Sierra

Central apnea is difficult to treat. Generally CPAP machines use pressure to hold the airway open to prevent obstructive apnea. However with central apnea the airway is already open, so more pressure does not help and in many cases it makes it worse. There are at least a couple of different types of central apnea. One is where you have mixed apnea and when you use the CPAP to treat the obstructive apnea then the central apnea becomes worse. Generally that is what is being done in a titration test. They start with a lower pressure and then increase it to the point where obstructive apnea is controlled, but central apnea is not aggravated. This can be called pressure emergent CA. The other possibility is that central apnea is high and dominant even without pressure. That is more difficult again. About the only way you can help with a BiPAP machine is to cycle the pressure up and down to try and assist breathing. I have a ResMed APAP and I am in the first category. I have found that if I do not use the EPR (difference between inhale and exhale) and keep the pressure low, I can control the CA's. After much testing I ended up with a fixed 11 cm of pressure and EPR during the ramp only. But, if you have excessive CA with no pressure that is unlikely to work.

I do not have any experience with BiPAP machines, and the tuning of them to do what you say can be tricky. I think the most I can do for you is give you links to each specific type of machine and you can try and compare them. The link to the ResMed is for the BiLevel machines only and it explains how they work a little better. The DreamStation manuals cover everything from fixed CPAP's to BiLevels. Much harder to read, but the adjustments available should be in there somewhere.

ResMed AirCurve Technical Manual

DreamStation Technical Manual

Studies have shown that BiLevel machines do sometimes work, but not always for difficult CA cases. The next step in dealing with CA is the ASV machines (Adaptive Servo-Ventilation). They basically follow each breath and adjust the pressure to keep you breathing. The BiLevel is more of a broad brush approach, and not breath by breath. My thoughts would be to try and get one of the BiLevel machines on a trial to find out if it controls the CA well. And if not, then you may want to investigate the ASV option. It requires a special heart function test before it will be prescribed.

Some CPAP machines like the F&P and DreamStation try to anticipate your breathing pattern an used a timed approach to switching from inhale to exhale pressure. To my knowledge the ResMed does not do that. It switches pressure based on flow, so you really should be in control.

Do you know what your minimum and maximum pressures are set at?

It may be possible to set up your machine for more comfort however. Here is what I suggest for the ResMed AirSense 10. To make these changes you need to get into the Clinical Menu. To get into the Clinical Menu just hold the Home key and round set key down at the same time for about 5 seconds. You navigate in this menu the same way as in the User Menu. If you need help see this Technical Manual for the AirSense 10.

• Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
• Start Pressure - I would set this to 7 cm. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep. You normally want the start pressure to be high enough that it feels easy to breath. If this seems like too much then set it lower. The start pressure cannot be higher than your minimum pressure, so to do this you would need to adjust your minimum pressure up to match your start pressure.
• EPR: On
• EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective. Since you likely need so little pressure you could also try it with the EPR on full time. You could also try it with EPR right off.
• EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep. If you switch the Type to full time, then it will do this all night.

Hope that helps some. If you post your min and max pressures I may be able to be more specific...

It may be possible to set up your machine for more comfort. Here is what I suggest for the ResMed AirSense 10. To make these changes you need to get into the Clinical Menu. To get into the Clinical Menu just hold the Home key and round set key down at the same time for about 5 seconds. You navigate in this menu the same way as in the User Menu. If you need help see this Technical Manual for the AirSense 10. With your pressure settings I would set the machine this way for maximum comfort and effectiveness.

• Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
• Start Pressure - I would set this to 7 cm. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep. You normally want the start pressure to be high enough that it feels easy to breath. If this seems like too much then set it lower. The start pressure cannot be higher than your minimum pressure, so to do this you would need to adjust your minimum pressure up to match your start pressure.
• EPR: On
• EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective. Since you need so little pressure you could also try it with the EPR on full time.
• EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep. If you switch the Type to full time, then it will do this all night.

Hope that helps some,

I know what that feels like. I got a bad cold in January with a cough. I ended up coughing all night, which is a bit of a challenge with a CPAP mask on. In any case I over exerted my rib muscles and it really hurt. I did use ibuprofen which you cannot. I guess I might try acetaminophen to see if it helps.

