100+ Central Events

[cmk009]

Hey All,

Thanks ahead of time, I am brand new to all of this. 

new CPAP user of 3 weeks. The first week was great with very minimal AHI. I did not use an SD card to record because I was not concerned. 

This week my AHIs have increased dramatically and I am clocking around 135+ Central Airway events per night. The majority being at the end of the night roughly around the same time

I have done my best to read the already existing forums and will appreciate some clarity:

Is this SWJ? 
The central events seem to correlate with alterations on the 'pressure' chart. Any alterations I can make that you all notice?

I am kind of questioning if I have sleep apnea now. My original home study noted an AHI of 18 but I did not know enough then to specify whether or not it was central or obstructive events.


My insurance is changing in mid-August and everything will be drastically more expensive for me so really trying to get this figured out. 

Thank you for your help!


           

[OpalRose]

It would be helpful to know if there were CA's on your sleep test.
Can you get a copy of it?

Try a narrower pressure range, like 7minimum, 12 max.

Set EPR setting to 1.

Repost tomorrow.

[cmk009]

OpalRose,

Thanks for your advice I will do as advised. 

Attached is the PSG and home study. 

Might be inconsequential because I laid there for 7 hours and didn't sleep much. 

I have another PSG scheduled for next week and will update accordingly.


Appreciate your help!

Kevin

   

[OpalRose]

There was definitely some central apnea on your test, but hard to say how accurate it is if you were awake for most of it.

[cmk009]

Hey,


Attached is a zoomed image of the other night where I had a lot of centrals.

Also opalrose I tried changing the EPR settings but had a difficult time tolerating it. Last night I found the EPR ramp setting and that helped.

I have had a significant decrease in AHI but this has been on my old settings and using a pillow to prevent rolling onto my back. I set up a camera and wearable O2 sensor and noticed all CA runs began with rolling to my back, hence the change.

Can anyone make sense of the pattern seen in the zoomed flow rate image? 

Thank you very much.


   

[cmk009]

Apologies,

I attached the wrong image. Here is the zoomed image.


   

[Millstone50]

You may need an ASV.

[Sleeprider]

You are likely on the wrong device. Your diagnostic test shows higher CA than OA, and that control be the case with failure of CPAP therapy for efficacy and clear evidence of Cheyenne-Stokes respiration (CSR).

You need to decide if you want rapid resolution of this problem now by buying your first ASV (used) or fighting with your doctor and insurance to move to the correct therapy after extensive test and failed therapy modes. If you want to use the expedited path, go to DotMed and search respiratory/bilevel and use the keyword ASV. I’m on my phone and will fill in details later. Check the process for used machines and I’ll fill in more information about how this works and ends.

[cmk009]

Okay I will.

Is it definitely CSR? The frequency is not longer than the 40-45 seconds I read about in the criteria. 

the attached photo is not of me but what I have been comparing CSR to. It seems to have wider crescendo decrescendo than what I am experiencing, mine are ~<20s. 

Thank you for your clarification. I am changing insurances soon and may just pick a higher premium plan for this year and make sure to get all of this covered, my Doc has been pretty amenable to my suggestions and whatnot.

Thanks so much, 


   

[Sleeprider]

I don't know if it really matters whether we call this CSR or my preferred term, periodic breathing. It describes a pattern of alternating hyperventilation and hypoventilation, and in this case with a central apnea at the nadir. The more important point is that your CPAP therapy is failing to provide the expected efficacy and you should be referred for a titration that includes a trial with ASV if indicated. The kinds of problems showing up in your charts can be nearly 100% resolved with ASV. We can certainly try some different settings on your CPAP to see how your respond. I normally like to see a trial of using EPR, however the bilevel pressure of EPR may actually increase CA events, however I have seen it lower AHI and even have no effect. If you would like to turn on EPR Full-Time at setting 1 we can observe how it affects your therapy.