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Second night on APAP, lots of Central Apneas, is this normal?
#1
Second night on APAP, lots of Central Apneas, is this normal?
So I finally got my AirSense 10 Autoset and figured out how to log OSCAR data. My sleep study REI was 36. I've attached my Titration results table as well.

It seems like the machine is preventing all of my OA events, but the CA is quite high. It was hard to fall asleep and definitely noticed some of the apneas while trying to fall asleep. The period from around 3:30-7:00 was after I woke up and finally was able to somewhat fully fall asleep. I felt so much better during my titration study, not sure what is different now.

I know that the machine cannot prevent CA events, is it normal to have so many and for the durations I have starting out? Will it get better? I desperately want this to work but I'm concerned now that maybe just an APAP cant solve my issues Sad It also seems like with using the machine, I feel the apneas more than if I'm sleeping without the machine (if that makes sense) without the machine I don't really get fully awakened by events, just feel bad in the morning.

I will also note that my home is very dry (around 30% humidity) and I had a humidifier and set the machine to a high setting. I ended up getting rained out which woke me up too. 

Thanks for any assistance!

[attachment=30320]

[attachment=30321]

[attachment=30319]

Also, here are my at home sleep study results:
RESPIRATORY DATA:
The study started at 01:06:36 and ended at 08:48:22 and the total recording
time was 457 minutes. By convention, sleep is assumed for the whole
recording. Snoring was noted. There was a total of 275 respiratory events. Of
these events, the total number of apneas was 54 (6 obstructive, 10 mixed, and
38 central) and 221 hypopneas. The respiratory event index (REI) was 36.1
events per hour of study time. The mean oxygen saturation during the study
was 92.0%, with a minimum oxygen saturation of 80.0%. The patient spent 44.3
minutes at oxygen saturation measured less than 90% (9.7% of recording time)
and 19.8 minutes at oxygen saturation measured at or less than 88% (4.3% of
recording time).
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#2
RE: Second night on APAP, lots of Central Apneas, is this normal?
Central apnea is nothing new for you and they were present in both your diagnostic and titration tests. The problem with centrals and central hypnoses is that they are consistently inconsistent. In your titration results, we see the non-linear relationship of CA to pressure.t

[Image: attachment.php?aid=30320]

It is not normal to have so many central events, and increased pressure is unlikely to resolve them. You will need a change in diagnosis from obstructive sleep apnea to complex sleep apnea, and a titration on ASV that demonstrated efficacy. If you plan to use insurance, you will need to discuss your unsatisfactoroy results on CPAP and point out both your home diagnostic and titration tests showed continued CA events.

Your diagnostic study noted more central and mixed (38+10) than obstructive (6), and an incredible 221 hypopnea. This is a common pattern for someone with complex or predominately central apnea. Based on what I see in your sleep study, titration and CPAP results, I'm fairly certain you will ultimately need an adaptive servo ventilator (ASV) which is a specialized PAP therapy that provides pressure support to improve respiratory volume during hypopnea or ensure a breath is taken during central apnea. ASV also provides sufficient positive air pressure to treat the obstructive component. That will be quite an investment, and you should know that before getting ASV, you will be detoured to bilevel without backup rate and have to fail that before getting a bilevel with backup rate which may or may not be ASV. We can guide you through the process and many members here are successfully using ASV. The biggest determinant of your success will be to have a very cooperative doctor that listens and advocates for you. Until you are confident that your doctor is on your side, it will be very frustrating. Here is our wiki article on justifying advanced PAP machines http://www.apneaboard.com/wiki/index.php...P_Machines

Sometimes central apnea is reduced when constant fixed pressure is used. I recommend you try fixed CPAP pressure or set the minimum and maximum pressure the same. I would consider starting at fixed pressure of 8.0 cm and see if any variation up to 10 works to reduce AHI. Auto-pressure will destabilize your central apnea and it's just better not to use it. This is only your second night, and I'm sure you will be expected to trial CPAP for about a month before your doctor will consider looking at central apnea. We can see what can be done, and as part of that I'd like to see a zoomed-in image that shows the flow rate wave-form. That means about a 3-minute long closeup as shown in the wiki http://www.apneaboard.com/wiki/index.php...al_options
Sleeprider
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#3
RE: Second night on APAP, lots of Central Apneas, is this normal?
The machine can’t treat central apnea. A more expensive machine can but insurance won’t let you get it until you show this therapy will not work. So instead of treating it we try to avoid it as much as possible.

