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How long for centrals/clear airways to subside after starting apap?
#1
How long for centrals/clear airways to subside after starting apap?
Hello,

I've started using a ResMed APAP machine about 4 days ago. The AHI on my at home sleep study was only 1.8. I tinkered the pressure settings and turned epr on/off but don't really know what I'm doing. When I turn EPR on it seems to increase the incidence of "Clear Airway" which I have read is a central apnea. I was wondering if anyone could provide me with some guidance with the settings/pressure on my machine to try and help reduce my obstructive apneas/hypopneas while keeping "Clear Airway" low as well. I've read that central apneas are common when starting therapy but if so how long for them to subside? Thanks for reading and for your assistance.

I have some oscar data here:



Also, for some reason the data starts at around 4 despite my going to bed around 2:30.


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#2
RE: How long for centrals/clear airways to subside after starting apap?
Nice to have you here, what was your AHI before? Did you have anxiety on first day?

As i did read, yes, they are common at start, the point is to flush out CO2 of your body.
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#3
RE: How long for centrals/clear airways to subside after starting apap?
My AHI was 1.8 on the sleep test. I don't how that's different from RDI but that number was 11.8. I wasn't really anxious for my first day because I was excited to finally try and fix my sleep problems.
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#4
RE: How long for centrals/clear airways to subside after starting apap?
With your settings the EPR is doing nothing. 

Let me explain. EPR is exhale pressure relief, which means that the min pressure is the exhale pressure and the EPR is subtracted from the min to make it easier to exhale. 

However, 4 is the LOWEST any pap machine can go. So with your setting of 4 there is no room to subtract EPR from. 

If (lets say) your min was 7 and epr was 3. 

Your inhale pressure would be 7 (min) and your exhale would be 4 (min 7 - 4 EPR). 

That is how it works - so your settings have nothing to do with your centrals.  If get centrals BECAUSE your therapy is eliminating mor CO2 which tells your body it does not need to breathe. 

If this is therapy emergence it will be a couple weeks for your body to adjust. If your sleep study had them in it you may need a different pap machine to control 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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#5
RE: How long for centrals/clear airways to subside after starting apap?
On another note I think your min is to low. As I wrote earlier 4 is the absolute min the machine can go. These machines are used by children too. 4 may be ok for a child but I can’t believe 4 is enough air for an adult. 

If you have no leaked in your mask 4 would be like breathing through a straw. I need 9 to 10 (depending on the type of mask) or I’m air starved and would be taking off my mask to get enough air. 

7 min is what I would try.
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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#6
RE: How long for centrals/clear airways to subside after starting apap?
How would I be able to tell if the sleep study had central apneas? The test was done at home so the data may not be as detailed as what an in person sleep study might provide.
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#7
RE: How long for centrals/clear airways to subside after starting apap?
As I understand it, you should have been given a copy of your study. If not, DEMAND it. It is your data and it is your health and it is your body. HIPPA says you can have it. One of the experts will likely come along and have something to say by way of confirmation.
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#8
RE: How long for centrals/clear airways to subside after starting apap?
If it was at home you may not be able to tell that you had centr. I believe that you have to have a belt type sensor to tell.
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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#9
RE: How long for centrals/clear airways to subside after starting apap?
Correct, if your sleep study had an effort belt to strap around your chest, it could/should have listed Central versus Obstructive Apnea.

Let's try this setup edit, Min pressure 6, EPR to 1 full-time. Leave Max where it is as it doesn't appear to be an issue. This way we're changing as little as possible at once. I'm wanting to see what occurs to events, CA or otherwise, by reducing EPR which should bring CA down. But realize that other Obstructive events may go up as well. Expect that it may happen, as CA versus OA are two opposing sides of the Apnea teeter-totter. Actions to push CA down will in most cases make Obstructive events go up and vice versa.

Note that CA are consistently inconsistent meaning up and down frequently without setting changes.

It's good to keep Ramp off as you've been, due to the CA. Eventually most don't use it after getting used to PAP therapy.

OK just change EPR down to 1, review what OSCAR reveals next session, post here and tell us how and what changed and how you felt.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: How long for centrals/clear airways to subside after starting apap?
Hi,

Thank you for the response. I'll try min pressure 6 and epr 1. Also, I have an in-person sleep study on August 3rd which should tell me whether or not I experience centrals as a result of treatment or by themselves. Thanks for your support!
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