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Clusters of Central Apnea with BiPAP
#1
Clusters of Central Apnea with BiPAP
Hello all, 

As I had repeated flow limitation using CPAP I have switched to BiPAP. But there's massive amounts of central apneas. I've been on BiPAP for 2 months now so shouldn't any central related events disappear slow by slow. 

Can anybody please provide advice on what settings I should switch to? 
   
   
Kind Regards, 

Imti
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#2
RE: Clusters of Central Apnea with BiPAP
TECSA doesn't always go away over time. If you're on too high of a pressure, or more importantly, too high of a pressure support with BiPAP it can certainly induce them. It is the buildup of CO2 in our bodies that triggers the drive to breathe, and using CPAP/BiPAP can disrupt that balance and cause us to "overbreathe" and expel too much of it at one time, especially if you're using a pressure higher than one just needed to stabilize your airway. It's essentially the same concept behind hyperventilating, if you did it right now you wouldn't have the drive to breathe for at least a few seconds. This can be exacerbated even further on BIPAP because of the pressure differential, making it even easier to breathe out and to breathe in. And you are definitely on a pretty big pressure support.

My advice would be to lower your IPAP in increments of 1-2 every night until you either see the centrals go away or you start seeing signs of obstruction again. If the centrals don't go away but some flow limitation comes back, you might have to do some tinkering with your EPAP too. Hope this helps, lemme know if you have any other questions.
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#3
RE: Clusters of Central Apnea with BiPAP
I also have a vauto and I found (and many others have also) that the trigger setting can help a lot to help with central apnea.  Go to the trigger setting and choose VERY HIGH.   That helped me a great deal with my centrals.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#4
RE: Clusters of Central Apnea with BiPAP
Hey Coutherino, 

Thank you for your prompt reply. 

Ahhhh, I'm finally starting to understand it now. I'll seek to lower the IPAP every night and see if that clears up the central apneas and if I do see signs of obstruction, I'll raise the EPAP to keep the airway open during expiration. 

I'll definitely keep you in the loop and let you know of the outcome. Thanks heaps, means a lot for a newbie like me!

Kind Regards, 

Imti

Hey Stacey, 

Thank you for your reply. 

I'll switch that trigger setting ASAP and hopefully see these centrals go down! Fingers crossed haha!

Kind Regards, 

Imti
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#5
RE: Clusters of Central Apnea with BiPAP
Imtiqurr: 
I am also a relative newbie, but am using the ResMed Aircurve 11 Vauto. 
It looks like you are in "S" mode. 
I am actually using Vauto Mode to let the machine help me determine what my range needs to be.
For the first couple of weeks, I focused on what EPAP pressure it took to eliminate obstructive events.  6.5 to 7 seems to be enough to keep all of that under control with occasional exceptions, most likely positional.
Since then, I have been tweaking Pressure support and/or Max IPAP numbers, to see if I can clean up some of the "junk" breathing, without going too high, which causes leaks and general chaos. 
At this point, I am running in Vauto mode, with an EPAP of 7, Pressure support of 3.4, and Max IPAP of 12.  However, since I am in Vauto mode, my constant pressure on inhale or before exhale is really only 10.4, and I have got a "buffer" above that which the machine can go to automatically (up to 12), if it needs to.
The last couple of nights the machine has never gone above 11.2, so I have some unused "buffer". 
I did also set "trigger" to high. 
Hope you get it sorted. 
Tom
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#6
RE: Clusters of Central Apnea with BiPAP
Hey Tom, 

Thank you for your reply. 

It seems like the setting that coutherino and staceyburke recommended have worked out really well for me, a big decrease in central apneas.  

As much as I would like to experiment with the VAUTO mode on BiPAP, I've heard it doesn't do too well on maintain pressure and constantly cycles through pressures which could ruin therapy.

Thelankylefty27 explains it really well in this video, highly recommend you watch:
https://www.youtube.com/watch?v=Jgzudnze0ck&t=1178s

Let me know what your thoughts are!

Kind Regards, 

Imti
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#7
RE: Clusters of Central Apnea with BiPAP
Lanky Lefty doesn't always know what he is talking about.  Most here much prefer the Vauto setting.  Try it.  Smile
Machine:  ResMed AirCurve 10 Vauto
Mask:  Bleep DreamPort Sleep Solution and F&P Nova Micro

Link to thread about switching from Autoset to Bilevel:
https://www.apneaboard.com/forums/Thread...+a+bilevel

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#8
RE: Clusters of Central Apnea with BiPAP
Hey Deborah

Haha sounds good! I'll give it a crack!

Kind Regards, 

Imti
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#9
RE: Clusters of Central Apnea with BiPAP
I would agree that a range like 6 - 20 is just silly.  However, if you set an epap base, and specific PS with a cap, you control the range within which the machine can work as needed to control any issues which pop up. I like it, but your settings are up to you.
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