CPAP causing CSA events?

So while I'm on day TWO of my CPAP therapy and I FULLY REALIZE that it will go away in time or require some kind of adjustment to me, machine, or mask, what I'm experiencing is as follows:

With my resmed airsense 10 autoset machine acquired less than 24 hours ago, and phillips respironics nose/mouth mask (and later the nose 'bubble'-type pillow thingy I took home from my sleep study), humidity on 6, hose temp on 82º, and flow on 11...i lay comfortably supine as I drift off and just as I enter "sleep" and exhale, I do not inhale. Within seconds, due to my internal lung alarm, I find myself needing to inhale aggressively because I feel close to passing out...and fighting the positive air pressure in, exhaling is labored so I take a good two big breaths before I'm normal again.

Then as I drift off again (never really making it to 'sleep'), this repeats. For a total of 4 hours and 22 minutes of mask time and recorded are what are meant to be OSA events of 10 per hour (which are really CSA events I assume), I continue with this struggle. A couple hours last night until I just removed the mask and went to sleep on my own (quite restfully, without interruption), and again after I woke at 7:00am for a couple hours with the nose pillow mask instead of the nose/mouth mask...same thing.

So yes, it's day ONE. My studying (substantial since I can't sleep) indicates that CSA is from heart failure, kidney failure, or a host of other illnesses that cause the signal from brain to lung muslces/diaphragm to not fire, which I don't have. Only a couple places like Mayo Clinic suggest the CPAP usage can cause it and that it may simply go away with more CPAP use - which I"m hoping is the case!

SO....what are your experiences with suffocating when trying to sleep with a CPAP? What did you do? How did it go away?

I do not get this when I sleep unaided by the CPAP.

jpcmt

Hi jcpmt

I haven't done any research into CSA but I have always understood that too much pressure can cause CSA events.

When I first got my machine I started the pressure at 11 with only OSA events and gradually pushed it up to 17 which induced a number of CSA events. I dropped the pressure back down and the CSA events stopped. I didn't need 17 Just 12 or 13 works fine for me but I wanted to know what would happen.

I am not familiar with the machine you are using but I think you need to take it back to the place you got it and talk to them about it.

I'm not very trusting so I would never leave a machine in control to the extent they seem to with the auto CPAP machines.

If you are comfortable at 11 then why is the machine usually preset to go as high as 20. Why isn't it limited to just 14 or 15?

There may be a good reason but I don't know what it is.

First can you give us a little more information about your machine setup. Your machine will display some information like the example below:

• The two numbers on the right near the top are you minimum and maximum pressures. What are they?
• The number in the middle of the circle when you first turn it on is the ramp start pressure, if it is set. What is it?
• The icon in the bottom left indicates the ramp setting? Is it on Auto or?
• Do you have a heated hose? It will be marked as a ClimateLine on the gray fittings at the end.

I am not quite following your event event frequency. Where are you getting this information? There should be a count in events per hour. In total it is called AHI, and then may be broke down into CA or central events, OA or obstructive events, or hypopnea.

In short yes, it is true that PAP therapy can increase the frequency of central events, but it usually goes away after several weeks.

2 things. First to help with adjusting try reading a book, watching tv, or playing games on your phone while wearing your CPAP. I've never seen what the issue is with being tethered to a machine with a mask designed to blow air into you all night long thru 6 ft of an elephants nose, nothing could be more natural right?

Next, download Sleepyhead and post your nightly charts. Those, combined with how you feel will help us help you get your therapy dialed in. The charts to include are

*event flags *Flow Rate *Flow Limit *Pressure (not Mask Pressure) *Snores *Leaks

Yeah, I'm plenty acclimated to wearing it because yes, it's totally normal to be walking around with a face mask on with a elephant hose coming off my head! lol I think what I'm finding in my limited use is that the face mask is not good for me...it's way to laborsome to exhale even with the exhale assist feature on my machine in place. And it produces the CSA events the most. The nose pillow works better and I have far fewer CSA events. I'm going to experiment by not turning it on until its right about time to sleep (instead of having it on and running while I read, adjust, and take an hour or so to fall asleep) so the "events" it measures (OSAs) will be what matters so that I and the doc can see if it actually helps. I'm pretty sure the machine is measuring all the CSA events equal with OSA events and that is skewing the data. Once that's done, the doc can get a good sampling of data and be able to adjust the pressure and maybe, gremlin, I could use the face mask without the CSAs and so much labor exhaling. That'd be nice.

Thanks for your replies. And if any others have such problems - onset of central apneas - due to using a CPAP, I'd love to hear what you did to resolve. Thanks! And yes bonjour, downloading sleepyhead right now! Thanks for that. Just wish it worked on android platform too like the resmed app...which is kind of sparse on data, but nice still. jpcmt

EDIT ugh, just installed sleepyhead and realized it uses data from SD card and while my machine has a slot for SD card, it transmits realtime cellular data so it doesn't use SD. I"ll get my RT to remotely turn on recording data to SD since I don't think I can mess with the machine and go fishing for the feature on the device. Then I'll start getting the data. Excited to see if it reports more specific data than the "myAir" app gives (score, usage hours per day, mask seal, events p/h, mask on/off). Thinking of getting an oximeter too for a bigger picture.

Is there a popular, low profile oximiter you guys use at night that gives an alarm and possible records Sp02 over night with time stamps or something? Be cool if they have such a thing on the cheap.

Your machine always records to the SD card as long as it is installed and not locked.
The Oximeters cost about $100. SleepyHead is currently compatible with Contec CMS50D+, CMS50E, CMS50F and CMS50I serial oximeters.

Pulse Oximeters are medical devices used to measure blood oxygen saturation. During extended Apnea events and abnormal breathing patterns, blood oxygen saturation levels can drop significantly, and can indicate issues that need medical attention. SleepyHead gives you the ability to track Oximetry data alongside CPAP session data, which can give valuable insight into the effectiveness of CPAP treatment. It will also work standalone with your Pulse Oximeter, allowing you to store, track and review your recorded data. SleepyHead is currently compatible with Contec CMS50D+, CMS50E, CMS50F and CMS50I serial oximeters. (Note: Direct importing from bluetooth models is probaby not possible yet) You may wish to note, other companies, such as Pulox, simply rebadge Contec CMS50's under new names, such as the Pulox PO-200, PO-300, PO-400. These should also work. It also can read from ChoiceMMed MD300W1 oximeter .dat files. Please remember: If you are trying to sync oximetry and CPAP data, please make sure you imported your CPAP sessions first before proceeding! Important Notes: For SleepyHead to be able to locate and read directly from your Oximeter device, you need to ensure the correct device drivers (eg. USB to Serial UART) have been installed on your computer. For more information about this, click here. Contec CMS50D+ devices do not have an internal clock, and do not record a starting time. If you do not have a CPAP session to link a recording to, you will have to enter the start time manually after the import process is completed. Even for devices with an internal clock, it is still recommended to get into the habit of starting oximeter records at the same time as CPAP sessions, because CPAP internal clocks tend to drift over time, and not all can be reset easily.

Are you starting at a pressure of 11? CPAP is more likely to induce central events, especially at onset, at higher pressures. Perhaps you could set a ramp and start at 4 cmH2O. Once you have settled into sleep the problem will most likely go away.