Sierra

Central apnea can be difficult to deal with, and can have a number of different causes. I have not heard of diet being one of them. Sedative drugs like opiods can be a cause, and other medications could contribute to it as well. Your best bet is to talk to your sleep doctor assuming you have access to one.

If your machine is compatible you may want to consider downloading SleepyHead. The software is free, but you need a PC or Mac computer with a SD card reader to use it. It will give you a much clearer picture of what is going on through the night, and may prompt some questions for your sleep doctor.

What you could try is reducing the Pressure Support minimum and maximum to zero. You currently have them at 2 to 8. That would reduce the red pressure line (IPAP) in your graph to be equal to the green line (IPAP). In many people EPAP is your effective treatment pressure for apnea. At the same time you could adjust your minimum EPAP to 7 cm. That should give you a good idea what pressures you really need during the night. If may be possible, if they are well under 20 cm, you would be better running the machine in Auto CPAP mode, rather than deal with the complexity of the BiPAP mode.

Edit: Those high IPAP pressures (red lines) may be part of what is waking you up in the night.

Some comments on results - You are getting large clusters of hypopnea and Vibratory Snore during the ramp up of pressure when starting a session. These could likely be largely avoided by using a higher start pressure so the machine does not have to ramp up as much to get to an effective treatment pressure. My other previous comments about machine set up remain unchanged. I'm thinking you may be running much higher pressures than necessary because of the use of pressure support. The high leak rates also seem to follow the higher pressures.

On screen format I would still suggest clicking on the little triangle beside the current date in the top left hand corner. That will get rid of the calendar and make more room to show all the statistics and setup data. And the graphs could be shrunk in height so you can display more graphs on the screen. Click and drag on the grey dividing lines. The event tag display could be shrunk in height too. Here is an example of what I find useful for format.

My wife has been using a CPAP for nearly 4 years now. She got immediate relief from it, and has used the equipment essentially every night since. She averages 8 hours and 45 minutes a night, and has 100% compliance. I was not such a willing candidate to join the CPAP club. I got cornered by my doctor and reluctantly agreed to a sleep study, which I failed. The one night at home sleep study was horrible. The first night on the CPAP was almost as horrible. Unlike my wife I got no immediate benefit from using a CPAP. I never felt I needed one in the first place, but the sleep study said differently.

That was 6 months ago, and over that time I have gotten slowly used to it, and now can get a good nights sleep with it, and if I dare say, perhaps better than before CPAP. But that has come with a lot of effort. I've tried many things including 5 different masks, and I am at over 20 different revisions of my machine settings. If there is anything that has gone wrong with CPAP, I'm sure I have experienced it!

With that said if you can provide some more information on what you have for equipment, how it is set up and more specifics on what you think is waking you up, I and others here I'm sure can make some suggestions as to what you might try. What would be helpful would be your machine model, your mask model, machine minimum pressure, maximum pressure, start pressure etc.

In general sedative type drugs have been blamed for causing or aggravating central apnea, with opiods probably being the worst. Sleep medications are more controversial as to their effect on CA. Something to discuss with your doctor for sure.

I have heard of this issue, and as you say it is considered more of a nuisance than a serious medical condition. I think it is a basically a change of shift problem. The day shift guy that is controlling your breathing goes home before the night shift guy takes over, to put it in analogy form.

My thoughts would be to wait until your sleep study results come in. For sure ask for a written copy of the study results as there is a lot more detail on the report than can be remembered with just a verbal discussion. If the conclusion of the study is that you have sleep apnea that needs to be treated with a CPAP, you might get some relief from the therapy. A CPAP addresses obstructive apnea by keeping the airway open with pressure. With a central apnea there is no obstruction, so pressure does not help. That said, if you have the right kind of machine, it can provide a split in the pressure supplied during inhale and exhale cycle while you are going to sleep. That MAY help prevent your issue of stopping breathing when you are going to sleep. I am a CPAP user not a medical professional, so that is just my opinion. And my opinion again about machines is that the ResMed AirSense 10 AutoSet does the best job of the getting to sleep phase. It lets you use this split pressure (Expiratory Pressure Relief - EPR) while you are awake, and then when the machine detects you are asleep it stops the EPR. Treatment during sleep can be more effective with EPR off.

You should also ask your sleep clinic that did the test what they think of your condition and might improve it.

The other thing I have found helpful in keeping the mask straps in place is a satin pillow protector. They seem to be intended to be used to keep your hairdo intact, but I find they are slippery enough to allow your head to move on the pillow without dislodging the mask straps. There are some quite inexpensive ones at Bed Bath and Beyond in the US and Canada. They have a zipper to keep the cover on. Normally a satin pillow case is hard to keep on the pillow.

Rest and Renew Satin Pillow Protector

You should continue to gather more data, but just based on this one daily report I would discuss the following possible opportunities with the sleep doctor that recommended you get a BiPAP.

1. There may be a possibility you are not gaining anything from the pressure support which appears to be set at a variable 2-8 cm. Ask about simply reducing the pressure support to zero. This could significantly lower your maximum mask pressure and reduce your mask leakage problem and provide more comfort.

2. Reducing the pressure support to zero may leave you too little pressure when going to sleep. Ask about increasing the minimum EPAP which is currently set at 4 to say 7 cm.

3. If you go ahead with those changes and it reduces pressure, then next ask about reducing Maximum IPAP pressure. It looks like the highest you reach now is 16.5 cm. It may be possible to set the max IPAP to 13 cm or possibly lower. You would need to see what effect setting pressure support to zero has first before settling on a revised max pressure. The idea is to limit the pressure when more pressure is not doing you any good. It may put a bit of a limit on that pressure spiking that DreamStations typically do (the red trace on the graph).

I've never used a Fitbit, so can only speculate. My thoughts would be that you are not totally settled with the CPAP and mask, and that in turn is changing your sleep patterns. It does take some time.

The best way to figure out what the CPAP is doing is by downloading SleepyHead and viewing your detailed data with it. It is free software and needs a PC or Mac, and a SD card reader to use it. Your CPAP also has to be compatible with the software. Here is a basic instruction manual so you can see what it could do. It may uncover opportunities to improve your machine setup and will report on mask leakage issues which also may be disturbing your sleep.

First the good news. An AHI of 1 is way better than an AHI of 100! The machine can obviously do a good job of normalizing the breathing compared to no machine. That long period of time from 3:30 to 6:30 is a bit odd. Were you awake during that time?

I think your settings are basically OK for the basic phase of determining what pressure you need. Eventually you may want to consider limiting the pressure once you determine that will not impact your obstructive apnea frequency. Your mask leak rate is a bit high, so you may want to work on adjusting that.

Some suggestions to make your daily screen shot more useful.

• The DreamStation reports the VS2 Vibratory Snore, and nobody really seems to know what it is useful for. The flags for it make a mess of the display, and most with a DreamStation turn that function off in SleepyHead. Click on that blue box near the center bottom of the screen. There is a set of switches which will be green. You can switch VS2 to red or off.

• The full month calendar does not add anything and clicking on that little triangle to the left of the current date suppresses the calendar. Clicking on it again restores it, if you need the calendar.

• The Pie Chart does not add any info not already there and takes up space as well. On a PC you can suppress that by going to File, Preferences, Appearance, and then uncheck the Show Event Breakdown Pie Chart. This will let more important information display.

• On a PC pressing F10 suppresses the right navigation screen which is not necessary, but it seems you have done that already.

• Left clicking on the grey dividing lines between the graphs, and dragging lets you scrunch down the graphs to show more on the screen.

Gather and then post some more daily screen shots and any further adjustments may become apparent.