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06-26-2023, 06:44 AM (This post was last modified: 06-26-2023, 06:51 AM by Andrewc88.)
Central Apneas rise out of nowhere
Hi everyone.
Hoping for some help with a rise in central Apneas. I'm based in the UK so I have no doctor or consultant (4 year waiting list) that i can ask for help, so here's hoping someone here can.
I have been using CPAP Resmed 10 for around 9 months. It took a while to get used to, but it has been great overall. My AHI was under 2 most nights. This was until 2 weeks ago where I started waking up regularly to breath and noticed that my AHI had went upward of 15 a d as high as 25 with most showing as central.
A couple of weeks ago I had a few nights with 0 centrals and now I'm getting upward of 20.
Other info
I use a full face mask. A cheap one i got on Amazon a few months ago, but I found it better than the expensive one I had before.
I was diagnosed with OSA by using a home testing kit. I don't think it could determine if CAs were present then, but I had an AHI of 19 and 34 when lying on my back. Snoring was loud too. I include this because I assume it is more consistent with OSA than purely CSA.
Switching to an ASV is not an ideal solution as I have just bought the CPAP for £900, but if that's what I need to do I will.
I have included some Oscar screenshots.
Any suggestions or advice would be very welcome. Thanks
What ever is going on in June needs some attention. All the graphs are helpful, but the main thing people will need for analysis is full screen screen shots that include the detail data to the left of the charts.
The one screen you have with the clustered CA marks looks to be positional or movement related to me. Probably a little too soon to be contemplating ASV, lets get some eyes on to give you some advice. Also your flow limits are too high in general and don't appear to have ever been managed as needed.
Did you make any settings changes mid June that could be the cause, have you changed sleeping arrangement significantly?
Thanks for the reply. Very appreciative of support here.
That's the weird thing, I didn't change anything. It had been working so well I didn't need to.
The only change I think I ever made was to turn epr and ramp off because I read somewhere that it would help.
Interesting reading on flow rates, I hadn't really heard of that before. The link to anxiety is interesting also as that is something I have difficulty with. Though it's nothing new to me and hasn't really increased in June. What changed could I make to improve flow rates?
Actually Flow Limits are what you need to work on, the paper was just explaining how they can be seen in the Flow Rate graph. Its good you turned off ramp, not much therapy happens there, and zero events get logged during ramp, not because they don't happen, they just aren't logged.
We use EPR to treat Flow Limits, if you are prone to CA then you might want to keep it low, like 1 or 2 as you work dial in the therapy. Here's more on Flow Limitations -> https://www.apneaboard.com/wiki/index.php?title=Flow_limitation
The main thing about adjusting settings for treating CA events is to confirm the events are true Central Apnea events, not positional or movement related events, we tend to hold our breath when adjusting position, bedding, pillows etc, resulting in events that are flagged as CA causing quite a bit of distress in folks, heavily clustered events like what is shown in the one screenshot are generally positional and not actually a cluster of Central Apnea events. The problem with making adjustments without confirming the details of the flag is it will generally lead to less effective settings overall.
It would be wise to get good a discerning what is represented in a CA flag before making machine adjustments assuming they are all Centrals. Whoever labeled this image should have wrote Central Apnea then Not Central Apnea as they are both actually appropriately flagged CA events. CA is a Clear Airway event, just not all CA events are central apnea.
Remember the flag is a Clear Airway Event Flag, not a Central Apnea Event Flag.
I am going to try turning the epr back on again to see if that will help with the flow rate.
I'd hope that the CAS are clear airway movements rather than central Apneas, but the red flag for me is that I am waking up a lot gasping for air, I haven't had that I started to use the CPAP.
Would that suggest to that I'm experiencing Apneas?
EPR helps manage Flow Limitations seen as Flow Limit. in your screen shot from your daily view. In the Overview the label is Flow Limitations. Flow limitations are the beginning of apneas. If you reduce the intensity and number of Flow Limitations you reduce the number of Obstructive Apneas and Hypopneas. True Central Apnea events wont show much in the way of Flow Limitations.
If you are concerned about Central Apneas you need to use the zoom feature of OSCAR and learn to discern them from a general Clear Airway events. Learning to do this will help you make better choices on machine settings. Focus on settings and sleeping arrangements that reduce the Flow Limits and you will sleep better all the way around. Sleeping arrangements that reduce Flow Limitations are things like the correct pillow for your sleeping style, side sleeper vs back sleeper. Soft cervical collars to prevent chin tucking. Chin Straps to prevent your jaw from dropping open and causing leaks, chin straps also help to keep your jaw up so the tongue is less likely to fall into the back of your throat.
Yes if you wake up gasping for air it could be apnea. That is why you have CPAP to begin with. It could also be the minimum airflow is too low, you were chin tucking, you could be sleeping on your back and the tongue is dropping into the back of your throat, the soft palate may be collapsing (all of the latter are causes of Apnea, all of them show up in your chart as Flow Limitations. Flow Limit. for short) You could have a sinus infection, post nasal drip etc.
Use OSCAR to figure out what is going on. It's the best tool available to you. Here is the guide -> https://www.apneaboard.com/wiki/index.php/OSCAR_-_The_Guide Look back at March April and May, what has changed, did settings get changed? Different mask? Its June, do you have allergies? Sinus stuffiness could make apnea worse.
Also remember to post full screen shots that show the Details section of the Daily page, this provides important information that people will use to help you get sorted out.
