Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New APAP user, worried about centrals
#1
New APAP user, worried about centrals
Hi everyone! I was recently diagnosed with mild OSA (AHI 12, RDI 18) and have been using my Resmed AirSense 10 about every other night for around 2 months. I feel no less tired than I did when I started, and often the APAP actually makes me feel worse, which is why I don't always wear it (I have a toddler and can't really afford to feel much more tired than I already am!). My sleep feels really fragmented, like I take several naps throughout the night but get very little deep sleep. This is basically what my PSG showed, except I think I got even less REM and deep sleep than usual in the sleep lab because I was anxious and kept getting woken up by technicians slamming doors in the background. OSCAR shows I've been having a lot of centrals, which is interesting since I only had one central all night on my PSG. I'm a little worried about the centrals but hoping they'll go away on their own with continued use of the APAP. One thing I'm trying is getting a smaller mask, as I've had some minor leaks with my medium Dreamwear full face cushion (which I got because I'm usually a mouth breather). Just wondering if anyone has any thoughts on the centrals based on the attached screenshots. Should I be worried about a neurological or cardiac cause for the centrals, or should I just assume they'll go away eventually? I don't have any medical issues besides hypothyroidism, which is well treated with medication. (Also, this is my first post, so please forgive me if my screenshots are strangely formatted or I haven't provided enough info.)

**Edited to add that my EPR is set to 2, and that my OSA was found to be positional.


Attached Files Thumbnail(s)
           
Post Reply Post Reply






Donate to Apnea Board  
#2
RE: New APAP user, worried about centrals
Welcome to Apnea Board and to the puzzling world of Apnea and Dr. McQuack.

Since you're in the US, HIPAA law permits you to request and receive your diagnosic and titration reports. Ask for the detailed versions, place them in your personal health folder and post a redacted copy here please. It's very likely your Central Apnea are treatment emergent flavored. This means within 3 months they'll diminish after your body figures out the PAP is flushing out CO2 and making breathing more efficient.

What to do about it? Take a look at your EPR and Ramp settings. If Ramp is on, turn it off. If EPR is active, turn it down to 1 or off if you can tolerate the airflow feel without exhale relief. We need to try and make your breathing a bit less efficient for a bit until your brain recalculates how to handle the more efficient PAP therapy breathing. Try it and post a standard OSCAR and tell us if it felt OK.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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.
Post Reply Post Reply
#3
RE: New APAP user, worried about centrals
(04-13-2021, 01:45 PM)mollyjz Wrote: Hi everyone! I was recently diagnosed with mild OSA (AHI 12, RDI 18) and have been using my Resmed AirSense 10 about every other night for around 2 months. I feel no less tired than I did when I started, and often the APAP actually makes me feel worse, which is why I don't always wear it (I have a toddler and can't really afford to feel much more tired than I already am!).

AHI of 12 means 12 events per hour, or one every 5 minutes, on average. So it's no wonder you feel tired. It's kinda like having someone disturb your sleep every 5 minutes. You are never able to fall into the deeper levels of sleep needed for you to feel rested and be healthy.

Your body is used to having to wake itself up so you can breathe, and it will likely continue to do so until you commit to using your machine all the time you are sleeping. Every other night is not enough.

I wouldn't be too concerned about your central apneas. You aren't having that many centrals. They will likely go away and your AHI will drop as you adapt to CPAP therapy. But you are unable to adapt because you are using your machine only every other night.

I realize it's tough to care for a toddler when you are exhausted, but if you commit to using the machine every night, all night long, and even for naps, you will adapt much faster and reach the point where you are no longer exhausted during the day. You will also begin to see lots of other benefits. When you don't use your machine you raise the risk of cardiovascular disease and stroke.
Sleepster

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#4
RE: New APAP user, worried about centrals
All of the centrals you have chosen to highlight are IMHO false in that they immediately follow arousal and you were likely holding your breath, see the recovery.larger breath at the completion of the "apneas".  We ignore those CA events, not the arousal, just the CA events.
See the detail at around 0133? see how the pattern is a gentle wave? This indicated that your breathing may be reacting to CO2 changes in your blood.  This is what drives treatment-emergent central apnea but This variance here should not be a concern of any kind.

