[Pressure] Pressure suggestions for addressing Central Events

[mperry99]

My AHIs are usually below 5, but my central events are typically 65-75% of the total.

I'd like to get rid of those central events, but I haven't arrived at a solution with various APAP and EPR settings.

I've attached an OSCAR report for a typical night, as well as my most recent sleep study.  The pressure and EPR settings are what my doctor recommended after trying other slight variations.  (i.e. 8-18 EPR 1, 8-18 EPR 0, 9-18 EPR 2)

My doctor and I talked about another session in the sleep lab to titrate me for both a BIPAP and ASV machine.  But he also said that as a practical matter, with the sleep study showing only 2 central events per hour, and my nightly AHIs below 5 he doubted that insurance (Medicare plus a supplement) would pay for either of those machines.  So, we haven't scheduled the titrations.

My questions are:

• Can anyone recommend some pressure settings that might reduce the central events without increasing the obstructive events?
  
• Would it be worthwhile to buy an ASV machine and experiment on my own?
  
• Or, are the numbers in a reasonable range such that I should quit worrying about it?
  

Thanks very much.

(I am using a Resmed Airsense 11 with a full face mask, by the way)

   
  Sleep Study Redacted.pdf (Size: 684.06 KB / Downloads: 7)

[Jay51]

Tough situation to be in IMO.  

Your CA's do tend to occur in clusters and not steadily all night long.  

You have a little bit of OA clusters in the chart you posted as well.  

My suggestion would be to try some positional apnea techniques to try to lower obstructive events, etc.  By doing this, you may be able to lower EPR or even turn it off completely.  That may help decrease your CA's.  Also, you may even by able to lower your epap a little bit if the positional techniques help you.  

Things like lowering pillow height, side sleeping vs. back sleeping (and having something like the edge of the pillow between you chin and chest), and even getting a soft cervical collar.  

You could even try bumping up your min pressure of 7 to your median pressure from OSCAR to 10.  Keeping your epap in a tighter range during the night may help decrease CA's as well.  This will take some experimentation to get a tighter range that is both more therapeutic and comfortable for you at the same time though.  

Here is some more reading on positional apnea from our wiki: 

• 5.3Positional Apnea
  

[SarcasticDave94]

The sleep study indicates Central Apnea are an issue. Here's your numbers:

10 CA, 7 mixed, 6 OA, 26 Hypopnea (of which these Hs are not separated into Obstructive and Central).

4 more CA an OA... Probably this can be labeled predominant Central Apnea.

Is the doctor addressing the CA? What's their plan on CA? Have they mentioned about the Central Apnea, or have they ignored mentioning?

[mperry99]

Thanks Jay.  I'll try these suggestions.

[mperry99]

Thanks for responding.

My doctor doesn't t have an explicit plan now, other than the titration he scheduled and then cancelled for the reason I mentioned in my original post.

I have a follow up session scheduled with him on June 16th, though, and will pursue it with him then.

[SarcasticDave94]

I'm supposing for you though, CA are an issue. Meaning they may be bothering you somewhat. Being that CA are consistently inconsistent, what amount of CA do you get? Not counting this chart, which seems to have about 18 CA events. Granted, some of that CA total was a cluster just before a mid sleep disruption, so they might have been sleep wake junk, at least in part.

[mperry99]

The attached page shows my CAs, OAs and Hypopnias for each night in May.  Is this what you are looking for?


  May Oscar Stats.pdf (Size: 28.96 KB / Downloads: 9)

[Jay51]

Thank you for posting that.  

CA's make up the largest percentage of your events. 

H's are 2nd.  

And OA' s are 3rd.  

This is exactly the opposite of most people on pap therapy.  

You can try the suggested changes to see if that helps any.  

If you optimize therapy on this particular machine, and it is still not satisfactory for you, you may need a different type of machine better suited to treat your complex apnea (you have mostly CSA, but still have OSA as well).

[SarcasticDave94]

Agreed, CA are your weak area for good therapy right now.

[mlmollenkamp]

Your charts are nearly identical to mine.  I've been using a machine about 20 years and have had complex sleep apnea from the beginning.  It will be difficult to get an ASV machine through insurance if your treated AHI is under 5, this is why I had APAP machines for all that time.  I found settings on my S10 machine that gave decent results, but I didn't feel right, especially after I had COVID in 2021.  I finally purchased an AirCurve 10 ASV on Craigslist and am much happier.  With the ASV machine I have an average AHI just over 1.  The nurse practitioner kept saying that if the AHI is under 5 everything is OK.  Mine was typically 3.5 to 4.5, but no one has explained why someone with an AHI of 4.5 is OK when someone with 5.5 isn't.  I wish I'd paid out of pocket years ago and not relied on insurance.  My used ASV cost less than my mattress and did a lot more for my quality of life.  

As for setting suggestions.  I spent a very long time exploring my S10 machines.  For me any level of EPR  would nearly double the number of CA's.  Standard response was better than soft response.  Using the full face setting with my pillow mask (P30i) decreased CA's a bit.  Capping the pressure helped.  Your obstructive apneas are all at pressures below 12, most are when the machine is running lower, 10 or below.  Try reducing the maximum to 11 or so and see if it reduces the number of CA's. If it does reduce it until you just see an uptick in OA's.  If the CA's are reduced more than the OA's increased you are close to optimum. For me accepting a few more OA's led to a much greater reduction in CA's.  Finally, oddly, my old S10 was better than my newer one, they had different firmware.  But the old machine had 18,000 hours on it and I didn't want to rely on it. That was what finally triggered me to buy the ASV, the S10 was never intended to treat central or complex apnea, ResMed says so.  It's optimized for obstructive apnea. For all of the time I spent fiddling around with the S10 I got minor improvements, but my worst night on ASV is better than my best night on APAP.  All of the adjustments I've done on the ASV are for comfort, it just seems to work.  

Finally, don't rely on just a night or two when testing changes.  I found that I needed to average over a month to actually know if a change was for better or worse because of the randomness of the data.  I found that it worked best to keep some notes and throw away the data from atypical nights i.e. not sleeping well for some unrelated reason.   Then average the rest.