Struggling with Central Apnea

[ImDigger]

I'm 6 months into therapy and my nighty Oscar readings are erratic and getting worse. My AHI varies 2+ to 26+. I'm using a RESMED F30 mask. The pressure wakes me up a number of times a night but it's not high - 10 max - seems like it gets stuck at 10 and I shut off and restart the machine for some relief. I just want to get my AHI to a consistently reasonable level and without the pressure blowing my mask nose seal loose.
Can someone offer some guidance here?
I have tried Nasel Pillows but I snore....tried Phillips and RESMED Full Face Mask but the Phillips exhaust bothers me and the RESMED makes my eyes face puffy. I am willing to revisit these though.

Attached are some screen shots 

   
   
   

[sfgiants123]

Here are a few things that might help. First off your pressure is not getting stuck at 10, your max pressure is set to 10 so the apap machine can not go any higher in these settings. How is your awake nasal breathing? Do you have any issues breathing through your nose? Any congestion or things of that nature? Do you know if you mouth breathe at night? If your nasal breathing is good I would say that nasal pillows are the best bet to deal with the feeling of high pressure. A full facemask has much more surface area so the leaks will be worse and most definitely more uncomfortable when leaking. If you do tend to mouth breathe at night then mouth tape and nasal pillows are a good solution. This has worked well for me. In 2/3 screenshots your 95% flow limitation is a little high which tells me you need more pressure. I believe an ideal therapy would have the 95% flow limit at 0.05 or under. Also you are set to 6-10 pressure but you median is hitting 8 or higher every night. I think you would benefit from setting the pressure to 8-10. At a baseline this should all help. Your events seem to be pretty much all clear airways which I am still learning about as I do not really struggle with these. I have heard that EPR could induce clear airway events. You have EPR set to 2 so I am not sure. Some people say turning it off could help with clear airway events but I would imagine no exhale relief on higher pressures would be quite uncomfortable. Maybe there is someone on this board that can address the CA events you are having. Does your OSCAR data normally look heavy on CAs? Lastly I am totally with you on wanting to get CPAP dialed in but not with so much pressure that it feels so uncomfortable that you can not sleep. I was in this same boat. I started on cpap pressure of 7-10 and my sleep was not good. I would up the minimum pressure and felt like I could not sleep but the data showed I needed more pressure. It took time and was uncomfortable at first. But with low mask leaks and some patience I was able to get accustomed to high pressure and now my machine is set to 11.6-12.6. And this is the best sleep I have ever had on cpap therapy. I would say it took maybe 15 days to adjust to higher pressures.

[ImDigger]

Hey sfgiants123 Thanks for the reply. Good info.

My nasal breathing is not a problem (I do snore w/o mask)
I have nasal pillows and tape I could try again. Started treatment Dec 22 with nasal pillows but got no guidance on what to expect…stumbled on mouth tape, tried it for a short bit but went with FF mask, then Airfit F30 nasal mask.

CA’s last month?…
3rd of May CA’s 23.72, 4th of May CA’s 14.48
Other 15 days of month had CA’s from 2-5 mins each day
And 9 days in May CA’s from 6-10 mins each day
Are these numbers reasonable? Some help please.

I will try 8-10 pressure and see how it goes. Maybe EPR OFF also but for now I’ll leave it on.

Anyone else take a look at my charts? Mine seem so far out of normal compared to most others on this board.

[Deborah K.]

Can you please post a copy of your sleep study with your personal information blacked out?  This would tell us a lot.  Do you know if you had a lot of central apneas during your sleep study?  I'm guessing you did.  If so, some of the experts here will have better advice than I can offer on what you need to do about that.

For now, I suggest that you raise your lowest setting to 7 and your highest setting to 15.  Your machine will only go as high as you need, so raising your highest setting from 10 to 15 does not mean you will just jump to 15.  Try that and let us know how it goes.

[ImDigger]

Hi ColleenReyes
I’m not getting any satisfaction from my therapists that’s why I am here. 
Spent a fortune on different masks and little guidance offered. My concerns are met with silence or indifference. Maybe to be fair they are very busy and have little time. I’m hoping to take charge of my own health care and learn what needs to be done.

[ImDigger]

Hi Deborah K

I did not get the sleep study report, it was sent to my Dr. But I do know my initial AHI was 35+

[ImDigger]

Hi Deborah K

I did not get the sleep study report, it was sent to my Dr. But I do know my initial AHI was 35+

I did copy the SD card after my 4 week trial and the Therapy Stats are:
AHI: 9.19,  OA: 1.01,  H: 0.41,  UA: 0.01, CA: 7.77
AV Press: 7.86, Max Press: 11.94, Av Epap: 6.0, Max Min Epap: 9.94…4.0

[ImDigger]

Set my pressure range 8-10 as suggested and I feel comfortable. Changed to FP FF mask I had laying around because it seems to fit better although the exhaust ports blowing air and noise are a little annoying I can put up with it. Also set EPR to 3. Seemed to breath easy and sleep well but my AHI is still high. CA's are still the same. Would someone like to look at my report and offer some advice? Thanks for the help.
   

[Jay51]

Welcome to ApneaBoard.  You do have quite a few central apneas (CA's).  This could be treatment emergent CA's - breathing better with your new autoset is washing out some Co2 - which can cause CA.  

The reason Deborah asked for a copy of your sleep study is because if it showed a lot of CA's you may need a different machine to treat your CA's.  

I see lots of variability of CA's based on the one post you had, so they could be treatment emergent and go away after a few weeks or so.  Time should tell which is the case.  

If you CA's continue to stay high, you may need a ventilating type of machine like an ASV, etc.  

Everything else looks pretty good: tidal volume, minute vent.  Respiratory rate ok but maybe a tad low.  No worries here.  Your inhalation time of 2.5 seconds is a little long, but ok.

[ImDigger]

Hi Jay51,
Thanx for the reply,
Background…I have been on CPAP for only 6 months and want to get dialed in. AHI numbers are all over the place. My therapist doesn’t seem to be very interested in me, that’s why I’m here. The first and only change I made to my settings was yesterday. Before that I was relying on my therapist to look in on me and make adjustments and recommendations… no help. Before I bought the machine I discussed the issue of CAs and possibly getting an ASV but was brushed off as not knowing what I was talking about (which was true) but I was just asking because of the 4 week trial results. Apparently they saw no need for an ASV.

You:
“I see lots of variability of CA's based on the one post you had, so they could be treatment emergent and go away after a few weeks or so.  Time should tell which is the case.
If you CA's continue to stay high, you may need a ventilating type of machine like an ASV, etc. “

Looking back 1 month of Oscar reports shows an average CAs 6+…a couple of times 20+
And before that much the same. Would my new pressure change fix this…after a few weeks of settling in?