100+ CA Events Nightly

[haligonian]

Hi all,

I just started CPAP therapy using a ResMed Airsense 10 and P30i nasal pillows. When I did the at-home sleep test provided by the sleep shop, I had an AHI of around 7 (averaging a 12 while on my back and 3 on my side). There was about 4.5-5 hours of good data during the test. It showed no central apneas.

Since starting CPAP a few of nights ago, OSCAR is showing over 100 CAs per night and it's scaring the living heck out of me. I spoke with the respiratory therapist at the sleep shop and she thinks that the ResMed is just sensitive the fact that I seem to be a naturally slow breather when relaxed. I frequently have multi-second breaks in breaths when awake and at rest.

However, the amount of health anxiety I have about these CAs is pretty high as it's startling to see in the data. Otherwise, I'm 40 and relatively healthy that I'm aware.

Does anyone else with enough experience concur with her assessment or should there be cause for concern? I was excited to start CPAP therapy but am now somewhat anxious to go to sleep.

Night #1 my CA index was ~12, night #2 it was ~9, and night #3 it was 16!!

I've attached some OSCAR graph data from nights 2 and 3. I did notice that, on night 2 while trying to fall asleep, it recorded a whack of CAs, but although I was very relaxed, calm, and still while trying to fall asleep, I was quite conscious and actually ended up getting up for an hour or so until I felt tired again.

Could it be the machine or should I be concerned??

   
   

[Jay51]

Welcome to ApneaBoard.  If you could access your sleep study and redact all personal information and upload it here, that would help.  (IF you had a lot of central apneas on your sleep study this would indicate you are using a pap machine that probably won't work for you long term.  

You have EPR set to 3 full time.  Reducing EPR usually decreases central apneas.  Try reducing it, or better yet, turn it off completely for a few nights and upload that data to see how much your central apneas decrease.

[haligonian]

I don't know if it's material to my question about the CAs, but I think I had a lot of "mouth leaks" or whatever they're called because my mouth was quite dry this morning and I kept waking noticing a sensation of air in the roof of my mouth. I may need a full face mask or a chin strap.

[Jay51]

Here is a link to help decrease leaks.  Mask Primer

You could try a chin strap.  Some people use mouth tape with a nasal mask.  If you can't get the leaks solved to your satisfaction, some suppliers here in the suppliers list give a 30 day trial period of their masks that they sell.

[haligonian]

Thank you, @Jay51. I've attached redacted copies of my sleep study (done a few months ago before I finally pulled the trigger on CPAP). 

Please let me know if anything else seems apparent. I will try adjusting the EPR setting tonight.

Sleep study:

   
   
   

[haligonian]

I'm seeing other threads with similar concerns, but in my case I had zero centrals during my study and nothing was flagged by the people who have seen it so far. Is it somewhat common for this to happen when starting CPAP? Seeing my index go up with something associated with significant health or central nervous system problems is causing me concern.

[Jay51]

It is odd to see this many CA's with a sleep study that showed zero CA's.   It may be treatment emergent central apneas also.  But turning down, or even turning off EPR seems to be the best strategy right now IMO.

[haligonian]

Thanks, currently lying here getting used to it with the EPR off. There's more resistance to the exhalation, but I've seen enough chatter in the last few hours about the issues EPR can cause with Co2 whereby CAs end up happening because we just don't need to rid ourselves of any Co2 so we pause breathing and it registers an event. I'm assuming this is why you suggest disabling it in the first place.

I have also been "awake" a lot at different points these first few nights - I'm very aware of the mask and trying to make sure I'm not knocking the mask out of my nose or pinching the tube. It seems like my initial deep sleep periods are much less prone to reported CAs. 

I'll give "no EPR" a go and see what happens!

[haligonian]

UPDATE: Last night I played with some settings. You'll see two "sleep" sessions in this graph. I put sleep in quotes because the first one was awful and I was essentially drifting in and out the entire time.

First, my settings. I reset my min pressure back down to 5 for both sessions and, based on the first few nights data, lowered the max to 12. 

Session 1
I disabled EPR. I found this uncomfortable and I was experiencing anxiety, so did not drift into a meaningful sleep. For the first hour or so, I was lying in bed with the mask on, but I was watching YouTube getting used to the pressure on exhalation. After about an hour (30 minutes in, the machine thought I had fallen asleep so it ramped from 4 to 5), I tried to sleep. It was mainly lying there *trying* to sleep (and briefly entering a sleep state by times), but after an hour of this I shut the machine down, got up, came and looked at the data on my laptop, and formulated a new plan. No more CPAP (late night me was very disheartened and overtired).

Session 2
I went back to bed around 3:30am and, at first, was not going to use the CPAP. I put on a Breathe Right strip and laid down. Something came over me and I was like "nope, if I'm going down with CPAP, I'm going down fighting" and I grabbed the mask and set it back up. This time, though, I enabled EPR and set it to 2 instead of 3.

If you remove that first sleep session, my AHI dropped to 2.5 with the CAs making up the bulk of it. Still concerns me to have centrals, but again, this does seem somewhat normal for new CPAP users?

I don't know if it was just that I slept more like a "real" sleep in session 2, but you can see the difference in central/clear airways in the graph session 1 vs session 2. This is a dramatic decrease to-date. The first session could easily be this continuum of sort of "awake/sleep" states that my anxiety had me in. My breathing felt shallow and the exhale resistance was not comfortable for me to overcome.

Finally, I did use a headband I found in the house as a makeshift "chin strap".

Not 100% sure how to interpret this as I guess I need more data (more sleep) before I can draw a firm conclusion, but I'm hopeful that this indicates progress? As always, I appreciate the insight of anyone who is more experienced and knowledgeable than I am. Cheers.

[Jay51]

EPR at 2 looks pretty good (your second session).  It looks like you may have struck the correct balance at EPR 2.  Try a few more nights and see if you get good results like this.  If these are all treatment emergent CA's then in the future as you adapt to them you may even be able to go back up to EPR 3.