Centrals do start while the body gets use to therapy and then lessen. Also they are inconsistent, meaning they come on suddenly and go away and come back. So one or 2 nights does not mean they will continue wit severity.

Now how to try to stop them is to try Cpap. That is where the min and max are the same. So I would try a min=8 max=8 no EPR( you don’t have any set anyway)

I hope that will help you tonight.
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: Second night on APAP, lots of Central Apneas, is this normal?
(02-24-2021, 09:33 AM)Sleeprider Wrote:  We can see what can be done, and as part of that I'd like to see a zoomed-in image that shows the flow rate wave-form.  That means about a 3-minute long closeup as shown in the wiki http://www.apneaboard.com/wiki/index.php...al_options

Thank you!!

Here is the zoomed flow rate, hope this is what you were looking for.

   
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#5
RE: Second night on APAP, lots of Central Apneas, is this normal?
That flow rate shows normal inspiratory peaks without much flow limitation and the centrals are just a lack of spontaneous effort. There might be a snore and swallow at 3:59:15. Notice how the breathing gradually restarts out of the CA rather than recovery breathing with larger amplitude with OA. Let's compare that to a period without events and see if we can better understand what good sleep-respiration looks like for you. Do try to take a longer zoom of 3-minutes. You can use the slider on the bottom of the Events tab to set the zoom window.
Sleeprider
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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.
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#6
RE: Second night on APAP, lots of Central Apneas, is this normal?
(02-24-2021, 10:24 AM)Sleeprider Wrote: That flow rate shows normal inspiratory peaks without much flow limitation and the centrals are just a lack of spontaneous effort. There might be a snore and swallow at 3:59:15.  Notice how the breathing gradually restarts out of the CA rather than recovery breathing with larger amplitude with OA.  Let's compare that to a period without events and see if we can better understand what good sleep-respiration looks like for you.  Do try to take a longer zoom of 3-minutes.  You can use the slider on the bottom of the Events tab to set the zoom window.

Here is a period without events. It is interesting that on my inhale the pressure lingers near 0 for a small time then takes a breath, or is that normal. I would expect a relatively consistent sine wave.

   
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#7
RE: Second night on APAP, lots of Central Apneas, is this normal?
That is perfectly normal respiration, and the timing is great. This shows us that normal respiration is very good and the only issue we are going to manage is idiopathic central apnea.
Sleeprider
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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.
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#8
RE: Second night on APAP, lots of Central Apneas, is this normal?
Interesting therapy thread on CA.
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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#9
RE: Second night on APAP, lots of Central Apneas, is this normal?
So a small update here. I set the pressure to fixed CPAP at 8 and it was hard to fall asleep, seemed like I was having centrals very frequently. Maybe I will try this again but I set it back to auto 7-10. I'm also noticing some CAs that have a weird breathing pattern and was curious about these. Most CAs are somewhat normal breathing pattern but there are a lot like this too.

I'm starting to cut out all supplements I'm taking to see if any are aggravating too.

   

   

   
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#10
RE: Second night on APAP, lots of Central Apneas, is this normal?
Teccrc be sure to include the chart that shows the full-night so we can see the relationship of events to pressure, and what your results actually were. If fixed pressure at 8.0 was uncomfortable, the fixed at 7.0 would be my next preference as fixed pressure is going to do better for most people at mitigating centrals.
Sleeprider
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____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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.
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