Central Apnea Emerging

Hi all - pardon me if this topic has already been covered and I missed it. I had a sleep study several months back that lead to a diagnosis of OSA. The sleep doc left a lot to be desired, but that’s a story for another time. They determined through an overnight study that I should wear a full face mask with a pressure of 8.

It took weeks to get used to it, but I finally did and started seeing decent results on some nights. I changed to a better sleep clinic a couple months back. They noticed my results were sporadic and recommend I go on auto from 8-15. My numbers got worse. On my next visit they told me I’m showing way more Central Apnea, so they recommended an overnight study.

I argued against a second study citing the first study, the results of which they have, should have provided enough info and that I can’t afford the 30% co-insurance on a second study. We changed my pressure back to 8 in hopes I’ll get the sporadic good nights I was getting. They recommended a Sleep Shirt designed to keep me off my back (though I don’t really sleep on my back much).

I guess I’m looking for general advice. That being said, has anyone had experience with CA revealing itself following changes in prescribed air pressure?

I’m a little nervous that I’m not getting this under control. The night before we made the switch to a range of pressure I only had 4.3 events an hour (a personal best since staring with the ResMed AirSense 10). I’ve been out of whack since.

Thanks!

Central events can be a result of you pressure being too high, so it's not so surprising that when your pressure was effectively increased you developed some centrals. It sounds like you were steadily improving at 8 cmH2O, so sticking with that for a while may be a good bet. Be aware that it is not unusual for automatic machines to misinterpret central events as obstructive, increase the pressure in response and wind up making things worse. If things don't improve eventually, you may need to think about that second study.

I have to know what a "sleep shirt" entails! Sounds like it emerged from the Spanish Inquisition...

Yeah, most devices to prevent you lying on your back don't work.

Ok, sleeptech and wiregeorge (and anyone else who's kind enough to weigh in)...

I met with my doc yesterday following last week's sleep study. As expected, I didn't get a good night of sleep and it was hard to tell if the study yielded clear info on how to move forward. He's going to continue me on the CPAP for now. The sleep tech at the lab was convinced I'd be moving to a Bi-PAP. The plan is to do constant pressure at 12cm and increase if needed. If the Central events continue, he wants to go to advanced modality therapy that is a bi-level with a backup rate structure. It's clear to me that docs basically guess and check. Meanwhile, I'm trying to pull myself together to feel normal on the day to day.

I picked up an SD Card and installed SleepyHead. Last night's data is attached here. I'm trying to wrap my head around it; any thoughts/tips are welcomed. I had much better sleep that last few nights at 10.2cm, but I'm trusting his judgment. I can provide some historic data but apparently the SD needs to be in the CPAP overnight to populate the waveform data (I'm guessing, since it's not there for previous nights. My plan is to stay at 12cm for a few nights and then increase by .2 - .4cm (up to 15cm) every couple nights until I find a sweet spot.

I'm determined to get this figured out and am really hoping these Central events subside.

Thanks,

O-

ResMed changed the way they work it all out last year, so this will affect it a bit.

I can tell you that heaps of people feel that they don't sleep very well during their study but almost all of them get plenty of sleep for analysis, so don't be too put off by that. Also, we'd rather see a bad sleep because the idea is to see a problem if there is one. Just reading between the lines, and please remember that I don not wish to contradict your medical professionals who have all of the data to look at first hand, I THINK what might be happening is that there was evidence of significant central apnoea in your study (hence the tech's comment). Your doctor wants to be thorough so they want to rule out under-treated obstruction by increasing your pressure to see if your AHI reduces. If it does this would suggest that there was still some obstruction that needed clearing up. However, if your AHI stays the same or gets worse, that suggests central apnoea. The doc's comment about "advanced modality therapy that is a bi-level with a backup rate structure" is just along winded way of saying BiPAP and, at risk of sounding rude, it sounds a bit like he doesn't really know too much about it. What he is saying is BiPAP in S/T mode rather than S mode, which is quite common and no one who uses it much would use such a wordy way of saying it. Still, it's far more to do with the tech who has to titrate it for you. I noticed that you have EPR on full time at 3. That can cause central apnoeas by hyperventilating you. Have you tried CPAP without EPR? If you are quite attached to it for comfort reasons, you can set EPR to ramp only, so that once you are asleep it stops. EPR is only a comfort feature, and I have seen it cause problems for many people, so if you are not completely wedded to it I would suggest trying without. If any of the jargon I have used (or anyone else has used) confuses you, please let me know and I shall try to decipher it. That's my job after all. Hang in there buddy. It sounds like the plan your doctor has for you is a sensible one. You should be working your way towards some answers.

If they hand around in large numbers, you move to a bipap and then onto an ASV. For 2 thirds of people, the CA settle down within 3 months on cpap.

I don’t know if this thread is still active but I am very interested in this subject. I have been diagnosed with complex apneas including OA and CA. I’ve been on CPAP for 10 months. I found that by using a nasal mask, a boil and bite mouth guard, surgical tape over my mouth, a chin strap and a tight strap over my mouth I was able to reduce the obstructives considerably. My Dr prescribed Pulmicourt in a nasal rinse before bed and I take 1/4 Zopiclone per night. My AHI is down from a max of 33 to between 0.80 to 3.5 at present. I turned on the EPR which almost eliminated the obstructives and hypopnia completely but increased the centrals. I track my results daily with the SleapyHead app. I can get up to 8 centrals per night lasting up to 29 sec but typically around 15 sec. Since the EPR setting (3) has reduced my AHI and obstructives specifically should I not continue with this setting? Should I be more concerned with the increase in centrals or is this an acceptable level? I know that I should be asking my doc these questions but she doesn’t seem to have much time for questions.

30 seconds is a long time not to take a breath. Usually it is increasing the EPR that reduces centrals not the other way round. If you have it set at 3 at the moment, try it at 2, but wait a few nights to what result you get before adjusting it again. If it gets worse, just go back to where you were. Sometimes you just have to try things, but do it slowly and with small adjustments. Go with the best average result you get between Obstructive and central. If you have an APAP it should deal with Obstructive Apneas, however, it has a problem dealing with Central Apneas. I would go for the lowest you can get in Central and leave the machine to deal with Obstructive ones, however, you do not want them to increase a lot either, so it might be a balancing act. Sometimes reducing pressure can help, I used to get quite a few Centrals, then I got a new machine that runs at a lower average pressure and the Central Apneas dropped almost to 0, but I still get the odd one. With the APAP and it running at a lower pressure I sometimes get a 0.0 result, however, when the headgear slips or I have a bad night it has been as high as 0.6 AHI with one central. This can be a bit frustrating!