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Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
#1
Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Hello! This is my first post here so go easy on me.

Typical story here. Early 30s, 6' and 200lbs. Always been a snorer, but last few years started to develop more of the OSA symptoms. Finally did a test through lofta since sleep medicine in my area was moving too slowly through insurance. Test came back with moderate apnea at 15.9. Test showed 0 central apnea, but I am not sure if the Lofta Watch PAT even tracks those properly?

Anway, got my CPAP and the first few nights have been:
AHI, Obstructive, Open Airway/Central, Hypopnea
2.9 - 0.10, 2.20, 0.5 
1.37 - 0.00, 1.2, 0.17
4.24 - 0.15, 3.36, 0.73
2.35 - 0.17, 1.68, 0.5
2.37 - 0.12, 2.12, 0.12
1.82 - 0.0, 1.36, 0.45

I feel very fortunate that the start of my therapy has gone really well, better than I could imagine. Genuinely, life changing for me overnight. The only concern i have really is the open airway/central apnea events. I have read this can be common when starting treatment, but some of the patterns in my breathing look like CSR? I have settled on keeping ramp on auto, and turning off EPR which seems to help. 

This one was last night:
   

This one was my second night, just a weird grouping. This was as I was falling asleep I think? Or at least near the start. This is the only time I've seen a cluster like this:
   

One other I found interesting:
   
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#2
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Someone pointed out to me I can share everything with SleepHQ if that is more helpful:
sleephq.com/public/teams/share_links/9c6149b0-1ebd-4e56-b3ff-1f65ecd14d77
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#3
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Some good news first, this isn't chayne Stokes. Did you have an centrals on your sleep study?
Breathe through your nose
Reduce sugar and processed food
Soft collar and seal your mouth

Sleep-well
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#4
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Yes, i'm not overly concerned but also new to this! Heres my WatchPAT Results:

   
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#5
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
If you're wanting to gain more usefulness from the EPR 1, bring your min pressure up to at least 5.

Most adults are going to feel somewhat air starved to 4 cmH20 minimum. Again, move this Min pressure up to between 5 and 7. Watch the CA chart to keep an eye on these events.
Mask Primer

Positional Apnea

Attach OSCAR, etc.

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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#6
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
I left EPR off last night, changed pressure from 4-20 to 5-10. I wanted to turn EPR back on, but just wanted to make one change at a time.

I think that really helped my centrals. I basically only had them when my mask was leaking, most of those in a cluster ~30m before I woke up. I think I remember twice waking up to air coming out my mouth. Hoping to turn EPR back on to 1 tonight, and Friday I should have a chin strap arriving to help with my mouth leaks.

Not the best score i've had, but feels promising!

   
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#7
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Last two days i've been 1-1.5 AHI after turning EPR 1 back on. This seems like a great setup for now, I'll see if I can eliminate the centrals. Thanks for the help!
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#8
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
It's quite normal to have a few CAs during the night, so your goal might be to keep the number down to a CA index below 1. You'll probably see some fluctuation from night to night, so just keep your eye on the overall trend.

BTW, you had some CAs on your sleep report. pAHIc 3% is WatchPat's best guess about CAs.

You're doing great! You can try re-introducing some EPR before long, raising your minimum (ramp included) to accommodate the pressure drop, as Dave has suggested.

On your snippets, you were not fully asleep during the periods of unstable breathing, so if you were having a polysomnogram test, those pauses in your breathing would probably not be scored at all.
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#9
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
Your CAs were very low in your sleep study, so you don't need to worry about them.  The ones you show are treatment-emergent and will lessen on their own as time passes.  If I were you I'd ignore them, and turn EPR up to 3.  This will probably increase your AHI for a while but will help in other areas.  EPR makes breathing more comfortable and, more importantly, lowers flow limits.  Flow limits are apneas that are too short in time to be recorded, but they do hinder therapy.

I also suggest that you increase your start pressure to 7.  This will improve therapy and comfort and will allow the EPR to work.
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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#10
RE: Starting CPAP - Central Apneas - Treatment emergent or Cheyne-Stokes?
(01-16-2025, 09:34 AM)darthalby Wrote: I left EPR off last night, changed pressure from 4-20 to 5-10. I wanted to turn EPR back on, but just wanted to make one change at a time.

I think that really helped my centrals. I basically only had them when my mask was leaking, most of those in a cluster ~30m before I woke up. I think I remember twice waking up to air coming out my mouth. Hoping to turn EPR back on to 1 tonight, and Friday I should have a chin strap arriving to help with my mouth leaks.

Not the best score i've had, but feels promising!


With regards to the chin strap, are you aware that the standard neoprene ones are not actually designed to work?  They wrap around the tip of the chin and the top back of the head, the problem being the jaw joint is located just in front of your ear, which is right along the line between those two points.  So traditional neoprene chin straps are applying a force directed almost directly into the jaw joint, which is the most ineffective and uncomfortable angle possible.  I'd suggest you check out the Knightsbridge Dual Band at Supplier 37.  (Please use that link or you will likely end up with a counterfeit!)
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