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[Treatment] Question about Central Apneas
#1
Gross 
Question about Central Apneas
On the chart I uploaded, the first session was using my AirFit P10 mask and a constant CPAP pressure of 15.  When I was first diagnosed years ago, I was told I had severe OSA and given a machine and a full face mask.  I was never able to tolerate the full mask and eventually stopped treatment until years later when I was feeling horrible and decided I needed to figure it out.  I took matters into my own hands and decided to try a nasal mask.  I tolerated that much better, but I am a mouth breather, so I ended up with a chin strap.  That first session is using my original pressure settings with a nasal mask and chin strap.

The second session is using my AirFit N30i mask with the interesting type of nasal pillow and a chinstrap as well.  In that session, I am also configured for AutoPAP on my machine with a low pressure of 12 and a top pressure of 20.  There is a huge difference in the chart and my AHI.  If I remove the first session, my AHI was .17.  I usually sleep with the N30i and the AutoPAP, but I was having a few rough weeks and thought going back to constant pressure might help on a different mask.

One of the first things that I see is that at the constant pressure of 15, I have a number of central apneas.  Is that most likely due to the constant pressure at 15, even though that was what I was prescribed?  Or could it be that it was caused by the mask.  I realize I made a couple of changes at once, so it makes it more difficult to determine.

1) Have I caused myself to have central apneas on constant pressure by using AutoPAP for so long?  Its been a few years consistently using AUtoPAP.
2) Are there other possible causes for the central apneas?

I have a Mirage Quattro Full face mask ordered and on the way that I want to try with the AutoPAP settings.  Should I also try it with constant pressure?  I really would like to get away from using the chinstrap for a number of reasons.

Thanks for any assistance!


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#2
RE: Question about Central Apneas
Your OSCAR data shows well treated, CA isn't high.

Quick thumbnail info on CA is there's 3 types, treatment emergent that occurs the first 3 months on PAP. Typically avoid pressure swings and pressure support until this diminishes. Second is pre-existing which shows on the sleep diagnostic study. This needs ASV to treat. Third is idiopathic, medical reason unknown. Mostly if the CA don't respond by diminishing in 3 months but didn't show on the sleep diagnostic study then this is a catch all. With this one OSCAR none of these scenarios seem to apply.

On this OSCAR sleep session, no real troubling CA occurs. So in this one night you didn't have a CA issue. Is there a trend of CA you're seeing? Take into account that CA are consistently inconsistent. They can and do vary per night.

So the thing to consider with your therapy, for some reason you're concerned about CA. Were CA high on sleep studies? Do CA trend high?

I think a possible change of therapy if you do rule out your CA concern, since you run higher pressures maybe you're a candidate for the ResMed AirCurve 10 VAuto bilevel.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#3
RE: Question about Central Apneas
I sort of felt that the low number of CAs I was seeing were probably ok, especially since I seem to be able to resolve them when I have a good fit and pressure.  There was no sign of CA on my original diagnosis, but that was quite a long time ago.  Since I put myself on the AutoPAP and pressures at 12-20, I have not seen many CA.  That first session last night was on that constant pressure of 15 and a different mask.  It seems like I am well treated with the current AutoPAP settings and I hope that the new mask I have inbound will allow me to not have to wear my chinstrap at night and still achieve the same level or better of AHI. 

Thank you for your thoughts! Thanks
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#4
RE: Question about Central Apneas
Yes I'd forgot your asking about masks. I'm not familiar with your new incoming mask, but if you can get it to fit comfortably with minimal leaks, sure you may not need the chin strap.

Recently I've had great success with Fisher and Paykel Vitera full face. It will serve as my go-to when I get a new machine soon.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#5
RE: Question about Central Apneas
I finally received my new mask after the craziness of the winter weather in middle Tennessee.  I started using my Mirage Quatro Full Face mask last night, so I no longer had mouth breathing issues.  That being said, my CAs still seemed high last night.  Can someone look at the latest snapshot and let me know their thoughts on the CAs?

1) Is this a high number of CAs?
2) Is there anything in the charts that would point to the cause of the CAs?

Thank you.


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#6
RE: Question about Central Apneas
They look positional in nature. Look at the number in parentheses in your Events tab under the CA category. This is the number of seconds the event lasted, or hover over the event market in the Events graph to see the time as well. I am expecting them to be in the minimal range. If you have recently set your EPR to 3, they could be just treatment emergent events. If so, they should subside in time.

The big question is; How do you feel?
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#7
RE: Question about Central Apneas
I feel ok. I did not recently change the EPR setting to 3. Should I consider decreasing EPR or disabling it?  I always figured CAs were dangerous regardless of if they were treatment emergent or non treatment related. I don’t like to think that I just stop breathing due to my brain as opposed to something obstructing.
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#8
RE: Question about Central Apneas
You do it all the time while you are awake and don't know it. If these events last longer than about 25 seconds each, then it may be a cause of concern. Yours are sporadic, usually indicative of having taken a deep breath just prior to the recorded event, or based on an arousal or movement.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

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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#9
RE: Question about Central Apneas
That’s good to know. I have been concerned about flow limitation being a cause. I just ordered a new cervical contoured pillow. I feel like my pillow has been causing too much of a bend to my neck while sleeping and wondered if that could cause low limitations.
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#10
RE: Question about Central Apneas
The CA in this latest chart, at 0.82 is minimal and doesn't require addressing.

What may need considering is weaning you off Ramp. You have a pressure of 8 for 30 minutes. This can be a problem by restricting therapy for that longer time. Eventually the goal is cancelling Ramp completely.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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