that was why there were lots of CA events in the last part of the night.

Any other suggestions for now? Or should I just let the settings be for a little while?

   

[Sleeprider]

How your feel wins over the AHI. Centrals are not particularly disruptive to sleep or stressful to your body. They occur because your respiratory needs are met and the biochemical feedbacks that drive respiration allow respiration to slow or pause momentarily. You will find most of these are short and breathing resume gradually without big recovery breathing like you see with obstructive apnea. With bilevel, we could make the machine trigger with less uflow and stimulate a breath during these pauses, but with the CPAP we just have to wait for your body to adapt to the improved ventilation and lower CO2. There is a hack called enhanced expiratory rebreathing space (EERS) that can stabilize CO2. There is a wiki on that topic.

[jcp519]

I will look into EERS hack on the wiki. I just checked and you are correct that most of the CAs are 10-15 seconds without a huge jump in breathing. I may talk to my doctor about looking into a bilevel device if the problems persist. I'll post updates as things continue to change.

On another note, its interesting to learn the science behind what is happening in my body. I work as a scientist at a sleep device company so dealing with this myself has certainly given me a new appreciation for all the work that goes into designing the machines.

Again I appreciate all your help with this. Its definitely improving my sleep!

[Sleeprider]

There is also a wiki on Respiratory Drive that gets into more details of feedback loops, apneic breathing and therapy onset central apnea. You seem like someone that can fully grasp the article and apply it in your conversation with the doctor and your own therapy. https://www.apneaboard.com/wiki/index.ph...tory_Drive

[jcp519]

Thank you for the info. I'll give it a read in my spare time. 

I plan on building an EERS and just ordered a few parts to do it. We'll see if it makes a difference in my case or not. I may end up starting another thread to put together a nice write-up for others to follow how to build it and how the EERS titration goes.

[jcp519]

Wanted to give an update on how the changes went on the second night.

All I can say is WOW. I haven't felt this well rested in at least 10 years... and I'm in my mid 20s. No trouble at all getting out of bed early in the morning either. I wasn't tired even once during the day until it hit 7-8pm. No more feeling like I just got out of a boxing match. I feel terrible for the people that didn't get treatment until much later in life.

Centrals are still there, no surprise, but less than the day before. Seems my pressure never really need to go much above 8.5 cmH2O most of the night, which was much more comfortable than before when the pressure would jump around everywhere.

I'm excited to see if the EERS is able to resolve the rest of the CAs, once the parts come in. It would be nice to see an AHI of under 2 for the first time since starting CPAP.


   

[jcp519]

Another update:

Had a slightly worse night than the day prior, but still feeling alright today. Certainly better than before.

Seems like my body wants to take me up around 5:45-6 the past few mornings. Had a zone where I took of the mask and then put it back on after around 10 mins, then got an episode that the machine labelled as CSR. I'm going to guess that the machine calls it CSR, when its actually just periodic breathing. I'm young, relatively fit, and don't have any signs of heart issues so it looks like periodic breathing for around 18 mins 30 secs, with apneas lasting around 15 seconds each. It does seem to disturb my sleep slightly as I'm not quite as well rested as I was.

This is not true CSR, correct? If not, and its PB breathing caused by treatment emergent CA, what would help to correct this? Would a decrease in EPR from 3 to 2 help alleviate this? Would an EERS also help with this by maintaining my blood CO2?


           

[Sleeprider]

Centrals are there, but glad you're feeling a lot better. It will be interesting to see how EERS works out. If you put together a DIY report on setting it up, I'll include it as a link in the wiki. Two other alternatives exist. Moving to bilevel like the Aircurve 10 Vauto lets us set a high trigger which switches the machine to IPAP pressure with minimal spontaneous flow. This pressure increase is often enough to stimulate a spontaneous breath where a central might otherwise occur. The gold standard for CA is the ASV. We have had some good success with EERS, so I'm glad to see you pursuing that option.

[jcp519]

I'll certainly try to make a nice write up for the EERS when I get the supplies.

It took me 2.5 months to get a cpap with very obvious sleep apnea symptoms because my doctor and DME took forever to do anything. I'm contemplating taking things into my own hands instead of waiting for another useless sleep specialist to give me the run around for another few months. (Seems to be a trend from reading the forums)

If I decided to get a used ASV without a prescription by buying one off of facebook/craigslist, are their any things I need to worry about? I managed to find a few available for $500-$700. Are their any risks for using an ASV other than the less than reliable information about LVEF?

[Sleeprider]

The whole risk of ASV is completely unwarranted for individuals not diagnosed with severe heart failure, and newer ongoing HF trials suggest the excess deaths in the HF-SERVE study cannot be replicated in a study with better methodology for titration and patient compliance. Anyway, you're in good company with a lot of members here using ASV successfully. Probably the biggest obstacle is initial sleep disruption from changing pressure with new users. The machines achieve near zero AHI. You are kind of borderline as to whether to consider it, but you would be event-free. Most people using ASV for therapy onset central and complex apnea get effective treatment with a much lower pressure support range than the defaults.