Others may be more of a concern bout these are not.

These zoomed images should include the same charts as the full night view so we don't have to bounce back to the full night view to see what was happening on the other charts,

Try setting EPR = 1 and see if that helps.  I would be interested in seeing other zoomed views to see if these are the rule or the exception.
Post Reply Post Reply






Donate to Apnea Board  
#5
RE: New APAP user, worried about centrals
Thank everyone for the helpful replies! I'm happy to hear that the central apnea event I posted looks to be treatment-emergent.

I've attached what seem to be the most important portions of my sleep study results. Please let me know if any additional info would be helpful.

My EPR is currently set to 2 (ramp is off), so I will decrease it to 1 and post the results here. I will also make an effort to wear my CPAP every night going forward.


Attached Files Thumbnail(s)
           
Post Reply Post Reply
#6
RE: New APAP user, worried about centrals
Yes with the low CA count on the diagnostic, that points to treatment emergent and some may be false positive meaning something like you reposition yourself in your sleep and holding breath while moving. Try dropping EPR to 1 and see if it helps.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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.
Post Reply Post Reply
#7
RE: New APAP user, worried about centrals
Also, here is some data on another central apnea. Going forward I will make sure to include all the relevant rows in the zoomed-in screenshot so you don't have to go back and forth between screenshots. Unfortunately, I took these screenshots previously, before I knew better, and I took them on a different computer than the one I'm using now, so this is all I have for the moment.


Attached Files Thumbnail(s)
           
Post Reply Post Reply






Donate to Apnea Board  
#8
RE: New APAP user, worried about centrals
(04-13-2021, 09:38 PM)mollyjz Wrote: I will also make an effort to wear my CPAP every night going forward.

like I know it will be hard at first, but eventually you will start feeling much better.
Sleepster

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#9
RE: New APAP user, worried about centrals
Molly, all those centrals in the close-ups are false. That is because immediately prior to them you had an arousal. Those CA events are mostlikely your holding your breath during the arousal. It also looks like you had a leak spike at the same time (this is why you should always include the other standard charts in your zoomed view). This also supports the arousal.

Now the question is why the arousal?
Post Reply Post Reply
#10
RE: New APAP user, worried about centrals
Thanks for the encouragement and the feedback on those additional centrals. I'm attaching zoomed-in data on a few centrals from last night, when my EPR was set to 1 (decreased from 2). Unfortunately I'm having just as many centrals as before. Any ideas as to what I should try next?


Attached Files Thumbnail(s)
           
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
  I've been using my APAP for a week, symptoms wors V2e. AmirKas 162 2,461 07-25-2021, 11:53 PM
Last Post: Geer1
  Centrals: Do you have Complex CSA or other type? S. Manz 5 152 07-24-2021, 08:08 PM
Last Post: SarcasticDave94
  How long for centrals/clear airways to subside after starting apap? blancobonzo 9 200 07-23-2021, 10:30 PM
Last Post: blancobonzo
  Different AHI with different apap machine? BreathingIsLife 17 259 07-23-2021, 08:46 PM
Last Post: BreathingIsLife
  Centrals: Finally getting some sleep with my ASV therapy S. Manz 2 110 07-21-2021, 05:25 PM
Last Post: S. Manz
  How to Fix Flow Limitations and Treatment Induced Centrals with BiPap Bijingus 9 272 07-18-2021, 07:16 PM
Last Post: SarcasticDave94
  [CPAP] New APAP user, help with numbers and settings integrated 14 262 07-17-2021, 04:02 PM
Last Post: integrated


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.