This said, I never had that occur from simply using a CPAP. Do you know what your pressures are set at and where it goes during the night? OSCAR can help determine that.

The best thing you can do with a mask is try different adjustments to see what works. Most times it is tighter than it needs to be, but you can only find out what is right by making adjustments and trying it. Do you know how much the mask is leaking?

A few points. First it does take some time to get used to sleeping with a CPAP. It probably took me months along with a number of mask changes to settle on what was best for me. Until you get comfortable with wearing the machine the net benefit may not be high, especially when you start with such a low level of apnea.

It is also possible that your machine is not set up as well as it can be. Do you know what is preventing you from sleeping as well as you could? Mask fit? Leaks? Do you know what pressures are being used? What is your AHI when using the machine?

I would suggest you download OSCAR to have a look at the data on your SD card. It should give you a good idea what is going on. The software is free, and you need a PC or Mac with a SD card reader.

It sounds like you know how to get into the Clinical Menu. Here are some settings I would suggest you try.

• Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
• Start Pressure - I would set this to a minimum of 7 cm or as much as you feel comfortable with while going to sleep. You can set it up to as much as your minimum pressure. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep. Many users and some sleep technicians leave this set at the default 4 cm. That can feel very suffocating while the pressure ramps up.
• EPR: On
• EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective. If you are currently using EPR full time this may allow you to use less pressure during the night. 18 cm is a lot...
• EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep.

Set up this way the machine will hold (not ramp) the pressure on inhale to your selected Start Pressure. On exhale it will reduce by the 3 cm EPR value for comfort. When you go to sleep the EPR reduction will stop, and the machine will go into automatic pressure control and only increase pressure when you need it. With the EPR off it should increase the pressure less than if it is on. Lower pressure tends to reduce leaks from the mask and feel more comfortable.

If you have a PC or Mac with a SD card reader you may want to download OSCAR. It lets you view the detailed data collected on your SD card. It can be very informative as to what is going on during your sleep. You know where the pressure goes, how much the mask is leaking, when events occur, and much more. Here is an example of what the Daily Report looks like. This is my sleep from last night. I have an Auto Machine but now have it set to fixed pressure CPAP mode. I have a fixed pressure of 11 and a ramp start of 9. You can see how it holds that pressure while backing off on exhale until I go to sleep. It looks like it took about 20 minutes to go to sleep the first time. I managed to pull the hose of my mask about 1:50 or so, and went to sleep in about 10 minutes after that. You can see from the Event Flags when I had events during the night.

To get into the Clinical Menu just hold the Home key and round set key down at the same time for about 5 seconds. You navigate in this menu the same way as in the User Menu. If you need help see this Technical Manual for the AirSense 10. With your pressure settings I would set the machine this way for maximum comfort and effectiveness.

• Mode: If you don't need more than 12 cm maximum pressure the "For Her" mode may be better
• Ramp Time: Auto - This will hold the initial ramp start pressure until the machine decides you are asleep
• Start Pressure - I would set this to 7 or 8 cm. This will ensure you are getting enough air to not get a suffocating feeling while going to sleep.
• EPR: On
• EPR Type: Ramp Only. This will cut the pressure back on exhale only while you are awake. After you go to sleep it will stop the cutback and make the pressure more effective.
• EPR Level: 3 cm. This will drop the pressure 3 cm on exhale until you go to sleep. This makes it easier and more comfortable to get to sleep.

Set up this way you will start with a 7 or 8 cm pressure on inhale. On exhale it will reduce by the 3 cm EPR value to 4 or 5 cm. When you go to sleep the EPR reduction will stop, and the machine will go into automatic pressure control and only increase pressure when you need it. With the EPR off it should increase the pressure less than if it is on. Lower pressure tends to reduce leaks from the mask and feel more comfortable.

If you have a PC or Mac with a SD card reader you may want to download OSCAR. It lets you view the detailed data collected on your SD card. It can be very informative as to what is going on during your sleep. You know where the pressure goes, how much the mask is leaking, when events occur, and much more.

Hope that helps some. Any questions just ask.

I use the same AirSense 10 machine, except it is not the For Her version. It is going to take some time to get used to sleeping with a mask on your face. However, there are some simple things that can be done to make it more comfortable in going to sleep. Do you you know if it is in the For Her mode? And what are your pressures set at?